The Challenge of Medicare and the Most Affected - Research Paper Example

Medicare Medicare Introduction Medicare refers to an insurance program provided by the federal government to persons of65 years and above (Schieber, et al., 2009). The insurance cover also coves persons of a younger age but with different forms of disabilities. People who have kidney failure and constantly go through dialysis or may opt for kidney transplant are also covered by the Medicare program (Schieber, et al., 2009). Medicare covers hospital insurance, essentially inpatient services, medical insurance that covers outpatient services, advantage plans that focuses on services offered by the private sector and prescription drug coverage (Schieber, et al., 2009). However, it is of essence to note that this insurance program is faced with numerous challenges that have led to strains on various stakeholders that access help from this program. This essay will attempt to assess the Medicare Insurance Program and the issues that have faced this program, the costs of the challenge and the possible solutions that could help solve the issues facing the insurance program. The challenge of Medicare and the most affected As Schieber, et al (2009) write, Medicare has had its share of problems for the longest time. Among the challenges that Medicare faces ranges from financial problems to management issues that have seen the insurance program fail to deliver services as would be expected of them. Failure of Medicare to fully deliver its services is huge challenge as the beneficiaries fail to get the required services. With reimbursement of funds being a major challenge, it is obvious that the persons with chronic conditions will not help as they would wish. On a deeper insight, it is evident that the population is growing by the day. Schieber, et al (2009) write that as soon as the younger generation get to their old age, the healthcare system will not provide the required services to the aged. This fact explains the reason behind the healthcare services being very expensive for a majority of US citizens. The Medicare challenges affect a huge percentage of people, organizations and even government agencies. However, it is very crucial to note that the tax payers are the most affected persons by the challenges of Medicare. As seen in the research conducted by Schieber, et al (2009), the American workers are spending too much of their pay towards the Medicare program, but most of them do not enjoy the outcomes of the health service. Worse still, the authors continue to indicate that some individuals actually spend from their pockets to get treatment (Schieber, et al., 2009). An analysis of this fact explains that there are inequalities that exist in the US health care delivery program despite it being a government funded insurance program. The employers are also affected by the recent Medicare program. Schieber, et al (2009) argue that the managers will be forced to employ fewer people and ones that are not eligible for the benefits of the Medicare Insurance program. This move will aim to reduce the strain on the employees’ pockets to cover the medical needs of its employees, especially the retirees. Hospitals are also suffering a great deal as a result of the challenges that have taken over Medicare. Schieber, et al (2009) assert that individual or private hospitals are suffering a great deal as they do not have their own cost structures under control. In as much the individual owned hospitals are struggling to provide care for their patients, they strongly feel that they do not get proper pay for the services that they offer to their patients (Schieber, et al., 2009). This explains why the hospitals call for their protection as well as their physicians who contribute a lot to the US health care system. The number of patients are also increasing in the nonprofit hospitals, as a result of the challenges of Medicare; thus, a huge burden to the physicians in context. Government agencies have also had their share of problems as far as the challenges of Medicare are concerned. A good example is that of Centers for Medicare and Medicaid Services (CMS) that has had issues in an attempt to negotiate payment rates with Medicare (GAO, 2014). CMS also struggles with the payment methods that would ultimately ensure effectual delivery of services, administration of the program to serve the beneficiaries and also defending the program from management issues that have led to mishandling of funds, abuse and even improper expenditure (GAO, 2014). This conflict of interest results from the fact that CMS is of the opinion that Medicare is more directed towards paying for volume as opposed to focusing on the quality of services to its beneficiaries. In the long run, GAO (2014) writes that CMS is wary of staying in business due to procedural issues that result from the Medicare. Costs of the Medicare challenge As Schieber, et al (2009) argue, the costs of Medicare are increasing by the day. This results from the aspect that government budgets are controlled by the need to finance the benefits of Medicare. In fact, the authors write that the government’s spending on health care is higher than that of national income. In year 2018, it is projected that the