More patient charges may need to be introduced for the NHS alongside an acknowledgement that not all pensioners are "poor", a report has said.
The current health and social care systems are no longer fit for purpose while funding needs an overhaul , the Commission on the Future of Health and Social Care in England said .
Increasing general taxation or introducing more charges - such as for treatment or hospital stays, or cutting freebies such as elderly bus passes and prescriptions - all need to be considered, it said.
The commission's report said the current system results in a lottery for patients and calls for health and social care to become more closely aligned.
It said: "The c ontrast between a health service free at the point of use and a social care service that is means tested - and publicly funded only for those with heavy needs - results in a lottery - the type of ailment you have will determine the financial support you get to cope with its effects.
"The outcome of this lottery is that there is no equity - similar needs do not receive equal treatment."
Established by the King's Fund charity, the commission said that, at a time when health and social care should be converging to meet the needs of people with multiple conditions, "the two systems are instead diverging, with publicly funded social care becoming a residual service available to those with only the very greatest needs".
On top of that, the NHS appears to be heading towards its own financial crisis, it said.
"In other words, a crisis in social care is already with us, and another looks to be on the horizon for the NHS, at least in terms of finance."
The report points to "har d choices" that must be looked at "squarely in the eye", with several possible ways of increasing revenue and resources - and suggests a combination of all of them is likely.
One is for greater productivity in both health and social care while another is cuts to other areas of public spending.
Other ways are either a rise in taxation or new and/or higher patient charges, and an a cknowledgement "that all pensioners are no longer poor pensioners".
The blanket exemption from prescription charges for those aged over 60 could be removed or increased to 65, under one of the models considered by the report.
Prescription charges and the cost of pre-payment certificates could also rise while those currently exempt from charges - such as pregnant women and those on maternity leave - could have their entitlements scrapped.
Extending charges for dentistry could also increase revenue while a fee for visiting the GP - say £5 to £25 - could be introduced, the report said.
Outpatients could be charged £10 for hospital appointments while those who fail to turn up could also be charged as a penalty. Costs for hospital stays or hospital treatment may also be considered.
The winter fuel allowance and free TV licences for the over-75s could also be reconsidered, with the money diverted into health and social care.
Free bus passes and concessionary travel cost around £1 billion in 2010/11.
The report, which is regarded as interim and will be followed up with another one, said England should move towards a single, ring-fenced budget for health and social care.
The commission's chairwoman, Kate Barker, said: 'The current systems rub up against each other like bones in an open fracture.
"The lack of alignment between them leads to serious problems of co-ordination, with the NHS and local authorities battling over who should pay for what, and patients, service users and their families left confused and bewildered. This is not sustainable - we need a new settlement fit for the 21st century.
"This report is our stake in the ground. The prize we seek - a single, seamless health and social care system that offers equal support for equal need - is a significant one. This necessitates making choices about how to pay for a better system - hard choices that we must look squarely in the eye."
Chris Ham, chief executive of the King's Fund, said: 'We welcome the commission's report - it sets out a compelling case for change and hard choices that need to be faced. These choices present a significant challenge to politicians but with NHS and social care budgets now under huge strain, this is a debate we need to start before, not after, the next general election."
Dr Alison Cook, d irector of external affairs at the Alzheimer's Society, said: " Too many older people, especially those with dementia, are being let down by fractured health and social care systems ill prepared to meet their needs.
"Given that one in three people over 65 will develop dementia, this complex web of services that deal with crisis after crisis are unsustainable - and frankly, not good enough."
The NHS Confederation represents all organisations that commission and provide NHS services.
Chief executive Rob Webster said: " There is now a consensus that joined up or 'integrated' services for health and social care are essential in the 21st century. This fits the needs of patients. A similar approach for health and social care finance could, in principle, help make this a reality. There will be much to consider in taking this forward - from real term budget allocations for local government reducing by 14 per cent in the last four years, to the balance of risk across the health and care system, and the issues of charging for social care versus free NHS care. These will need to be addressed if we are to spearhead positive change towards a truly integrated health and care system.
"Delivery of such a radical development must be accompanied by a greater emphasis on commissioners setting standards and rewarding providers for delivering quality care and outcomes, not just how much activity they carry out. It's also important that the way care is financed reflects the real needs of people, not theoretical models.
"Crucially, we must face up to the need to look at the value our public services deliver, and how we resource them. This report is a valuable part of the debate and the NHS Confederation looks forward to providing the voice of NHS leadership to as we look to develop a positive future for the health and care system."