Reducing Medicare and Medicaid entitlements: a contentious environment ensues

Since our public officials now lack the courage and political will to raise taxes or to constrain Medicare and Medicaid benefits, we can expect that: 1) the private sector and future generations will pay an increasing share of these entitlements, 2) major cutbacks in Medicare, Medicaid, and health maintenance organization (HMO) reimbursement will result in the aged and poor experiencing decreased access to care and will hasten the current thrust of physicians, hospitals, and insurers forming powerful health networks, 3) these new regional alliances functioning as virtual monopolies will result in the public demanding that state-sponsored health services commissions be established, and 4) the weakest health networks, often in underserved areas, will be fiscally squeezed by inadequate reimbursement, so that by the turn of the century, many of these facilities and HMOs will seek bankruptcy protection as a means of restructuring their long-term debt.