Medicare Essay Examples & Outline

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Medicare


Medicare has made tremendous steps in terms of its growth; it originated in the U.S in the twentieth century camouflaged as worker’s compensation. The worker’s compensation intended to protect employees who were injured while on duty. The great depression changed various aspects of Medicare. After the stock market crashed in the United States in 1929, the need for government protection from bankruptcy became inevitable.

This necessitated the signing of the social security act by President Roosevelt in the year 1935 (Aspen Health Law Center,1998). The social security started small, and it was mostly based on government’s collection of paychecks of workers. However, as time went by the funds taken in the form of taxes were used to create pensions schemes for workers. Many Americans thus felt that they were supported financial protection (Staman, 2010).

In the year 1952, President Kennedy envisioned reforms in the social security arena; it was specifically designed to ensure that all the elderly persons in the United States were entitled to Health insurance. However, this dream held by President John F. Kennedy was thwarted by the medical industry and the Congress. In the wake of the general President’s death, his successor Lyndon Johnson continued to push for the health care bill and the civil rights and economic opportunity act of 1964 was incorporated and in the year 1965 the health insurance for the elderly was passed. Ever since the birth of Medicare in the year 1965, there have been great milestones that have been made in this health care industry (Oliver, 2005).

Medicare was further overhauled in the year 1983 when diagnosis-related groups (DRGs) were included in the medical lexicon and by the year 1984, hospital payments were determined entirely on the basis of the patient’s diagnosis rather than the daily charges. For this reason, Medicare began paying for the average cost to treat a patient’s diagnosis rather than the daily charges that it used to pay for before (Oliver, 2005).

The first legislation that was aimed towards improvement of Medicare came in the year 1965, when the Congress created Medicare under the title XVIII of the social security act. The Act was established in an effort to ensure that all people aged above 65 years old regardless of the income or medical history had health insurance. In the year 1972, the Congress expanded the Medicare eligibility to younger persons who had permanent disabilities. The congress passed unanimously that these persons would receive social security disability insurance (SSDI).

In the year 1980, the Medicare secondary payer Act of 1980 came into effect (Dismone, 2000). This Act included the prescription of drugs into the insurance coverage and enabled people to get more medical attention as they were enjoying free government drug subscriptions. In the year 2001, Congress further expanded the Medicare Act and covered young people who had ALS (amyotrophic lateral sclerosis) (Marmor, 2000).

During its formation, Healthcare was mostly concerned with hospital and inpatient services; however, since the year 1997 it was broadened to include physician’s visits, outpatient’s care, and other necessary medical services. Under the equitable budget act of 1997, the Congress added Medicare benefits through private plans. 2003, the PL 108-173 Medicare as well as Prescription Drug development and Modernization Act was signed into law by the President. The act touted change in the introduction of the entitlement benefit for prescription drugs through subsidies and tax breaks (Oliver, 2005). In the year 2010, President Barack Obama signed into law the Health Insurance and Education Reconciliation act that included all United States citizens into federal sponsored health care (Staman, 2010).

Since the inception and inauguration of the prospective payment system, physician’s fee freeze, as well as other cost-cutting measures, many physicians have been in many cases approached with income generating opportunities that related to its practices. However, most of these opportunities present potential criminal and civil liability under the federal Medicare as well as anti-fraud abuse provisions (Staman, 2010).

The federal civil monetary penalties under the Section 1128A of the Social Security Act/42 USC 1320a-7aa), shows that health care professionals as well as entities are prohibited from the presentation or causing to present claims for the services of individuals which were not provided as claimed (Dismone, 2000). This provision often deals with the persons and entities that know that the claims are fraudulent and false and therefore, prohibits any person from providing misleading information that could reasonably be expected to influence the decisions regarded when discharging inpatient hospital services.

The anti-kickback law or better known as the criminal punishments for Acts involving federal health care programs (Section 1128B for the social security act/43 USC 1320a-7b). This act stipulates that the entities and individuals are prohibited from willfully and knowingly making false statements in the application of benefits or payments which are all under the federal and state health care programs (Aspen Health Law Center,1998). There is the prohibition against the knowingly soliciting or receiving any remuneration including kickbacks, rebates and bribes.

Self-Referral Law/Limitations on Certain Physician Referrals (Section 1877 of the Social Security Act/42 USC 1395nn) prevents physicians as well as their intermediate families having an ownership or even compensation relationship with a clinical lab from making referrals to it.

These laws about Medicare have been pivotal in changing the current Healthcare system. The pertinent terms of the Care Act aim to increase the sources of this Medicare insurance program funding. They also provide incentives for employers to adhere to the Act and stipulate the available penalties for defaulters.

To reduce Medicare expenses for the individuals and the government, some mechanisms were formulated which include subsidies, insurance exchanges, and mandates. The mechanisms are geared towards the provision of affordable and qualitative-insurance coverage for all the Americans despite color, race, creed or level of income. It tries to bridge the gap in regard to health care within all the population whether currently insured or not. It emphasized the health first rather than the economic status of the patient (Klein, 2006).

However, since being signed, the Act has faced criticism from all corners of the political fronts including some of those allied with the sitting president who advocated the bill. The reforms needed for successful implementation of the Act have not been spared. All matters of issues have been raised concerning its feasibility and legal authenticity.

The legal aspect has been the point of concern for the most of the critics. Whether genuine or just another loophole to be used to shoot down the enactment of the Act, the legal perspective has its merits as depicted by the suits presented to the courts in relation to the Act.

There have been a myriad of these all over the nation, but the most notable are the ones involving the independent business alliance and other petitioners versus the U-S-A Secretary of Health Branch and that of the human health services and other petitioners versus Florida. The first case had a lot of impacts and this is why it led to some changes in the original framing of the Act. The penalty provision has been since overhauled by the courts. The second case more or less affirms the same.

The cases have for this reason helped to restructure the provisions to some acceptable standards though more changes are still being called for from different platforms. They can, for this reason, be said to have streamlined and offered the much needed legal guidelines on more effective implementation of the well-intentioned Patients Protection and Affordable Care Act (Blatt, 2002). The resulting restructured act is more feasible and represents the views of all including those who oppose it. The equity in the applicability of the Act across the board was also ensured. Nevertheless, it led to the expansion of a better Act that will cater for all the affected parties currently and in the future.

References

Aspen Health Law Center. (1998). Health care fraud and abuse. Gaithersburg: Aspen Publishers
Dismone, R. (2000). Medicare: History of Provisions. New York.
Peterson, K. (2010). Medicare . CATO handbook for policy makers , 34-75.
Staman, J. (2010). Health Care Fraud and Abuse Laws Affecting Medicare and Medicaid: An Overview. Washington D.C.
Theodore Marmor, G. M. (2000). Medicare's Future: Fact, Fiction and Folly. American Journal of Law and Medicine Vol. 26 , 226-248.
Thomas Oliver, P. L. (2005). A Political History of Medicare and Prescription Drug Coverage. New York.