Healthcare policy overview and implementation

Medicare: Healthcare to Protect the Elderly

Medicare has been around for a long time, and is the main source of healthcare insurance for the elderly. If it were not for the government-funded Medicare, many elderly people in this country would have to do without much needed physician appointments and prescription medications because they would not be able to afford them. There are stories every winter about elderly people who suffer in their homes because they can either afford their medication or their heating bill, but not both. This is something that should not be happening, but no system is perfect, including those run by the government. Some elderly people do not have or cannot get Medicare, and some don't really need it because they are covered in other ways.

Some older individuals have other insurance, for example, such as through employers that the individual has retired from. There are still companies that offer this, but more employers are getting away from paying insurance premiums for their retired employees, especially as the ex-employee ages and begins to have more health problems. Like pensions, company health coverage for retirees is beginning to look as though it might become a thing of the past, available to only the very few chosen people that retire as heads of large corporations, instead of offered to the working man who put in his 30 years or so with the company. Even those retired individuals who still have company health insurance are often asked by their ex-employers to use Medicare first, and their company insurance second, to keep costs down. If they don't, they may find that their insurance will be cancelled, or that they will have to start paying all or part of their premiums.

The idea behind this, of course is that the government is funding Medicare, so the ex-employer won't have to pay for anything or have his insurance rates raised as long as the ex-employee isn't filing any claims against the insurance. This is helpful to the company, but sometimes difficult for the elderly individual who is used to having high-quality health insurance, and suddenly finds himself dealing with managed care, which is somewhat different from standard insurance. There are often not as many choices with managed care as there are with standard insurance plans, but Medicare still plays a very important role in the protection of the elderly.

The Role of Medicare

The main role of Medicare is to provide affordable health insurance to elderly individuals throughout America. There are some specific issues that come up when dealing with elderly individuals and how to see that they get proper health-care. It has been suggested that there are four specific goals of health care for the elderly, and that Medicare does the best that it can to make sure that these goals are met. It is likely that not everyone would agree that Medicare is meeting these goals, but these are still the goals that Medicare allegedly attempts to meet for all elderly individuals. The first one of these is that every elderly person who lives in America should have all necessary care. The second goal is that there should be no waste, or unnecessary care, in the Medicare program. This is important because it will allow physicians and others to use all of their available resources to provide necessary care for as many individuals as possible. The third goal is to raise the level of care that is provided to elderly patients. This should be based on how necessary the care is, the excellence of the care provided, and whether or not the patient is satisfied with their care. The highest standards of each person's individual dignity should be taken into account during this care.

The fourth and final goal is that elderly patients need to take responsibility to make sure about the health-care system is working for senior citizens. They should move from being passive users of the health-care system to being active participants in their own health care. This will also helped to improve the health-care system for others. They should provide information that will help evaluate new way of doing things, but being forced into participating is not suggested. Helping the health-care system to change is probably the most important goal, because these elderly individuals are directly exposed to the way it works and can easily offer suggestions on what they find good or bad about the system. By doing this they are not only helping themselves, but they are helping others who will be involved in the Medicare system in future generations.

Medicare's Original Plan

Originally, Medicare's plan was to be able to provide all of the elderly people in America with good quality health insurance. This was a noble cause, but unfortunately Medicare ran into more problems than it really expected. It was designed with a specific growth rate in mind, but because of the baby boomers and their impending retirement, the amount of people needing Medicare's services is going to rise quite sharply. The other problem that Medicare has been plagued with ever since it began is the continual rising cost per beneficiary, which is making it difficult to provide quality care for everyone, since there is a limited amount of money that the Medicare system receives. Because of these two problems, the original plans of Medicare are not really feasible in today's society. Instead, Medicare must look toward alternative ideas because they have not really deviated very much from their original plan, and this is costing them a great deal. Several different things were considered by the Medicare system as ways to potentially make the system more cost-effective. The most logical and efficient idea that Medicare arrived at was to use managed care organizations.

The Impact of Managed Care

Managed care has greatly affected the way that Medicare works. When President Clinton was in office, he attempted to change many of the Medicare policies, but the system was still in very serious financial trouble, and that has not changed very much even up to the present day. Because of this, Medicare is making changes in the methods that they used to reimburse private plans for treating the patients that have Medicare. Instead of paying the traditional fee for service Medicare and Medicare HMOs, private plans and HMOs need to actually be paid on the basis of what the local health-care market for each type of plan can support. Many think that this is somewhat of a radical idea, but in order to successfully keep the Medicare program into the future it needs to find a way to lower its costs significantly. Managed care can help do this, but there is great concern that the quality of services that are provided by managed care organizations will not live up to the quality of services that many Medicare recipients are already used to receiving.

Similarities Between Medicare and Medicaid

While it is true that Medicare and Medicaid are not the same thing, Medicaid works on the same basic premise as Medicare does. While Medicare covers elderly individuals, Medicaid covers poor and low-income individuals who are in need of care for themselves or their children. It is important to mention Medicaid here because many of the problems that plague Medicaid also plague Medicare. This is understandable since they all are basically the same government program with different target markets, and understanding how Medicaid works can give individuals a clearer understanding of Medicare as well.

