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Medicaid and Medicare Private and Public Health Issues

The major payers in private healthcare (other than government programs) are employers, and this has been true since the inception of health insurance programs. There are several reasons why this is so, but one of the main reasons is employees are a defined risk pool based on the work performed for the company. Healthcare insurance companies are able to predict the financial risk (as in an experience rating) taken by the type of employees. If, for instance, the work is dangerous or injury prone, such as direct care in a nursing facility, then the cost to insure that group would be higher than for employees working at a telecommunications office. Government healthcare programs, such as Medicare and Medicaid, do not measure the cost of healthcare by the experience ratings.

Based on your understanding of the topic, answer the following:

Can programs like Medicare and Medicaid adopt such methods to defray costs? If yes, how would they implement such methods? If no, what suggestions would you make to defray costs?
Most of those receiving Medicare and Medicaid benefits are not employed.

How the recipients of these programs be categorized into different risk pools? Explain.
The aging population is a force in healthcare continuing to have a dramatic effect on the direction of healthcare services. Many have discussed the aging population as the reason for the rising cost of healthcare. The pre- and baby-boomer generation (1946-65) were less knowledgeable and informed regarding the health risks and, therefore, engaged in risky behaviors that increased their susceptibility to chronic healthcare issues later in life.

What does that mean to the viability of Medicare and Medicaid?
Regardless of how many changes are made to Medicare to try to keep it solvent, aren't the sheer numbers of eligible recipients versus the ever decreasing number of people paying into Medicare the real reason why Medicare will cease to exist in its present form?

Do you agree with this question? Why or why not?
The British national healthcare system owns many hospitals and directly employs workers. General practitioner salaries are set by the British government. The funding for healthcare services comes mostly from the government. This is significantly different from the US healthcare systems. Consider the issues with government healthcare programs in financing and administration.

Would the US be able to transit to the British style of national healthcare? Why or why not?
In comparison to the British system and US system, what would be some of the challenges the US would face in adopting a national healthcare system? Discuss at least three challenges.

Employer-sponsored healthcare benefits should be maintained or done away with in favor of a government sponsored healthcare program? Why or why not? Think through this situation as representing both an incentive and a hindrance. If it is a hindrance, then what is it hindering in the way of government-sponsored healthcare programs?

Solution Preview

Yes, programs like Medicare and Medicaid can adopt such methods to defray costs. The Affordable Care Act, despite controversy, was critically needed because it drew attention to the issue, which many took for granted or failed to see the serious global and local (US) issue. Despite political and logistical challenges, health care is in a serious state. Just today, there is a news release on challenges in Russia, with THEIR health care reform (see Russian doctor rebellion causes headache for Putin, By NATALIYA VASILYEVA, Associated Press). Recently, this writer spoke with a man that traveled to Michigan to have dental care, where he had capped his options in Canada and couldn't get treatment so he traveled to the US.

Just because a person does not have any money or pay for services, as in the case of Medicare, doesn't mean that he or she should have a blank check for whatever the doctor orders. People on the low income grid are NOT a one size fits all group. There are those that were born and raised in poverty, and either do not have the education or resources to get anything else. The population of highly educated but unemployed is another group. There is also the population that is educated but impaired and likely can never find a way out, due to disability. Finally, to name a few, there are the mentally impaired, tribal, military and other 'exceptions.' Collectively, this is a really huge pool that either might have a good personal gene pool, making their need occasional or long-term.

A critical question is, "Should those who never or rarely contribute to society through payment or tax contribution get substandard care?" Some wealthy circles are entirely out of the loop now and paying to play. The doctor does not accept any insurance, knows the patient by name and is not a number. The wealthy patient pays out of pocket and gets top notch care. (Wealthy Families Skip Waiting Rooms With Concierge Medical Plans, Bloomberg News, By Elizabeth Ody March 16, 2012)

Can they, technically yes, a system could be adopted like the insurance system but at least in the US there is a heavy lobby and political factor that might never allow it to happen. It may evolve by default but every time it has come up for review there has been huge backlash with Clinton and Obama, as visible examples. The problem is that simply ignoring the problem and put to the filibuster mode is dangerous, as well. Taking the mind your own business mentality, is narrow-minded. The population of need is too big and will get out of hand quickly, putting society at large in serious danger. The timing, support and dire need have to be big and powerful for it to work and until then, NO.

If yes, how would they implement such methods? It comes down to a matter of private or public. Like with the prison systems, also in financial and challenging management issues, health care with more diverse culture than in earlier days is too big to put in a one-size-fits-all mentality. If no, what suggestions would you make to defray costs? PREVENTION and ...

Solution Summary

Private vs. public health care, insurance, payment for service delivery issues both in the United States and other areas of the world are discussed. 2050 words.