Despite providing health care coverage to 50 million older Americans, Medicare is often the target of criticism that the program is too expensive, ineffective, inefficient or simply a bad idea.

"Sometimes people get a picture in their mind that our health system is in shambles or we can't do anything right," says Dr. Harlan Krumholz, a cardiologist and health care researcher at Yale University School of Medicine. Krumholz was lead author on a groundbreaking study that analyzed death rates and hospitalizations for Americans covered by Medicare. His findings: Medicare beneficiaries "are better off than they were 15 years ago."

The study, published last month in JAMA -- the Journal of the American Medical Association -- found a marked, steady decline in the death rate of Medicare beneficiaries from 1999-2013. That included in-hospital deaths and deaths of patients within a year of being discharged from the hospital.

Additionally, the number of Medicare beneficiaries needing major surgical procedures also declined, as did the average stay for those who did need hospitalization. Perhaps most surprising, the average cost to the Medicare program for a beneficiary who needed hospitalization fell from $3,290 to $2,801.

"My hope was we were getting a return on all that investment," Krumholz says. "What I wasn't prepared for was the size of improvement we've seen."

Krumholz believes there are several reasons for the results. Technological advances have made health care more effective, allowing some procedures that, in the past, required hospitalization to be done on an outpatient basis. Hospitals, primary-care physicians and specialists are also getting better at treating older adults in the Medicare program. "We've doubled-down on our efforts to promote safe and effective treatment in and out of the hospital," he says. Preventive services, such as mammograms and colonoscopies, are now fully covered by Medicare Part B as part of the Affordable Care Act. Medicare Part D, rolled out in 2006, has helped many seniors avoid becoming critically ill by making prescription drugs more affordable.

And older adults are taking better care of themselves. "Fewer hospitalizations means health is improving," Krumholz says. "This is the case of people not getting sick."

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Still, there are red flags. Krumholz worries about the prohibitive costs of some new drugs and notes there are plenty of other problems still to be addressed. "We're far from where we need to be," he says. "But we have to be proud of the [better] health that we're providing in the United States. We're making tremendous progress."