Student research topic of choice

Medicare, Wealth and Equality of Healthcare

The premise of this position paper is that wealth, not regulation, determines the quality of healthcare available in the United States, citing the inequality of the Medicare Program as a case in point. A rich man in a poor country is more likely to live longer than is a poor man in a poor country; moreover, a rich man in a rich country is more likely to live longer than a poor man in a rich country (Smith, 1999, p.16). The first part of the preceding statement is self-evident. A rich man, no matter where he lives, is able to procure the means by which to stay healthy.

The second part of the statement raises serious questions about the quality of life a rich country provides to all of its citizens.

Increases in life expectancy are mainly due to improvements in three basic social conditions: better nutrition, a clean water supply, and access to health services" Smith, 1999, pg. 16). The countries, then, that should boast the longest life expectancies are those in which one finds these social conditions. It follows that a rich country, rich in resources and personal wealth, provides better social conditions than a poor country. Smith depicts a direct correlation between life expectancy at birth and the percentage of a population that can expect to receive basic health care within one hour's travel (pg. 16).

The United States provides minimum health care to most of its population over the age of 65 through the Federal Medicare Program. These benefits have not been comprehensive because they did not provide for prescription drugs within the benefit program. However, "Congress has passed a costly prescription drug benefit for older Americans - a bill that we endorsed to close a glaring gap in Medicare" Holding Down Drug Prices (2003, Nov.28). The New York Times, pg. A1. Yet, this program change "is (also) the least likely to come to fruition on the seven-year schedule set by Congress" Scant Support is Seen for Rivals of Medicare (2003, Nov. 28) The New York Times, pg. C1.

The Medicare Program does not currently provide a comprehensive package to people over 65. They must resort to supplemental health plans and health maintenance organizations to meet their needs. To do this one must have money. The Wall Street Journal, in their What's News section explains, "Americans eligible for Medicare should see new supplemental insurance options and benefits emerge by spring. (2003, Nov. 28. front page). Understand, these options are not being provided by Medicare, but by supplemental insurance companies. This means that if one can afford a supplement or choose to switch their Medicare benefits to a Health Maintenance Organization, they could see an improvement in benefits. Medicare is not changing, but how they pay managed care companies is. The hope that the managed care companies will translate the change into increased benefits is not a guarantee.

But some analysts say that private insurers will have little incentive to cut prices in competing for members because the government will pay private plans the same amount for each member that is spends on those enrolled under traditional Medicare" (28, Nov. 2003) The New York Times pg. A20. What does this mean for the poor? It means that more money will go to plans that offer less. People who have the purchasing power to keep their traditional Medicare will benefit and people who must choose between traditional Medicare and an HMO must choose between the types and cost of coverage their plan provides.

Is the original position a valid one? Is Medicare inadequate? Smith writes, "Differences of income within countries, even poor ones, are as great as the differences between them (pg. 116). With this in mind, one might examine pages 22 and 23 of Smith's Atlas. The very red ink covering the United States and Canada, Western Europe and Japan indicates that in these countries the purchasing power of people is the greatest. By 2010, there will be a new President, a new Congress, and a new economy. The bill is more a hope than a reality. In the meantime, purchasing power is the yardstick one must use to measure health and longevity. Smith illustrates the purchasing power of people around the globe (pg. 39). The United States, Switzerland, and Singapore have the highest purchasing power per person in the world. These three countries also share the greatest life expectancy.

However, Smith also states, "in most rich countries more than 10% of the population live in poverty" (pg. 22). He also notes, "One big issue is the costs of health care for those who have retired from paid employment" (pg 117.) How could this be if Medicare provides adequate coverage for all in an equitable fashion?

The truth of the matter is complex. Wealth is still the determinant of longevity because longevity proceeds from more than adequate healthcare. Richard L. Clark, writes in an article printed in The Wall Street Journal, "Medicare regulations (reported to be more voluminous than the entire IRS tax code), Byzantine payment rules, 40-plus million uninsured people, complex payment formulas, and so on, are the real problem" (Letters to the editor). Health-Care complexities Work Against All of Us. Pg. A9.

It seems that the system itself, the Medicare system, prevents those enrolled from enjoying the wealth of one of the wealthiest countries in the world. If one is not able to buy supplemental insurance, the inequality continues to exist. According to an article in The Wall Street Journal, Humana, an HMO, "raised its co-payments in the plan and steered customers toward more generics" and Secure Horizons, another HMO, "may restore coverage for some selected branded drugs, not just generics" (pg. A4).