The Federal Medicare Program For Public Integrity

AARP, American Association of Retired Persons, is considered by Human Events as one of the most powerful lobbies. Many websites state that the focus of AARP is not the seniors, nut the money involved. The tactics the AARP are considered “scare tactics.” American Association of Retired Persons used scare tactics by scaring the seniors into thinking their Medicare benefits were going to be taken away from them by congress without their support. Obamacare was highly supported by the members of AARP, why? The AARP convinced its members without Obamacare their Medicare would be reduced. However, this was not the case, it did not protect Medicare benefits, and it actually cut 500 million each year.

The Pharmaceutical lobbyist has a very powerful impact on the outcome of Medicare Part D. They were the ones that wrote the bill and presented it to the House and ultimately, it was passed. However, the tactics that were used were extremely questionable and unethical. A Democratic Representative from Michigan stated: “I can tell you when the bill passed, there were better than 1,000 pharmaceutical lobbyists working on this” (Singer, 2007). The

Since the late 1980s, Medicare has reimbursed physician services using the Medicare Physician Fee Schedule (MPFS), which encompasses 10,000 procedure codes. Each code is assigned resource-based relative value units (RVUs), which are designed to reflect physician work, practice expense, and malpractice expense. To adjust for local differences in cost of living, each RVU is modified using geographic practice cost indexes (GPCIs) and then converted to dollars using a “conversion factor.” This system rewards physicians who produce a high volume of services; not surprisingly, Medicare Part B expenditures have grown rapidly.

The Patient Protection and Affordable Care Act (Obamacare) had mame dramatic changes in the field of the health care system, especially in Medicare, that will seriously take effect in American seniors. Indeed, much of the health law’s new spending is financed by spending reductions in the Medicare program. In addition to the provider payment reductions, Obamacare significantly reduces payments to Medicare Advantage (MA) plans by an estimated $156 billion from 2013 to 2022.( Elmendorf, letter to Speaker Boehner). About 27 percent of all Medicare beneficiaries are enrolled in MA plans, a system of regulated and private plans competing against each other as an alternative to traditional Medicare. MA plans are attractive to beneficiaries because they offer more generous and comprehensive coverage than traditional Medicare by capping out-of-pocket costs and offering drug coverage to a rasonable

The purpose of this essay is to discuss Medicare Part D, as well as the influence of the various interest groups and governmental entities during this process. This essay will discuss both the policy process and the policy environment (the key players involved and other circumstances that shaped this policy-making effort), how stakeholder groups influenced the final outcome of Medicare Part D legislation, the specific strategies and tools that were used most effectively, and if the fact that Medicare Part D passed corresponds with my understanding of policy and politics.

Less than a hundred years ago, in the late 1920’s and 30’s, almost 90% of Americans did not have health insurance (Fall of HMO’s 4). They used a variety of home remedies and when medical assistance was truly needed, they paid for it out of pocket, even incurring vast amounts of debt. This had been the case throughout history, and it changed due to an important factor, medical equipment. The industrial revolution finally caught up with the medical industry and the country saw a vast change in the scientific instruments used by physicians. These instruments required a lot of money to make and care for which caused prices to rise. Due to this massive problem, a committee was formed of health care professionals and after a 5 year study, the Committee on the Cost of Medical Care suggested that health insurance co-operatives start. These corporate medical practices became known as Health Maintenance Organizations (HMO’s) and preferred provider organizations (PPO’s), and up until the 1970’s, were an experiment to regions across the U.S. Factors that hindered health care included bullying of “money politics” from both sides of the isle as well as Presidential views and tactics as well. President Nixon first

In 1965, Congress created Medicare. Seniors were forced into the free-for-all of Medicare, personal responsibility was replaced by paternalism, and, predictably, unrestricted health care for older Americans lead to frenzy of spending by patients and doctors. Those who had clamored for Medicare argued that, since the state subsidizes seniors' medical care, the state ought to pay for everyone's health care. In an act of pragmatism, President Nixon proposed the HMO Act, which Congress passed in 1973. The law gave millions of dollars to HMOs, which, until then, had constituted a small portion of the market.

