How Effective Are the Medicare and Medicaid Health Programs for America\'s Aging Population

Medicare and Medicaid are government-sponsored programs whose objective is to provide patients with health assistance upon meeting specific criteria. Medicare is the federal program that provides insurance for elderly patients aged 65 and over, and approximately 40 million people are enrolled in this program. Medicaid is an insurance program that is available for disadvantaged persons, including the elderly, who cannot afford health benefits because of low incomes or other factors. Both programs are subsidized by government funds and in many instances, will cover the costs of basic medical care as well as specialized testing and supplies. However, as time progresses and the elderly population increases and requires additional medical care, it is evident that Medicare and Medicaid are assuming less responsibility for healthcare costs, leaving the majority of the costs to be assumed by the patient. Furthermore, the necessity for prescription drugs is on the rise, yet pharmaceuticals are only covered by Medicare when they are used in a hospital setting. Currently, Congress is in the process of developing a bill that would provide $310 billion for prescription drug coverage under Medicare over the next ten years, and $40 billion would be given to hospitals and doctors in order to increase payments (Economist 28). However, this plan is not the absolute answer to the problem with Medicare today. Furthermore, Medicaid is not a fail-safe plan in its own right. Elderly persons are left to absorb much of the cost of their healthcare expenses in today's market, and their pocketbooks are increasingly wearing thin. In order to reestablish Medicare as a dominant force in today's healthcare market, government leaders must evaluate Medicare and Medicaid in their current states and must determine where reform is necessary in order to save the financial portfolios of its distressed recipients. This discussion will provide a lengthy argument concerning the implementation of a national prescription drug plan for elderly persons that are dependent upon Medicare and Medicaid for their medical insurance needs. Since prescription drugs are costly and vital to the improvement of the overall health and well-being of elderly persons, they should be the key characteristic involved in Medicare and Medicaid reform.

This issue was chosen to be the topic of a lengthy discussion because of its relevance to an ever-increasing elderly population in the United States today. It is critical for residents of the United States to gain an awareness of government initiatives such as Medicare and Medicaid. Furthermore, it is important to diagnose their problems as well as to determine possible mechanisms for reform in order to maximize their benefits for the elderly population.

Brief History of Medicare in the United States

Medicare is managed by the Health Care Financing Administration and is composed of two primary areas: Part A and Part B (Vladeck 50). Medicare Part A is also known as general hospital insurance, and covers payments for inpatient care, skilled care in nursing facilities, and hospice care (Vladeck 51). The funds for this type of program are obtained through regular deductions in earned wages, and these funds are kept entirely separate from those earned for Medicare Part B (Vladeck 51).

Medicare Part B is a voluntary program that provides coverage for a variety of physician services, laboratory tests, medical equipment, and ambulance services (Vladeck 51). In 2001, the required premium for Medicare Part B was $46.50 per month, and if it is chosen by the elderly person, the cost is deducted directly from the monthly Social Security paycheck (Vladeck 51).

Since its inception in 1965, Medicare has been enormously successful overall. In recent studies, approximately 90% of all Medicare enrollees are satisfied with their coverage in comparison to 60% of those polled who possess private health insurance (Vladeck 51). Furthermore, access to Medicare for those over 65 years of age is the first step towards the establishment of universal health care for all individuals. In fact, access to quality health care for elderly persons does not decline with age as opposed to activity in other countries. The availability of health care has undoubtedly contributed to the longevity of elderly persons over the past few decades.

Problems That Medicare Faces

Despite its continuous overall success in the healthcare market, Medicare is faced with a number of problematic issues that must be evaluated in future years. Primarily, with the onset of an increasingly aging population, it is inevitable that a large influx of baby boomers will necessitate Medicare in the coming years (Vladeck 52). It will be a tremendous challenge for Medicare advocates to determine how to manage this anticipated increase in enrollment in the near future, estimated at 77 million users by 2030, an increase of 38 million over current figures (Vladeck 52). Secondly, although Medicare benefits are quite generous for possessing a status as a form of universal health care, increasing numbers of restrictions are being placed on Medicare enrollees as well as health care providers. These two problems pose a serious threat to the future effectiveness of Medicare policy for seniors in the United States. However, it should be noted that Medicare policymakers and advocates regularly engage in debates regarding these issues, but it is difficult to determine if any significant will be taken in the near future.

Additional challenges that Medicare faces include the options available for managing patients that require end-of-life care, which accounted for approximately 27% of all expenditures in recent years (Vladeck 53). Furthermore, the establishment of a universal health care policy for all enrollees is difficult to imagine and even impossible in a country that strongly emphasizes heterogeneity in society. Moreover, different policies exist within different regions and states of the country, so it would be extremely difficult to combine these differences into one widespread benefit plan. Finally, more and more doctors are refusing to accept Medicare patients because they cannot afford to absorb skyrocketing operating costs, and many Health Maintainence Organizations (HMOs) are eliminating Medicare business because of inadequate payments (Korcok 1322). These issues constantly haunt Medicare and often contribute to system breakdown in a diverse society.

