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It will identify key cost and quality problems facing the program and review solutions included in the recently passed Affordable Care Act that might provide solutions. The Medicare program faces many challenges as it moves into its second half-century of service.
It is buffeted by the cost of treating an expanded population of older beneficiaries, particularly as the "baby boom" cohort moves into retirement and begins to put greater utilization demands on the system.
In addition, the costs of providing care continue to rise at a rate that many find unsustainable. Cost issues are compounded by concerns about variations in the quality of care that is provided.
These challenges collide with major philosophical differences within our legislative and policy making bodies, leading to conflicting notions about how to respond to an expanding demand for services, how to establish sensible cost-containment strategies, and how to provide Medicare services that are comprehensive and of good quality.
Any use of the contents of this publication without the express written permission of the publisher is strictly prohibited. About the Authors Alfred J.
His experience includes administrative and legislative advocacy, litigation and litigation support, writing, program planning and development, and workshop presentations.
He is also a board member of the American Occupational Therapy Foundation. Chiplin is a former chairperson of the Public Advisory Group, of the Joint Commission that certifies the quality of health care organizations. He is a member of the Washington, D.
Bar and the Mississippi State Bar. Bethany Lilly was a legal fellow in fall at the Washington, D. She said that there were conflicting discussions about the stability of the Medicare program: In addition, the seminar ended in a heated discussion about whether certain Affordable Care Act ACA provisions on paying for quality, reducing hospital readmissions, and providing for alternative delivery systems are likely to make the Medicare program more sustainable by saving costs by ensuring that beneficiaries get the Medicare-covered services they need, including preventive services.
Medicare provides a foundation for the health and wellness of Americans who are 65 1 or older and for younger persons who qualify for Medicare on the basis of disability. This article will provide an overview of the policy debate that led to the creation of the Medicare program.
It will also identify key cost and quality problems facing the program and review solutions included in the recently passed Affordable Care Act ACA that might provide solutions.
The Pre-Medicare Debate In his definitive survey of the history of medicine in the United States, Paul Starr 18 identified four major cost-related factors for the development of the health care system in American life: These historic concerns reach into our current national dialog and influence the American debate over what should be done to provide necessary, high-quality services in ways that are cost-efficient.
In the s and 20s, medical science had developed to a point where the first two factors mentioned above were becoming determinative — medical procedures were becoming more advanced and expensive.
This increased risk lead many European countries to adopt various forms of government-run health insurance in the s, but the United States did not follow suit. This debate began inwith the founding of the American Association of Labor Legislation AALLa progressive group that began pushing for state-run public insurance in the late s.
This initial defeat did not stop the advocates of a national health insurance system. Following many complaints about the increased costs of medical care in the s, 34 the idea of government-run health insurance was revisited in the s.
It did not recommend a national health insurance program but did recommend that the government push for the creation of a private health insurance system. The AMA and the physician members of the CCMC strong disagreed with the idea of any kind of insurance and several committee members who favored a national public health insurance program issued a dissent to the recommendations.
Health care costs continued to rise in the s and early s as the market control by licensing boards and new scientific developments and associated physician education costs drove up the cost of care. The Roosevelt Administration created the Committee on Economic Security CES to study unemployment and pension issues, which included a subcommittee on medical care and health insurance.
First, there were multiple reports from the Social Security Board discussing health issues and recommending national insurance. Beveridge lectured extensively in the United States on the content of his report and on the need for social insurance.
Wagner and Murray introduced Senate Bill58 in conjunction with their colleague Congressman Dingell introducing House Resolution Taft, the chairman of the Committee on Labor and Public Welfare, proposed a federally financed medical welfare system, run by the states, and compulsory for the poor.
Davis, favored the Baruch proposal because it had a broader base of support. Jacob Javits and Rep. Ferguson and Taft accused the Administration of pushing socialized medicine in When Truman took office, the public supported a national health insurance system four to one. The players were changing: The American Hospital Association AHAnot a major player until this point, decided that it approved of government subsidies for private insurance, although it did not go as far as approving of a national health insurance system.
InI S. Forand of Rhode Island introduced a bill that was limited to covering the hospital costs of Social Security beneficiaries.
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