Where Medicaid is concerned, most of the individuals that this program serves are in inner city, minority populations. A study recently prepared for The Commonwealth Fund indicated that many of the clinics and other places that these people can get health care provided health care because they were legally obligated to do so. They do not get paid as much for these individuals as they do for others, and this makes a difference in the quality of care that these individuals often receive. Most of these people are individuals who are living in inner cities, are of a minority race, and are living below the official U.S. government poverty line. In 1995, Medicaid provided services to over 35 million Americans. Increasingly, Medicaid has been relying on managed care to help them out and see that these individuals get health-care coverage. Some individuals who enroll in Medicaid now receive health-care services from managed care organizations, while others get their health-care services from case management systems.

Much of the reason for this difference is that the number of Medicaid-needy individuals is growing so rapidly that the system is having trouble keeping up with them. Eventually, Medicaid will run out of money, because the government only allocates so much for the program. This can harm many individuals who are not able to get any other kind of health-care coverage on their own. This is true even of seemingly nonfatal conditions such as asthma or ear infections, as even these problems need treatment and follow-up examinations to protect the health and well-being of the child or adult that suffers from them, and make sure that they do not developed into something that could be much more dangerous or possibly even fatal if left untreated.

Kaiser Commission report on the future of Medicaid deals with the problem of Medicaid spending. There was rapid growth in Medicaid, especially between the years of 1988 and 1992. Since 1992, the growth rate for Medicaid has gone down, but there are still a great many individuals needing services. Even though the growth rate has slowed, there are still important lessons to be learned from 1988 to 1992's figures. Because of the growth explosion during those years, Medicaid decided to work with managed care and try a few other avenues that might help them have more money to help more people. Basically, it made them aware that there was a problem with the current system and they could not deal with the number of individuals who needed them as effectively as they thought they would be able to.

It looks as though Medicaid will not have a great deal of trouble helping individuals in the coming years, but as more individuals get divorced, lose their jobs, or have other financial tragedies befall them, they are often not able to pay for health insurance like they once were. Due to this, the growth of individuals needing Medicaid could start to rise again, until the same problems experienced in the late 1980s and early 1990s have returned once again and needy individuals must be turned away.

The Future of Medicare

So where is Medicare going? That is not an easy question to answer, but there have been some suggestions made as to what Medicare could do to help itself in the years ahead. Clearly, reform is needed. There are several ways to do this, and Medicare is looking at a few different options, such as shifting more of the risk for cost increases over to beneficiaries, using different managed care organizations in an effort to create competition which will help curb costs, and raising Medicare premiums. None of these ideas are necessarily good or bad in themselves, but individuals may feel one way or another about them based on how they will affect their own lives. Elderly individuals who already feel that they pay a high amount into the Medicare system, or pay enough at their doctor appointments and pharmacy, will likely not be happy about anything that asks them to pay more.

The Medicare system is going to continue to be with us, and managed care in some form or other will also be around. This is not necessarily a bad thing, and will depend much more on how skillful society is in transitioning from the Medicare system that is available now to one that deals primarily with managed care. The old Medicare system was more skillful at allowing preferences of patients and doctors, but the new Medicare system that is primarily managed care-based will be designed around a need to control costs.

As long as the quality of care does not suffer, Medicare should not have difficulties with the change. There may be a problem, however, in the fact that many people think that the managed care system, which was designed to reduce the cost of health care, has failed miserably in this endeavor. More research is needed into this area, especially in the area of chronic disease, which afflicts many of the elderly patients that Medicare treats. These patients cost more, and Medicare must find ways to offset this extra cost by cutting corners somewhere else. Preferably, the use of cost-cutting measures will not come with a high price tag for other elderly Medicare recipients.

One way that Medicare is thinking of cutting costs is by shifting the risk of cost increases to beneficiaries. This is used to stimulate competition and to also change the way that Medicare services are organized. Allegedly, it would deliver the same high level of care but at a lower cost. The two main options for this service are offering vouchers for beneficiaries so that they can purchase the care of their choice, and requiring that beneficiaries enroll in managed care plans. These could potentially be combined with each other, or they may be treated as separate approaches. There are, naturally, both right and wrong ways to reform the Medicare system, and even the definition of right and wrong can vary depending on who is being asked the question. There is, however, some general consensus on some of the wrong and right ways to fix the Medicare system so that it will work to the benefit of everyone involved, and in the interest of understanding Medicaid's future, those ways will be mentioned here.

Among the wrong ways to reform Medicare discussed by many who study the Medicare system are increasing payroll taxes, reducing reimbursement rates, and using managed care. Unfortunately, while payroll taxes have not gone up, and reimbursement rates have not gone down, managed care has already begun to come into the picture, and this is causing many problems for those who believe that managed care should never have become involved with Medicare in the first place. The right ways to reform the Medicare system would be through raising deductibles, allowing the elderly individuals to opt out of the program if they chose to, and raising of the age of eligibility for Medicare recipients.

These sound somewhat harsh, bet they are actually good ideas that would help the Medicare system get back on its feet and provide care to those who truly need it. Vouchers would be considered for elderly individuals with extremely low incomes so that they could pay the deductible if they truly needed to see a doctor. In addition, elderly individuals could receive vouchers equal to the average amount that Medicare would spend on an elderly individual over the course of a year. The individual could then use that to purchase other insurance or to make contributions to an account that they would use to pay for their medical care. Not only would they not have to worry about major health-care expenses because they had some money to cover them, but they would not have to deal with the rise in Medicare premiums.