Medicare and How the System Works

Health care cost has been the fastest rising and uncontrollable expenditure in the United States. The rate of its increasing costs has even outpaced the rate of inflation. When combining private and public health care spending, more is spent for the health care costs per person in the United States than in any other country around the globe. With regards to public health care, the GDP budget allocated is also significantly higher than many other Western countries.

Despite the unusual costs associated with the health services however, there is no form of national health care insurance which guarantees health care access to all American citizens. What the government offers is the federally funded Medicare program which generally covers health care services for United States citizens and long-term residents who are sixty-five years old and older. The U. S. government, after studying and scrutinizing the Medicare system for many years, continues to work at improving a much flawed, but much needed, health program.

As noted by Reed in a news article entitled “Medicare costs rise unevenly across U. S. ”, a study published in The New England Journal of Medicine shows that there is a shift in the demand for heath care cost since individuals use their health care insurances more as they age. As the nation’s population continues to increase and as more people age, researchers of the study pointed out that the medical industry suffers from a dramatic increase in the demand for their services and procedures.

This increase in demand requires the use of extensive technological innovations for health care research, which in turn, increases health care costs as well. To possibly reduce the spending allotted for the health care systems in the United States, researchers also pointed that there is a need to address the wide variations in Medicare costs. With regards to the previous research however, the study entitled “Slowing the Growth of health care costs” which was also published in The New England Journal of Medicine noted that technology used for research is an insufficient cause for the growth of health care costs.

Fisher and his colleagues noted that another factor that increases the health care expenditure is the use of direct-to-consumer marketing by drug companies which encourages the public to demand for and purchase expensive brand drugs. To address the problems associated with the rising expenditure for the health care needs of Medicare beneficiaries and other individuals in the United States, many program modifications have been introduced to both public and private health care programs over the past several years.

Many health care institutions promote preemptive medication avoid serious health problems. A typical example is when patients are directed to have angioplasty or bypass surgery before they experience a heart attack. Another technique that the government uses is the promotion of wellness programs. Through these programs, people have access to information about healthy lifestyles. In addition to that, wellness programs promote the idea that people will spend less on healthcare if they will be aware on the actual cost of healthcare.

The use of new medical technologies is also another way to possibly reduce health care costs on a per patient basis. These new treatment procedures and technological innovations usually have fewer side effects than prior medication methods. A particular example is the use of laparoscopic surgical procedures that actually reduce the length of hospital confinement. The establishment of Health Maintenance Organizations (HMOs) which shift financial risks to the health care provider is also another technique implemented to hold health care costs down.

Despite these efforts implemented in the past, critics on government programs still consider the Medicare system as a failure. According to Fuhrmans’ article entitled “Cuts await Medicare insurer”, this health care system is considered bureaucratic and restrictive, therefore denying care to many Americans. Most critics believed that judgment and service provided by health care providers are guided by the corporate bottom line. As a result, physicians treat their patients as industrial commodities rather than afflicted human beings.

In the flawed health care system, only healthy and profitable customers are encouraged to join health clubs and people who need extensive and long-term care are disregarded. Moreover, the patients are no longer regarded as the main participants in deciding the financial and medical factors that will affect the health care services that they will receive. As an effort to reduce health care costs, Medicare beneficiaries with chronic conditions are given less treatment in hospitals and the rehabilitative care is passed on to rehabilitation centers, nursing homes and home health care.

Physicians also avoid the recommendation of expensive treatments due to fear of the shift in costs. As noted by Reed in his report, some doctors even admit that they no longer tolerate patients who need complex and expensive treatment. In “The Path to a High Performance U. S. Health System” created by the Commonwealth Fund Commission on a High Performance Health System, health reforms are again introduced under the governance of President Barack Obama.

With the aim of improving the much needed Medicare system, the comprehensive health care system reform will include the establishment of a national insurance exchange program that reduces administrative costs and lowers the costs for health plan coverage. Based on the report “Obama Offers Broad Plan to Revamp Health Care” published in the New York Times, the reform of the Medicare system will include an increased payment for primary care services by five percent. The government will also encourage adoption of a medical home to promote coordinated care.

The system restructuring also includes new policies that will require changes in the way health care costs are paid and funded. Furthermore, the reform will also include stimulated competition for high quality services for both public and private health care plans, investment in information systems that promote health care and safety, and increased federal excise tax on cigarettes, beer, and other alcohol products. Despite the fact that there have been many studies proving that the Medicare healthcare system is faulty and inconsistent with the aims to reduce health care costs and promote public health, the U. S.

government has – and still keeps on – trying to improve the care program that the country greatly needs. Among the most evident problems with this health program is the wide variations in Medicare costs and the incomprehensive identification of the causes of the rising health care costs. Since the government has sought to address only few causes of health care costs (i. e. per patient expenditures and rising health care demands), the implemented solutions remain ineffective. The shift of financial risks to the health care provider even made the Medicare system incompetent and unbeneficial as government services are becoming profit-ventures.

In the face of these flaws and problems, the government still tries to reform the system. Instead of looking forward to a brand new system, the nation can only hope that the new reform plan will greatly improve the essential public health care program. References: Davis, Karen. Investing in Health Care Reform. The New England Journal of Medicine. Boston: Vol. 360, Issue. 9; p852 Fisher, Elliott, Bynum Julie P, & Skinner Jonathan S. Slowing the Growth of Health Care Costs. The New England Journal of Medicine. Boston: Vol. 360, Issue 9; p849 Fuhrmans, Vanessa.

Cuts Await Medicare Insurer. U. S. News: Wall Street Journal (Eastern edition). New York, N. Y. : pA2 Pear, Robert. Obama Offers Broad Plan to Revamp Health Care. The New York Times (Late Edition (East Coast)). New York, N. Y. : pA17 Reed, Abelson. Medicare Costs Rise Unevenly Across U. S.. The New York Times (Late Edition (East Coast)). New York, N. Y. : pB3 The Commonwealth Fund Commission on a High Performance Health System. The Path to a High Performance U. S. Health System: A 2020 Vision and the Policies to Pave the Way. The Commonwealth Fund, February 2009