An overhaul of the Medicare program was not a part of the deal to avoid this week's fiscal cliff, but health policy experts say that change is coming — only it probably won't be soon.

 

Both Democrats and Republicans had said Medicare changes were necessary to reach a fiscal compromise, but at least for now, Congress brokered the deal without changing the benefits seniors receive or upping the Medicare eligibility age.

Widener Law professor John Culhane said strong forces make the Medicare "problem" hard to ignore: an aging population, fewer workers paying into the program and retirees who are living longer.

Culhane directs Widener's health policy program. Because the Medicare program is so huge, Culhane said even "small tweaks" are hard to implement.

"The only way I see this happening at all, is a very gradual phase in," he said.

Some critics say the Medicare program is brokey beyond repair, but Field said the pressures driving up Medicare costs are external to the program itself.

"It's kind of like the parable of the frog in the boiling water," said Field, a professor with the Earle Mack School of Law and the School of Public Health at Drexel University. "The water gets hotter and hotter until at some point the frog realizes it's too late to hop out."

"It's not just a question of attacking those government programs," Field said. "Those government programs are not mismanaged; they are just operating in a world in which medicine gets more expensive almost by the day."

President Obama wanted a tax increase on upper-income Americans, and Field said, bottom line, Obama got that this week.

"I think it says that it's more likely that the president will get his way and less likely that conservative Republicans will get their way in terms of major restructuring of Medicare and Medicaid," Field said.

Congress will likely renew those debates in coming months. The lawmakers delayed a set of automatic spending cuts but a 2 percent reduction in payments to Medicare providers still looms.

Culhane said something's got to give.

"It's always a question of whose ox is getting gored. Whose constituents are most affected, and who can make the right political compromises. But at some point something will need to get done. Do I have confidence that it will be done in the next few months? No."