Medicare’s 60th Anniversary: Policy, Politics and Payments

Am J Geriatr Psychiatry. 2026 Mar 11:S1064-7481(26)00092-8. doi: 10.1016/j.jagp.2026.03.003. Online ahead of print.

ABSTRACT

Recent contributions by Dr. Jang and colleagues and by Dr. Lepkowsky in The American Journal of Geriatric Psychiatry (AJGP) and AJGP Open Science prompted a timely review of Medicare’s 60-year history and its current policy trajectory. Medicare has been influenced by ongoing partisan debates over expanding benefits, controlling costs, and whether Medicare should be considered an insurance or entitlement program. Despite these tensions, Medicare remains one of the nation’s most popular federal programs. This editorial review examines contemporary efforts to control costs through value-based payment models and expanding privatization of Medicare through Medicare Advantage plans (MA plans). The first approach aims to improve provider care through financial and quality incentives, like accountable care organizations (ACOs), boosting patient outcomes and satisfaction. The second approach shifts beneficiaries from fee-for-service Medicare to privately managed health plans using benefit design. Both use financial incentives to offer the promise of improved access, satisfaction, and outcomes. However, ACOs and MA plans may disadvantage beneficiaries with complex conditions, including late-life psychiatric and neurocognitive disorders. While healthcare delivery science may inform future policy decisions, political forces will continue to shape benefit design, beneficiary choice, and organizational models of healthcare delivery. The 20th-century promise of comprehensive, affordable healthcare coverage for older adults faces 21st-century challenges in achieving the quadruple aim of health care: better care, lower costs, improved population health, and improved provider well-being.

PMID:41933985 | DOI:10.1016/j.jagp.2026.03.003