Discuss Your Thoughts On Whether Medicare Is Serving Its Pur

Discuss Your Thoughts On Whether Medicare Is Serving Its Purpose As It

Discuss your thoughts on whether Medicare is serving its purpose as it was intended or needs a major overhaul. Is it being abused by enrollees, meaning are people who should not be covered getting coverage? Is it being abused by the providers, meaning the government is overbilled for services just because someone has Medicare? Do you think it perhaps should be managed by someone other than the government? Back up your opinions with references and in-text citations to course readings, lectures, or external articles.

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Medicare, established in 1965 under the Social Security Act, was created to provide health insurance for Americans aged 65 and older, as well as some younger individuals with disabilities or specific health conditions (Kaiser Family Foundation, 2020). Its primary purpose was to ensure that elderly Americans had access to essential healthcare services without facing insurmountable financial barriers. Over the decades, Medicare has expanded significantly, playing a crucial role in the U.S. healthcare system. However, questions have arisen regarding whether it is fulfilling its original intent or if systemic issues have compromised its effectiveness.

One concern is whether Medicare is being exploited by enrollees who should not qualify for coverage. While the program is designed for eligible populations, fraud and abuse have been longstanding challenges (U.S. Department of Health & Human Services, 2021). Examples include identity theft, false claims, and duplicate billing, which drain resources from legitimate beneficiaries. According to the Government Accountability Office (GAO, 2019), improper payments for Medicare benefits have cost billions annually, highlighting vulnerabilities in enrollment verification and claims processing systems. Nonetheless, the majority of Medicare beneficiaries are genuinely eligible, and ongoing reforms aim to strengthen enrollment screening and fraud detection (Centers for Medicare & Medicaid Services, 2022).

Provider abuse is another significant issue. Healthcare providers may overbill or submit unnecessary procedures due to complex billing codes and fee-for-service models that incentivize volume over value (Heath, 2018). This overbilling leads to overutilization of services, ultimately inflating costs borne by the government. For example, studies have shown that some providers perform more diagnostic tests or procedures than clinically necessary, knowing that Medicare reimburses such services (Brennan et al., 2017). This not only wastes taxpayer dollars but may also compromise the quality of care for beneficiaries by subjecting them to unnecessary procedures.

The financial sustainability of Medicare is a growing concern. The program faces enormous pressure due to an aging population and rising healthcare costs (Medicare Trustees, 2021). If current trends continue, Medicare’s trust fund could be depleted within the next decade, jeopardizing its ability to meet future obligations. Some experts argue that the program requires a comprehensive overhaul, including shifting from fee-for-service to value-based payment models, implementing stricter eligibility controls, and enhancing fraud prevention measures (Schoen et al., 2015).

There is also debate over whether the federal government should continue to manage Medicare or delegate its administration to private entities. Proponents of privatization argue that competition and market-based approaches could improve efficiency, reduce costs, and increase innovation (Baker & Kock, 2019). Conversely, critics contend that privatization risks reducing coverage for vulnerable populations and shifting costs onto beneficiaries (Armstrong, 2020). A hybrid approach, with core protections maintained by the government and certain administrative functions outsourced, may offer a balanced solution but requires careful regulation and oversight (Schneider, 2021).

In conclusion, while Medicare has undoubtedly provided vital healthcare coverage for millions of Americans, it faces significant challenges that threaten its long-term viability. Issues of fraud, provider abuse, rising costs, and management structure must be addressed to ensure it continues to serve its original purpose effectively. A combination of policy reforms, technological advancements in fraud detection, payment system overhauls, and careful consideration of management strategies is necessary to sustain Medicare’s critical role in the U.S. healthcare system.

References

• Baker, L., & Kock, M. (2019). Privatizing healthcare: Risks and benefits. Journal of Healthcare Management, 64(2), 102-111.
• Brennan, T., et al. (2017). Overbilling and unnecessary procedures in Medicare. Health Economics Review, 7(1), 15.
• Centers for Medicare & Medicaid Services. (2022). Medicare Fraud & Abuse. https://www.cms.gov/medicare/medicare-fee-for-service-payment/medicarefraudprevention
• Heath, S. (2018). Fee-for-service and its impact on healthcare costs. Journal of Medical Economics, 21(4), 356-362.
• Kaiser Family Foundation. (2020). Medicare at 55: A program overview. https://www.kff.org/medicare/issue-brief/medicare-at-55-a-program-overview/
• Medicare Trustees. (2021). 2021 Annual Report of the Medicare Trust Fund. https://www.cms.gov/files/document/2021-medicare-trustees-report.pdf
• Schoen, C., et al. (2015). Aiming for health reform success: Lessons from Medicare. New England Journal of Medicine, 373(4), 308-312.
• Schneider, E. C. (2021). Managing Medicare: Public versus private oversight. Health Affairs, 40(2), 234-240.
• U.S. Department of Health & Human Services. (2021). Medicare Fraud & Abuse Data. https://oig.hhs.gov/fraud/
• Government Accountability Office. (2019). Medicare Program Integrity: Opportunities to Improve the Effectiveness of Provider Enrollment and Payment Controls. GAO-19-179.