government will spend up to $4.4 trillion (CMS, 2014). Neuman, Juliette & Damico (2009) argue that individuals will spend more for their out of pocket spendings. The authors say that the rates have been increasing since 1997 to 2005 where the rates stand at $ 2740 and $15,000 respectively (Neuman, Juliette & Damico, 2009). The gap of the rise between the two years have risen to over 16%. For the older persons, especially the poor ones, it is anticipated that they will spend more and most likely their health statuses will deteriorate. The society will suffer a great deal from the challenges facing Medicare. This results from the aspect that the workers will be required to pay more for the health care services Holtz-Eakin (2005) and Schieber, et al (2009) argue that by the year 2030, the working persons will be expected to pay about three quarters of the Medicare program which is expected to rise to 12 % from 2.5% in 2005. From the Medicare challenges, other countries will always be wary not to fall in US’s trap. Solutions or alternatives from other countries The solution to health care issues need a long term solution an involvement of the concerned stakeholders. First, reducing the cost of healthcare can be achievable by cutting down the budgets on inappropriate preventive care programs just like Canada did (Hogg, Baskerville & Lemelin, 2005). In the event that USA adopts this option, the costs will be reduced since the government will prioritize on which aspects needs emphasis and which needs to be postponed. Borrowing from England that sought to increase the use of technology to edit the rules that govern the insurance companies as Emanuel, et al. (2012) write, USA may adopt the same so as they evaluate what sectors need to be changed and what changes need to be adopted in the present day system. Personal ideas To solve the challenge of Medicare, I propose that competition be brought in in the health sector. The government may allow for the manufactures and supplies of medical supplies to fight for a place in the market. In the event that competition is allowed among the key players, it is expected that the prices for commodities will decrease as each of the parties need to get a share of the market. This move will see to competitive bidding in terms of medical supplying, and all other commodities. This interprets to the fact that the government will reduce its spending in the production and supplying of medical facilities. In fact, the government will share costs with other stakeholders in the market. The market prices set by Medicare should also be spread to all the programs funded by the state. Secondly, to prevent the beneficiaries spending more for their health, I would recommend for a prohibition of referral by physicians especially to privately owned clinics. This is because these clinics mostly run based on their profit targets. This move will lower prices and call for functioning within the limits provided by the government program. This move will also make sure that the service providers practice within the set guidelines of the Medicare guideline. I believe that adoption of this move will reduce the costs of healthcare. Conclusion In conclusion, it is evident that the Medicare program is faced with numerous challenges. However, the major point of focus is the fact that the taxpayers are suffering the most from this challenge as they keep paying for services that do not offer quality care for them. It has also been noted that the government is spending more by the day; thus, placing US as one of the many countries that spend more on health care. Nonetheless, if effort is put, the situation can be changed, especially if the country borrows from the example of England and Canada that have successfully reorganized their health care systems. References CMS (U.S. Centers for Medicare and Medicaid Services, Office of the Actuary). (2014). National Health Expenditure Projections 2008-2018. Retrieved from http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2008.pdf Emanuel, E., Tanden, N., Altman, S., et al. (2012). A systemic approach to containing health care spending. New England Journal of Medicine, 367 (10), 949-954. GAO (US Government Accountability Office). (2014). Medicare Payment, Management, and Program Integrity. Retrieved from http://www.gao.gov/key_issues/medicare_payment_management_integrity/issue_summary Hogg, W., Baskerville, N. & Lemelin, J. (2005). Cost Savings Associated with Improving Appropriate and Reducing Inappropriate Preventive Care: Cost–Consequences Analysis. BMC Health Services Research 5 (1), 20. Holtz-Eakin, D. (2005). The Cost and Financing of Long-Term Care Services, Testimony of Director of the U.S. Congressional Budget Office before the U.S. House of Representatives Subcommittee on Health and Committee on Energy and Commerce. Washington DC: CBO. Neuman, T., Juliette, C. & Damico, A. (2009). Revisiting Skin in the Game among Medicare Beneficiaries an Updated Analysis of the Increasing Financial Burden of Health Care Spending From 1997 to 2005. NY: Kaiser Family Foundation. Schieber, S., Bilyeu, D., Hardy, D., Katz, M., Kennelly, B. & Warshawsky, M.J. (2009). The Unsustainable Cost of Health Care. Washington, D.C: Social Security Advisory Board. Read More