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U.S. Health Policy: Medicare

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Details: In November 2003 the U.S. Congress passed a controversial health policy bill that President George W. Bush signed into law. The new legislation makes the most far-reaching changes to Medicare since the program was created in 1965. Please address the following questions:

Why were changes to Medicare deemed necessary?
What are the main provisions of the new legislation? Do you think they accomplish the desired goals?
Who was involved in setting the agenda for this policy change? Discuss the roles and interests of specific agenda setters and their influence on the development of the legislation.
Why was the legislation controversial? Discuss the claims of the law's supporters and detractors. Who will benefit from the changes?
Do you think having electronically stored data (such as costs and access to individual patient files) played a role in the decision-making process?

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"In November 2003 the U.S. Congress passed a controversial health policy bill that President George W. Bush signed into law. The new legislation makes the most far-reaching changes to Medicare since the program was created in 1965. Please address the following questions:?

1. Why were changes to Medicare deemed necessary?

The changes to Medicare were deemed necessary for several reasons, and are somewhat controversial. For example:

1) The steady rise in reported costs deemed it necessary to make changes to Medicare.

In fact, health care benefits were a hot issue in labor negotiations, and it has put pressure on Congress to reach agreement on adding a drug benefit to Medicare. Therefore, it was about the changing demographic of the health care consumers, with the aging population. This is because the aging population means a greater strain on the health care system in terms of both cost and capacity. However, the government points out that is more about providing the seniors with a choice of drug plans versus pushing them out of the system. For example, one reporter says this:

"This past week, the Trojan Horse galloped off the pages of ancient mythology and into the United States Congress, in the form of a deeply flawed Medicare bill. Congressional Republicans, unable to succeed in past efforts to cause Medicare to "wither on the vine,?in the words of Newt Gingrich, were finally able to pass legislation that may spell the end of the entire Medicare program. How did they do it? By concealing it inside a long-overdue measure to provide America's 41 million seniors with prescription drug coverage." (http://dodd.senate.gov/index.php?q=node/3298)

The New York Times argues that the baby boom generation will indeed bankrupt the Medicare (http://www.tommydouglas.ca/articles/articles-aug03.htm).

2) The need for a more flexible health care system, with more choices for providers and consumers.

For example, it was argued that the need for a new modern Medicare system is about putting patients and doctors in charge of the Medicare system (Bush). In other words, it was about having a more flexible system, where the providers and consumers have more choices in how they receive their care and the new types of treatment that modern medicine offers: drug therapies, new medical devices, disease screening, and preventative care. It is also about providing equal access to these advantages for all seniors and disabled citizens on Medicare (http://www.whitehouse.gov/news/releases/2003/03/20030304-5.html).

3) A new Medicare system would address the increased number of uninsured Americans through various tax credits and other measures (http://www.tommydouglas.ca/articles/articles-aug03.htm).

New York Times: By ROBERT PEAR WASHINGTON, Sept. 29 - The number of people without health insurance shot up last year by 2.4 million, the largest increase in a decade, raising the total to 43.6 million, as health costs soared and many workers lost coverage provided by employers, the Census Bureau reported today (http://www.tommydouglas.ca/articles/articles-aug03.htm).

4) Increased seniors and the use of technology increases costs and therefore reform is required.

a. The cost of health care is rising at the fastest rate in more than a decade (i.e., Research is costly. New technologies are expensive, frivolous lawsuits against good doctors, and the patients are paying the price, doctors in hospitals are overusing certain tests and treatments as defensive measures to avoid litigation).

b. If harm is caused by serious misconduct, patients should also be able to seek reasonable punitive damages (i.e., "We need to pass medical liability reform through both Houses?says President Bush).

c. Misuse of the legal system by lawyers (i.e., the legal system should work for our patients--Our legal system must address medical errors, but doctors don't want to put anything on paper to improve health care quality because it might be given to a lawyer who is fishing around for a lawsuit). Solution: Medical Liability Reform

d. The need for greater information sharing between doctors and nurses without the fear that the lawyers used this information to sue doctors and hospitals. ("I'm going to ask Congress to pass a law to make sure that information developed for the safety and care of patients is not used by lawyers against doctors and hospitals,?says President Bush). Solution: Medical Liability Reform

e. The health care industry, while progressing in many areas, has lagged in information technology (i.e., increased need for modernization of information technology-- move from paper files, patient safety also improves when doctors can have access to health records without delay, etc.) Solution: New information Technology implementation

f. The need to renew that commitment and responsibility for the health of senior citizens, to make sure that the years of retirement are not years of hardship, needless hardship. by providing the seniors of today and tomorrow with preventative care and the new medicines that are transforming health care in our country. Solution: Drug Benefit Plans

For example, Lubitz and colleagues, using Medicare and other billing records and interviews about health status from 16,964 Medicare beneficiaries surveyed from 1992 through 1998, used complex statistical calculations to determine average longevity and end-of-life costs. "They found someone healthy and mobile at age 70 could expect to live 14.3 more years and accumulate about $136,000 in medical costs, in 1998 dollars, over those years. Someone with at least one limitation in daily activities, such as not being able to bathe or use the toilet unassisted, could be expected to live 11.6 years more, with cumulative medical expenses of about $145,000. ...

Solution Summary

In November 2003 the U.S. Congress passed a controversial health policy bill that President George W. Bush signed into law. The new legislation makes the most far-reaching changes to Medicare since the program was created in 1965. This solution addresses the questions related to Medicare thoroughly, such as why the changes were deemed necessary, the main provisions of the legislature, if the goals were reached, who was involved in the process, and others.

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1. Provide a ranking of what you feel to be the top three US health policy issues.
2. Explain the reasons for your selection and ranking of these issues.
3. To what extent are your selections and rankings related to your experiences with the healthcare system and how have they affected your perception of the US health care system and its policymaking.

Thank you.

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