Medicare and the Prescription Drug Quandary

Medicare is a consistent concern in the elderly population, particularly around major elections, where the numbers of voting elderly citizens are tremendous. Patients that are enrolled in Medicare often possess benefits through a private insurer, and once this possibility is exhausted, Medicare will cover the remainder of the costs. Other elderly persons depend on Medicare entirely for their health benefits, and if a doctor prescribes a prescription drug for a specific reason, the drug is not covered by Medicare. Therefore, the patient is left to absorb the entire cost of the drug or to live without it altogether. For patients who depend on life-saving prescription drugs, the costs can be tremendous and often impossible for elderly patients to handle.

In many instances, when elderly persons recognize the need for their prescription drugs but cannot bear the cost, many often cross the border to Canada to obtain their pharmaceuticals. Canadian law requires that a licensed practitioner to prescribe prescription drugs, and many American clinics who realize the overwhelming costs of drugs are sending their patients to Canada (Managed Care 1). The major deterrent in obtaining prescription drugs across the border is that many drugs are prescribed under different names in other countries. Therefore, there is a possible chance that the patient may obtain the wrong drug (Managed Care 2). If patients are willing to take these risks and their doctors are willing to bear the risk, patients are likely to gain tremendous benefits in the form of necessary drugs as well as money saved upon travel to Canada for this reason.

Medicaid Participation by Elderly Residents

The importance of Medicaid in elderly disadvantaged populations is critical to maintaining health and well being. For elderly persons who meet financial criteria, Medicaid will cover certain services in which Medicare does not participate, including dental services, prescription drugs, home care services, and long-term care nursing home visits (Ettner 238). With the possible decreases in Medicare funding a reality, Medicaid will be increasingly critical in providing health care services for new populations of elderly residents.

History and Background of Medicaid

Medicaid is responsible for absorbing the costs of particular health care services after Medicare is exhausted. Two types of persons qualify for Medicaid in the United States, the categorically eligible, and the medically needy (Ettner 239). Categorically eligible persons are classified as aged, blind, disabled, or the member of a family with dependent children that is typically headed by a female (Ettner 239). A medically needy person has accumulated a large amount of expenditures but do not meet the financial criteria for Medicaid. Therefore, they are able to deduct medical expenses from eligible income in order to qualify (Ettner 239). Medicaid is a valuable tool for individuals who may not be able to afford their own medical expenses if they are involved in a difficult financial situation. Since the program is classed as an entitlement initiative, federal contributions rise when the economy is on the decline or the number of participants increases (Ettner 252). However, current discussion surrounds the transformation of Medicaid into a block grant program, which would result in states providing additional funding to Medicaid programs or the elimination of certain services (Ettner 252). In other words, access to Medicaid programs may be threatened by governmental influence in the coming years.

The Importance of Medicare and Medicaid to the Elderly Population

Based upon the previous discussion, it is evident that millions of American elderly and disadvantaged persons depend on government-sponsored Medicare and Medicaid programs in order to obtain necessary health care services. Depending upon age and financial situation, a person may qualify for one or both programs. Both offerings provide patients with a number of quality services and relatively simple access to healthcare providers results in extremely effective access to health care. As the American population experiences growth spurts and the baby boomer generation gracefully ages, the dependence on Medicare and Medicaid to provide health services will be increasingly crucial to well being for the elderly population in the United States. If these programs do not maintain their current state of success or maintain similar circumstances, millions of Americans may be forced to accept other alternatives, including the possibility of living without health care insurance and access to medical care and treatment. These alarming truths may dramatically influence the state of a relatively healthy population with access to technology, medical care, and pharmaceuticals that are critical to well being and healthy living.

Research Methods and Resources

In order to assess the current research and statistics regarding Medicare and Medicaid programs, a number of resources were utilized, including journal articles and other internet sites of interest. However, the primary resources were taken from journals that discussed a number of characteristics and demographics regarding the past, present, and future states of Medicare and Medicaid in the United States.

Much research exists concerning the topic of the availability of prescription drugs for Medicare enrollees who do not rely on private insurers for their primary means of health benefits. Therefore, it was feasible to discuss this topic within the context of this discussion, since many viewpoints exist regarding the importance of prescription drug reform in this country. Since elderly persons are a primary source of voting power in the United States, it is realistic that government leaders are concerned with the outcomes of Medicare and Medicaid reform or lack thereof in a society that necessitates restructuring in many other areas.