As Medicare spending crosses $1 trillion, its share of the federal budget is higher than ever. Without reform, the program may not be sustainable much longer. 

Medicare just passed its sixtieth birthday. If it were a person, it is now only five years away from being old enough to qualify for itself. But at the rate spending is growing, it may not make it. In 1970, the entire program cost less than eight billion dollars; total federal spending was about $200 billion, so Medicare barely registered in the books. Last year, Medicare spending topped $1 trillion, and analysts expect the final 2024 figure to land near $1.12 trillion.?  

The price surge would be impressive if it were producing faster cures or longer life, but mostly it reflects a population aging into coverage and a benefit structure that grows automatically. In the program’s early days, Washington spent only about three cents of every federal dollar on Medicare. Now it spends roughly fourteen cents, nearly a five-fold increase and about three times the share devoted to all federal K-12 education aid combined.?  

That trajectory keeps bending upward. The latest trustees’ report projects that Medicare’s hospital insurance trust fund will run dry in 2033, two short presidential terms from now.? When that happens, the law requires an immediate cut in benefits or a bailout from the Treasury. Either choice squeezes taxpayers, patients, or both. 

The looming collision of simple math and demographic certainty is not a partisan problem. It is a national problem that crowds out everything else that Congress tries to fund, from defense to disaster aid. If lawmakers punt again this fall, they will pass another stop-gap budget that spends money the country has not earned while the biggest mandatory program keeps growing on autopilot. 

Roughly 10 to 15 more Americans will become eligible for Medicare within the next five years, on top of the majority of the 67 million Americans already covered by the program today. Medicare may be headed for retirement age, but the federal budget cannot retire from reality.