The Medicare Problem

The Medicare Problem

Medicare is a health insurance program for people who are 65 years or older and young people with disabilities. The health care program is not based on financial need. American citizens are automatically enrolled in the insurance coverage upon reaching the age of 65 years because they paid taxes while they were working, which is similar to other countries with Medicare programs. The cover is provided by government-owned institutions and some other private owned private insurance companies. The rising cost of the Medicare program is a crucial factor contributing to long term budget problem hence driving the necessity of reforming the program. The number of Medicare beneficiaries is growing at a high rate with the growing population. Medicare beneficiaries pay their healthcare depending on the services they are offered with. The more the services offered, the more the beneficiary will pay, and this fact has made some physicians do anything to the patients including unnecessary services to increase the amount to be paid by a Medicare beneficiary. Medicare exposes the program beneficiaries to the problem of a financial burden and some other challenges; therefore, prompting the need to address Medicare problems to find lasting solutions on the program.

Medicare program has three parts, which help to cover specific healthcare services to the beneficiaries. The three parts are Medicare part A, Medicare part B, and Medicare part D. Medicare part A covers the inpatient services and hospital stay services to the Medicare beneficiaries. Medicare Part B covers outpatient care, medical supplies, and preventive services to the covered individuals. Medicare Part D adds prescription to the original Medicare and also includes customer’s Medicare saving account plans (McRae,2017). Medicare insurance cover was first introduced in America in the year 1965, and since then various changes have been made on the initial insurance cover to make the cover more fit to the beneficiaries. Since its establishment, 55 million Americans had been covered by the program by 2015, which translated to one American for every six Americans was covered by the health insurance program. Although the health insurance plan has gained a lot of popularity, the Medicare program faces a host of challenges in the coming decades.

Financing is a significant challenge facing the Medicare healthcare program. Medicare has gained popularity, and a vast number of people joins the program every day, yet the number of people paying taxes to fund the program is significantly decreasing(Mazur,2016). The recent increase in the number of the Medicare beneficiaries has caused the program to strain in providing quality services to the members due to lack of enough finances. This means that Medicare will consume the largest share on the federal budget. To reduce national expenditure on Medicare program then the American government has to increase the eligibility age to access the cover, increase the current payroll tax rate and ask the wealthier beneficiaries to pay more for the coverage. Therefore, Medicare is not affordable to every citizen due to the lack of a reliable source of finance. The increase in the aging population has led to the rise in the federal spending on Medicare program hence affecting the other services financed by federal budget such as the retirement fund.

Affordability of the Medicare insurance cover remains a big problem for the eligible citizens. The health insurance cover only covers the essential health services such as drug prescription leaving the beneficiaries with the task of settling considerably out- of- pocket costs, which are critical to better healthcare. Various services such as dental care, eye care and long -term supports are some of the essential services, which are not covered in the Medicare program(Discepolo,2011). The primary function of any insurance protection is the out-of-pocket cap, which is not included in the Medicare program. As a result, Medicare beneficiaries end up spending more in search for better medical services than the non-beneficiaries hence making the health insurance plan unaffordable to most of the eligible citizens.

Policymakers on Medicare program face a significant challenge of ensuring that the program will be sustainable in the future. The aging population has increased meaning that more people are eligible for the coverage. Also, drugs in recent have become expensive and technology in providing healthcare has advanced and the trend continues in the future. These factors increase the resources required by the Medicare program to provide better services to beneficiaries. The policymakers have the challenge to make necessary reforms to ensure that the Medicare program will remain sustainable in the future with an increase in the number of beneficiaries. The ability of Medicare coverage to provide chronic care services is a great challenge. Patients suffering from chronic conditions require a more specialized treatment, which is costly. Providing better healthcare to patients towards the end of life is a significant challenge facing the Medicare program. Several reforms have been made on the Medicare program since its establishment to improve the quality of services provided to beneficiaries.

Numerous reforms have been witnessed in the past 50 years since the establishment of the Medicare program(Unroe,2017). All these reforms are towards solving the significant challenges associated with the health insurance plan. The growth of the aging population, advancement in the technology used in the medical sector and increased cost of drugs are some of the dynamics, which have necessitated the reforms. Increasing the expenditure of federal budget on Medicare is a reform, which has been established to solve the problem of financing of the Medicare program. Policy to raise the eligibility age Medicare to improve the service delivery to the beneficiaries is still debatable. Also, to solve the financing problem of the Medicare services, the government of America has negotiated with the wealthier people to pay more for the coverage to aid in financing the health insurance program.

Federal officials have in recently implemented health laws to improve the quality of services offered to the Medicare program beneficiaries. Accountable Care Organizations have been formed where doctors and other health care providers gather together and discuss how to effectively provide better services to patients with the promise of getting some a proportion of the savings. The reform has made a significant improvement in the way Medicare beneficiaries are handled when they visit their doctors for treatment. The federal officials have also implemented the health law where preventable hospital readmissions have been reduced and hence reducing Medicare expenditures on providing unnecessary services. A law was passed in 2010 that allowed Centers for Medicine and Medical Services to carry out pilot projects on advanced treatment methods to improve the quality of services offered to Medicare beneficiaries in America. The government of America has made many other reforms on the Medicare program some of which have improved the service delivery by the health insurance plan.

The government should consider raising the eligibility age of Medicare beneficiaries to 67 years. This will help to reduce the number of the potential beneficiaries and therefore, improving the quality of services offered to the Medicare beneficiaries. The government should also take the responsibility to finance research institutions to carry out pilot projects on how to improve healthcare services and implement these projects if they are successful. Public participation is also a key factor, which when considered more challenges facing the Medicare programs can be solved. Organizations and capable individuals should also take the responsibility to contribute in financing the Medicare program to ensure that the program does not face financial crisis and also make the program sustainable in the future.

In summary, the Medicare program have unmeasurable advantages to the aging population and the physically challenged people. Although the program has made several advancements since its establishment, it still faces many challenges. Financing of the Medicare plan is the major challenge facing the Medicare program. Reports show that Medicare finance sources are less as compared to the finances the program is spending in delivering its services a problem that threatens the sustainability of the program in the future. More reliable sources to finance Medicare plan should be initiated to ensure that the program continues providing healthcare services to the aging people to reduce the mortality rate.

REFERENCES

McRae, J., Vogenberg, F. R., Beaty, S. W., Mearns, E., Varga, S., & Pizzi, L. (2017). A review of US drug costs relevant to medicare, medicaid, and commercial insurers post-affordable care act enactment, 2010–2016. Pharmacoeconomics, 35(2), 215-223.

Mazur, E. J. (2016). Last Call for Common Sense-in Addressing the Fiscal Sustainability of the US Government. The Journal of Government Financial Management, 65(1), 12.

Discepolo, K., & Kaplan, A. S. (2011). The patient protection and affordable care act effects on dental care. New York State Dental Journal, 77(5), 34.

Unroe, K. T., Hollmann, P. A., Goldstein, A. C., & Malone, M. L. (2017). Medicare access and CHIP Reauthorization Act: what do geriatrics healthcare professionals need to know about the quality payment program?. Journal of the American Geriatrics Society, 65(4), 674-679.