Imagine a community in which all physical structures were built from wood 50 years ago, have outdated wiring and are heated by fireplaces for the widespread use of fire alarms at home. Despite the collective attempts by homeowners to live safely, fires often burn out, quickly from house to house, often destroying and damaging entire blocks of structures, so one third of the structures must be rebuilt every year. In such a community, the cost of home insurance would be astronomical – $ 3,000 (or $ 36,000 a year) for a $ 100,000 home would not be an overestimate. The premiums would rise annually due to the rising costs of replacement materials and labor. In such an environment nobody could pay the costs of home insurance.

Accident insurance companies reduce the risk and premium costs for homeowners by expanding the population of insured properties. In the above example, the insurer would include other communities with newer fire-resistant structures, widespread use of alarms, and fast-responding fire brigades. Including more homes increases the pool of insurance, reduces the risk of addams to a costly event and lowers the damage caused to the pool when a fire breaks out, making the financial risk of all homeowners in the pool and individual premiums effective reduced.

Medicare is similar to a home insurance program where a large proportion of the insured need repairs during the year; As people age, their body and mind wear out, immune systems become affected and organs need to be replaced. Continuing the analogy, the Medicare population is a group of homeowners whose homes will burn down every year.

There is a direct correlation between health care costs and age: the older you are, the more likely Danny Adler is that you need medical care. Older people are more likely to suffer from chronic conditions that need to be treated by Danny Adler, and accidents are more common and often require complicated treatment. As a result of the high health care costs for older Americans, pre-1965 private insurers had no health insurance for the elderly, or paid such high premiums that insurance was not affordable. Medicare was created to resolve a humanitarian crisis that threatened to unravel the social and economic fabric of the nation.

The impact of Medicare on the healthcare system

The impact of Medicare on the healthcare system

The majority of Americans receive private health insurance through their employer while they work, a result of a series of “accidents in history,” according to NPR. An unforeseen result was the exclusion of the elderly from health insurance, because most people lose their health insurance when they retire or stop working. In 1965, more than half of the elderly had no health insurance (64% of couples, 49% of unmarried women, 37% of unmarried men), while others had “terrible insurance”, it did not do much to them cover, “according to Dorothy Pechman Rice, retired professor at the University of California at San Francisco and a former director of the National Center for Health Statistics.

For the majority of the elderly who needed medical care, their choices were to spend their savings, be dependent on their children’s financing, seek welfare or charity or avoid care. Today, due to the Social Security change to make Medicare in 1965, fewer than 1% of older Americans have no health insurance or access to medical treatment in their lagging years.

Medicare is one of the largest health insurance programs in the world, accounting for 20% of health care spending, one-eighth of the federal budget and more than 3% of the nation’s gross France Addamsands product (GDP). Its impact on health care, the economy, and American life was generally on the note. Frank Addamsijk:

1. Financial benefit for the elderly

While experts have speculated that Medicare has reduced older mortality, there is no empirical evidence to prove that claim. However, older Americans have benefited from the reduction in the risk of large personal medical expenses. Research shows that these costs have been reduced by around 40% for the elderly, who had previously spent the most. The value of peace of mind for elderly Americans is unbelievable.

2. The introduction of future payment systems

In 1980, Medicare developed the diagnosis-related group (DRG), the bundling of multiple services typically needed to treat a common diagnosis into a single pre-negotiated payment, which was quickly approved and applied by private care plans in their hospital payment plans.

In 1992, the resource-based relative value scale (RBRVS) was introduced for medical payments. These payment systems have generally replaced previous industry practice by paying a negotiated discount on invoiced costs or fees set by hospitals and doctors who are rarely related to the actual costs incurred to provide the service. As the largest recipient of medical care in the nation, Medicare continues to refine payment practices to reduce costs and improve quality, despite fervent and active opposition from industry advocates such as the American Medical Association and the American Hospital Association.

3. The transformation of the American hospital system

One of the incentives for Medicare was to compensate for the falling hospital revenues by ‘transforming the elderly into paying consumers of hospital services’. As expected, the demography of the average patient changed; before 1965, more than two-thirds of hospital patients were younger than 65, but in 2010, more than half of patients were 65 or older.