Politicians knew they had to find a way to make Medicare solvent or, it would consume all tax dollars collected, but finding a way to rein in costs and make healthcare affordable for all Americans wasn’t going to be an easy task.

President Obama’s pledge to pay for the program by taxing the rich, who is anyone that makes more than $1 million a year (which would include President Obama) and will make for “a marketplace that provides choice and competition” (Conniff, 2009). He also proposes that reform is about every American who has ever feared losing their coverage if they become too sick, lose their jobs or even change their jobs. It’s realizing that the biggest force behind our deficit is the growing costs for Medicare and Medicaid programs.”

One class of American citizens view on the Patient Protection and Affordable Care Act is doctors, and it is very negative. Third-party payment plans already hinder the independence and integrity of the medical field. This act now will reinforce the worst of these features. Physicians will fall prey to more government regulation and oversight, and will now be increasingly dependent on a not to reliable government reimbursement for their services. A doctors job will only be become more difficult.

Medicare and Medicaid have cause a great deal of damage to the American society. "Years of scandal have shown the waste, fraud and abuse that is rampant in Medicare and Medicaid." (Fallen Guardians of Justice: How the Supreme Court is

Since its establishment in 1965 we have seen Medicare change as people’s needs change however being a federal program these changes do have an incredible amount of lag time. One of the first major changes to Medicare occurred in 1972 when President Nixon signed the Social Security Amendments of 1972 which extended coverage to individuals under age 65 with long-term disabilities, expanded benefits to include some chiropractic services and speech and physical therapy. During this time we see the American public growing tired of the Vietnam Conflict and lack of support and care for those returning Marines and soldiers with severe disabilities. As the protests escalate and the peace initiatives fail a key piece of legislation is signed showing government support and a willingness to extend health care benefits to this growing and vocal population of veterans (The Vietnam War, 1999). Also included in this Amendment is the encouragement of the use of Health Maintenance Organizations, President Nixon’s administration caught in the scandal of Watergate and pending hearings appeased the left and proposed the HMO Act, which Congress passed in 1973 (Phillips, 2003).

This is forcing the doctors to no longer accept certain insurance companies such as medicaid because they aren’t being reimbursed for the services they’re providing to the consumers that are using medicaid. One doctor, Dr. Martha Boone in Atlanta, Georgia, said that she would have to see 20 patients an hour in order to make any reimbursement from medicaid. She said that medicaid paid none of their bills coming from her office for 18 months and when her office sent registered letters to Medicaid to see what the problem was they said it was a computer error and still didn’t reimburse her office (Heritage, 2010). Because most doctors don’t receive money from Medicaid, most of them don’t accept it. “Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare, according to the hospital’s Web site.” (Connelly, 2009). This forces the Medicaid consumers to go to the emergency room when they need help since normal doctors rarely take their insurance. Dr. Lloyd Krieger says that the undoing of this healthcare bill is, “an urgent necessity.” because it is, “doing great damage even years before it’s individual mandates and other controls kick in.” (Krieger, 2011).

Due to the upcoming presidential election, the two major political parties, and their candidates, have been focusing on the primary problems that the nation will face. Chief among those problems is the future of Medicare, the national health-insurance plan. Medicare was enacted in 1965, under the administration of Lyndon B. Johnson, in order to provide health insurance for retired citizens and the disabled (Ryan). The Medicare program covers most people aged 65 or older, as well as handicapped people who enroll in the program, and consists of two health plans: a hospital insurance plan (part A) and a medical insurance plan (part B) (Marmor 22). Before Medicare, many Americans didn't have health

Suitable health care would not be possible for the elderly population in America without the assistance of Medicare Part A. Medicare did not come about easily. Currently Medicare spending is more than what is being collected, questioning future solvency. There are many challenges with sustaining Medicare into the future. Medicare’s past struggles, present outcomes, and future challenges confirm that a national health plan is ever evolving to meet the needs of the current population and spending inflation.