About the Medicare Health Program

Health care is always a hot button issue in any society. Some solved the problem by treating health care as a right and granting it to all its citizens. Others have created private insurance companies to care for those in need. The United States currently has a hybrid that involves private insurance companies and government sponsored plans. A major government plan in the United States is Medicare.

History

• The Social Security Act of 1965 called for the implementation of Medicare. Under Medicare, beneficiaries achieve eligibility on their 65th birthday. President Johnson signed the bill mandating Medicare and enrolled former President Harry S Truman as the first Medicare beneficiary.

Significance

• Medicare serves 43 million beneficiaries in the United States and is expected to eventually serve more than 70 million. It is the largest provider of health care services in the United States. Medicare has shaped the way medical claims are processed and how health providers are reimbursed for their services. The UB92 claim form, for example, was created and implemented under Medicare and subsequently adopted by private insurance companies as the official form the enter patient demographic information as well as record of services delivered. The pay for performance model is currently in its draft stage under Medicare, but already being reviewed throughout the health care industry.

Function

• Medicare has two major components that are commonly labeled as Part A and Part B. Medicare Part A covers hospital stays and governs the rules under which hospital stays are covered including the time lapse that must occur between hospital stays before both stays are covered. Medicare Part B includes post acute care such as nursing home, home health and rehabilitation facilities. It also covers DME or durable medical equipment. Payment models with both parts bundle payments for a particular period of time and based the payments on the patient's primary and secondary diagnosis. Payments must be supported by sound documentation from the health care provider.

Effects

• Without Medicare, millions of older citizens have no means to receive health care. Other health care models are based on employment and the ability to pay premiums that are often beyond the means of most seniors. Medicare extends the life of many citizens and allows for a higher quality of life for those dealing with chronic illness.

  Proponents of Medicare are largely made up of Democrats. Many Republican opponents argue that the cost associated with Medicare is crippling the tax base of the working population. They also offer anecdotal cases where care under Medicare is sub par and that the competition of private health insurance companies ensure a higher level of service

Theories/Speculation

• Health care costs are responsible for an inordinate number of bankruptcies leading many lawmakers to the conclusion that changing health care also will change the economic situation for many U.S. citizens. One option being offered is the expansion of Medicare to all citizens under a single payer option. This option is being countered with many other plans including coops as well as public and private options that will also include a Medicare expansion.