Medicare: Faces in the System

This documentary features a ten-minute Internet film that captures some of the various faces of people for whom the Medicare system is vital. The film includes interviews with a U.S. Congressman, the director of a rural health clinic, a doctor of pharmacology at that clinic, and four patients who rely extensively on Medicare.

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The United States' intensifying economic inequality casts a grim shadow over the nation's esteemed status as a land of opportunity and prosperity. The country prides itself on economic dominance and scientific achievements, yet it stands out as one of only two industrialized nations that does not provide complete medical services to its citizens. In 1965, Lyndon B. Johnson's administration attempted to match the success of Canada and Great Britain's healthcare systems by creating two national health insurance plans: Medicare and Medicaid. The former runs in conjunction with Social Security to provide insurance for the elderly who have worked in the United States for forty quarters, the permanently disabled, and those suffering from end-stage renal failure, while the latter is managed by state governments and provides assistance for the poor. The goals of the program were initially to eliminate economic barriers between patients and access to medical care, and to create a system of equal treatment for all individuals. After thirty-five years of additions and amendments, Medicaid and Medicare are

While the majority of Medicaid dependents are concentrated in low-class areas, such as the slums of metropolitan cities, the nearly forty million Medicare recipients are spread across the nation. As a resident of a fairly wealthy region of North Carolina, I rarely have the chance to interact with those supported by Medicaid. On the other hand, Medicare recipients, in the form of retired elderly, constitute a sizeable portion of the total population. The federal government's frequent legislation to modify Medicare, therefore, is more relevant to my daily life. Further, after having the chance to speak with the elderly, I see their experiences with the program, good and bad, are worth sharing with the public.

Relaxing on the porch of her cozy "tree house" of more than twenty years, Virginia Barron's face glows in the sunlight. She smiles as if she feels no pain from her right leg, which only a week before was operated on for reconstructive knee surgery. Despite the unavoidable discomfort that comes with surgery, Mrs. Barron's experience after the hospitalization has been relatively pleasant. She does not have to give up the luxuries of her life to fund the expenses of the surgery. The only costs Ms. Baron bears from her own pocket are the monthly premium for a supplemental insurance and, more significantly, the costs of prescription drugs. Part A of Medicare, which has insured her since she turned 65 in 1983, provides partial payment for the hospital costs. The supplemental insurance provides coverage for the rest of the bill. Further, fortunately for Mrs. Baron, the University of North Carolina at Chapel Hill hospital system doctors accept Medicare Assignment from Medicare Part B as payment in full. As the concentration of Medicare recipients in the patient population increases, doctors must accept Medicare patients, and thus Medicare Assignment, for fear of going bankrupt.

The appeal of Medicare in the eyes of doctors and hospitals has changed considerably since 1965. Joining Medicare in 1983, Mrs. Baron never experienced the original policies of the government-funded insurance. Before 1983, physicians and hospitals widely accepted the national health insurance because of the ability to earn large profits. In the time of retrospective reimbursement, often referred to as the "blank check" era, doctors received any payment from the federal government for patient treatment as long as the requests were "customary, usual, and reasonable." Despite the success of the program in making available high-quality treatment during this time, the policies in providing this service could not be maintained because the federal government unnecessarily lost billions of dollars to physicians and hospitals. The 2.9 percent income tax collected to fund Medicare did not provide enough revenue. As the number of Medicare patients rapidly climbed, the government could not continue retrospective reimbursement for fear of bankruptcy.

During the Reagan administration, Congress realized the program's major deficiency and adopted a new policy of Medicare Assignment, still present today, in which physicians receive a predetermined reimbursement depending on the diagnosis rather than treatment. Most specialists despised the new policy in 1983 and refused to continue to treat Medicare recipients. By the early 1990s, though, as the number of Medicare recipients continued to grow, physicians realized that they could not survive economically without the business of Medicare recipients. Even in 1995, when doctors and hospitals only received approximately sixty-eight percent of the payment provided by private insurance companies for patient treatment, they continued to serve ninety percent of the Medicare population. With over forty million insured today, the financial risk of not treating Medicare recipients increases every year. The prospective reimbursement based on Diagnostic Related Grouping provides funds, though small, which help hospitals and physicians stay in business. Further, allotting smaller funds to providers actually improved patient care. Providing less, more efficient care actually removes the risks associated with performing several tests and trying different treatments and improves the patient recovery rate.

The reimbursement policy, therefore, more affordably maintains access for Medicare recipients to the same medical care as the privately insured. In addition, with a relatively low administration cost of only nine percent, required mainly to determine whether certain disabled people qualify for Medicare, a significant proportion of funds is available for coverage. That is not to say, though, that all people supported by Medicare receive sufficient treatment. Problems in coverage that were experienced prior to 1983 still exist today. Medicare A, given to all those who qualify, solely covers hospital costs. The voluntary insurance, Part B, deducts a premium from Social Security checks to cover all physician and in-hospital services. The insurance's concentration on acute, rather than preventative care, limits the availability of primary care for the elderly who cannot afford to pay the premium and who do not qualify for Medicaid. Without access to such necessary exams as mammograms and Pap smears under Medicare A, those without Medicare B have to wait until the problems become serious before they can access insured treatment. The failure to provide all seniors access to physicians costs the government more money in treating illnesses that could have otherwise been prevented.

Even with Medicare A and B, the elderly do not receive complete medical coverage. The federal government considers some medical necessities, such as metal bars for bathrooms and adult diapers, as luxuries and refuses to fund them. Transportation for poor elderly to and from hospitals and clinics is often also a problem. Another deficiency is the refusal to fund prescription drugs, even though a solution to this problem is likely in the near future. For poor Medicare recipients who do not qualify for Medicaid because of a "large" Social Security income check, acquisition of medical necessities is at times near impossible. Medicare's partial coverage, though it provides some sort of medical assistance to over forty million people, has had significant but limited success in removing all economic barriers so that the federally insured can access the same treatment as those under private insurance plans.

Click Here to view video (use fast connection only: 21.5 MB file)