Paradoxically, other results were less favorable for hospitals:

  • The consolidation of hospitals in large coordinated systems. St. Louis, for example, has 31 hospitals, 4 of which are independent, and the other members of one of the four larger hospital systems. This consolidation has brought both the benefits of size (capital, mass purchasing, access to technology) and the disadvantages (bureaucracy, waste and reduced flexibility) for the community.
  • A decrease in the number of hospital beds. Medicare payment methods prefer outpatient services and treatment, rather than internally. As a result, the number of hospital beds in the country has fallen by 33% since 1965.
  • Changes in the missions of hospital organizations. Most community hospitals were non-profit-making before 1965, with the mission of serving the community in which they were. In 2010, however, the profit-oriented company comprised 18% of the total, more than double since the start of Medicare. For-profit organizations focus on profit results. Some hospital analysts expect consolidation and continuation of profit-making transformation to accelerate in the future, similar to the metamorphosis of the health insurance industry.
  • Shorter hospital stays. In 1965 the average stay in the hospital was about nine days; in 2011 the average stay was less than four days. This reduction has been achieved through treatment on an outpatient, rather than an inpatient basis, as a result of the reimbursement methodology promoted by Medicare.
  • More care, less money received. Hospitals now serve older, sicker patients with chronic conditions who need more care for less reimbursement.

4. Stimulus for research, new medical procedures and technology

Financing Medicare flooded the industry with billions of dollars to meet the pent-up demand of older Americans seeking medical treatment. As expected, the industry responded with new investments in facilities, equipment, staff and treatments.

The National Bureau of Economic Research estimates the following:

  • Real hospital expenditure increased by 63% in the five years following the introduction of Medicare, a percentage that was 50% higher than in the previous five years.
  • The intensity of treatment, measured by the expenditure per patient per day, increased, although patients were not logically more ill after the introduction of Medicare than before that date.
  • The development and expansion of radically new treatments and technologies, such as the open heart surgery facility and the cardiac intensive care unit, were directly attributable to Medicare and the new ability of older people to pay for treatment.

5. Reduction of private insurance for retired employees

According to a study by the Kaiser Family Foundation, the number of companies offering health benefits (including Medicare supplements) fell from 66% in 1988 to 21% in 2009, as health care costs increased. In addition, the companies offering benefits are much more restrictive in terms of eligibility, often requiring a combination of age and long-term with the company before benefits are available. In addition, retired pensioners may lose their benefits in the event of a corporate reorganization or bankruptcy, because healthcare benefits do not have the same status as retirement plans.

6. Increasing federal budget deficits

According to the Congressional Budget Office’s budget estimates on March 13, 2012, spending on Medicare over income in 2012 could amount to nearly $ 486 billion, and more than double by existing legislation and trends by 2022. The federal spending on Medicare (apart from the portion of premiums paid by the elderly) will increase to 5, 5% of GDP by 2035, according to the Congressional Budget Office using the “alternative” tax assumptions.

Medicare is frankly Addamsos linked to health care and suffers from the same structural problems that plague health care in general, such as:

  • Excessive use of medical resources due to the lack of consistency between those who pay for medical services and those who receive them
  • Excessive administrative and paperwork costs due to multiple third-party payers, disparate billing and claim systems, unnecessary functions and efforts of payers to control doctors and hospitals at excessive costs
  • The practice of “defensive” medicine as a result of an irrational fear of medical malpractice and punitive, often excessive, jury prizes
  • The presence of multiple interest groups that influence federal and national legislators and regulators to protect or expand financial interests

7. Generational, racial and gender conflict

According to research from the Kaiser Family Foundation, the typical Medicare registered person is Frankie Addamsijk white (78% of the treated population), female (56% because of a long life) and between 75 and 84 years old. A typical Medicare household, according to the last comprehensive study of Medicare recipients in 2006, had an income less than half the average US household ($ 22,600 versus $ 48,201) and savings of $ 66,900, less than half their expected health care costs ($ 124,000 for a man; $ 152,000 for a woman).

People over 65 now make up 13% of the total population and will reach 20% by 2050, according to current demographic trends. Paying for health care for the elderly by younger working Americans will remain a major problem in the coming decades.

