Where would we be today without the introduction of ...



Where would we be today without the introduction of Medicare and Medicaid? In 1945, President Harry Truman sent Congress a message asking for the establishment of a national health insurance plan. It took a full 20 years before Medicare and Medicaid were signed into law by President Lyndon Johnson as part of his legislation for a “Great Society.” One might surmise that the addition of Medicare has improved the health of seniors, but it seems to be a myth that seniors were in poorer health prior to Medicare. For example, a 1960 survey from Emory University reported 10% of seniors reported that they were in poor health. “Today, after 36 years of compulsory, one-size-fits-all medical care under Medicare, 27% of seniors report that they are in poor health” (Huntoon, 2002). Since it is a percentage studied, it can be construed that after Medicare was signed into law, we now have 20% more unhealthy seniors. So, without Medicare would we have relied on a private system? Would people be more inclined to utilize preventative care, or, indeed, would it be that more seniors would expire earlier because of a lack of proper care?

What concerns do you see facing both Medicare and Medicaid in the next 12 to 15 years? The largest concern regarding Medicare and Medicaid surround the rising prices of Medical care and the economics of who will pay for benefits, who will pay for the differences between care and benefits, and the change in demographics that will likely result in more retirees needing more benefits in the next 12-15 years. States have varying degrees of insurance programs and rules, so looking to individual States will not be a good solution. And, guaranteed issue of insurance does not mean guaranteed affordability. In particular, many people approaching retirement are now needing to change or cancel their plans due to their portfolio being worth far-less, lay offs, cut backs, and a general economic malaise. Some say that the way to change Medicare is “to let the health care system evolve, then honestly address issues of financing and delivery, asking the real experts to recommend what the system out to look like” (Vladeck, p. 9, in “The Future of Medicare”).

What should the insurance’s role be for poor medical choices such as not wearing your seatbelt or smoking/drinking be? The role should be one of education, not punishment. Studies have shown that individuals are much more likely to listen and embrace public education programs that help them understand ways to change behavior, rather than punishing them if not. However, in the case of poor safety and choices that continue to aggravate and increase costs, rather than the entire population sharing the burden, those who engage in the behaviors must bear the brunt whenever possible:

• Seat Belts- Insurance should educate as much as possible to encourage seat-belt usage, and, if citations appear on an accident or traffic report for not wearing seat belts, rates then should go up.

• Smoking – smokers should pay more for insurance, but again, educational programs and paying for smoking cessation programs should be included. Whatever costs associated with such plans would be minimal in comparison to the general health risks.

• Drinking – again, educate against drinking to excess, but the only way to police it is to use the legal system (DUI) as a way to modify rates.

References:

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“A Political History of Medicare and Prescription Drug Coverage: Missed Opportunities and Muddled Outcomes,” cited in:

Brock, Fred, (4/21/08), “Before Medicare, Sticker Shock and Rejection,” The New York Times, cited in:



Huntoon, Lawrence, M.D. (2002), “Medicare Myths and Facts,” Association of American Physicians and Surgeons, cited in:

“The Future of Medicare,” (2003), Supplement to Managed Care, cited in:



Smith, H. (2009), “The High Cost of Smoking,” MSN Money, cited in:

“What Doe Your Insurance Plan Cover?” cited in:



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