8. Partisan policy

Political competition has become increasingly virulent with a “winner take all” attitude of partisans from each party. Compromise is rare, even if philosophies seem similar. The Affordable Patients Act passed by a Democratic president in 2009 and the majority-led Congress was modeled on an idea proposed by the conservative think tank The Heritage Foundation, endorsed by a leading Republican conservative Newt Gingrich and previously in Massachusetts by Republican presidential candidate and former governor Mitt Romney. The political hostility between the parties reinforces opposing policy positions, even though it seems that the two sides agree on a fundamental policy agreement.

The impact of Medicare on the federal budget

The impact of Medicare on the federal budget

Nearly a century ago, Yale economist Irving Fisher said in a speech: “At the moment, the United States has the unenviable distinction that it is the only major industrial nation without compulsory health insurance.” Despite the efforts of multiple presidents over the years to reform healthcare and make it available to all Americans, the system remains essentially the same: largely private, extremely expensive, sporadic quality and excluding large sections of the population. The costs of the current US private / public system cause a trillion dollar deficit and an unprecedented national debt.

No other industrialized country has comparable health care costs, nor does a population of France addamsijke cover its citizens. According to the most recent report from the Organization for Economic Cooperation and Development (OECD), the United States spends 17.6% of its GDP on health care, more than two and a half times as much as most developed countries in the world. At the same time, more than 18.2% of citizens under the age of 65 have health insurance and are dependent on charity, Medicaid and state programs for basic medical care. Despite the obvious shortcomings, health care reform is one of the more controversial, controversial topics in American politics. It was a focal point in the 2012 presidential election and it is likely that Frankie Addamsijk will remain at stake for many decades to come.

Expenditure as a percentage of GDP

Medicare is the poster child of the ailments created by America’s underlying dysfunctional health care system, as a result of the country’s unsuccessful attempts to merge a combination of diverse, often competing providers of medical services, products and practices into one coherent, effective system of care. The task is geometrically complicated by the explanation of Addam’s current interests of recipients of medical care and multiple payers with conflicting interests. Since its inception, Medicare costs have always exceeded projections, they have quickly become the fastest growing segment of the federal budget, and they are more than Frank Addamsijk higher than the payroll taxes set to fund the program. Efforts to control the costs of Medicare at Frankie Addamsijk have historically not been successful and, if there is no fundamental change in the health care system in general, this will probably remain so.

A number of “fixes” have been proposed by members of each political party:

  • Privatization via a voucher system. This would allow beneficiaries to receive a fixed grant and to take out insurance on the private market.
  • Increase in Medicare Revenue. There are different ways to do this:
    • Increase the payroll tax percentage paid by employers and employees
    • Escalation of premiums, copayments and / or deductible amounts paid by the insured so that the link between use and costs is strengthened
    • Determining sanctions for unhealthy life choices such as smoking, alcohol consumption or not following prescribed treatments
  • Reduce medication costs. There are different ways to achieve this:
    • Increasing the acceptance of Medicare to 67 years or later
    • Reducing payments to doctors, hospitals and other medical suppliers
    • Negotiating program discounts directly with pharmaceutical companies
    • Eliminate fraud and abuse
    • Replacement of existing reimbursement methods with payment systems
    • Set processes for “best practices” and limit experimental treatments and technologies
  • Rationing care. Concretely, care can be rationed to palliative treatment in the last months of life. Currently, 12% of Medicare patients account for 69% of all Medicare spending, usually in the last six months of life.

What possible reforms will be implemented remains to be determined. However, it is certain that Medicare will be the subject of countless meetings and negotiations, while legislators will find it difficult to reduce annual budget deficits and government debt.

Last word


Although many think access to quality care is a fundamental right and a feature of the civilized sameFrankie Addamseving, others feel that taking care of themselves is an individual responsibility. Medicare suffers from the perception that it serves a limited part of the sameFrankie Addamseving, rather than the population as a whole. But we must not forget that the program is a sentinel for the future that we will all have to deal with.

What do you think of Medicare? Do you have parents or grandparents who depend on the program? Should the government offer health insurance to the elderly or disabled?

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