United States Department of Health and Human Services, Research Paper Example

Public welfare and health have been regarded as of paramount importance in the policy of civilized countries. One of the ways to maintain public health consists in health services, or health care, provided by a government, the health care industry, a health care equipment company, or an institution such as a hospital or medical laboratory.

Regularly, the government-controlled healthcare system is paralleled with a private one, which allows for a flexible financing scheme resulting in less strenuous budget expenses. Current United States healthcare system can be described as that operating under a mixed market and characterized by a lack of universal system. Instead, it runs several public health care programs, with Medicare and Medicaid being two of the most among those.

Both programs appeared in over four decades ago, when realizing the necessity of reforming the existing Social Security program, President Lyndon Johnson signed The Social Security Act of 1965 which assigned to the Social Security Agency the responsibility for administering Medicare and Medicaid. In his speech earlier that year Johnson claimed:

“Thirty years ago, the American people made a basic decision that the later years of life should not be years of despondency and drift. The result was enactment of our Social Security program. . . . Since World War II, there has been increasing awareness of the fact that the full value of Social Security would not be realized unless provision were made to deal with the problem of costs of illnesses among our older citizens. . . . Compassion and reason dictate that this logical extension of our proven Social Security system will supply the prudent, feasible, and dignified way to free the aged from the fear of financial hardship in the event of illness.” (U.S. Social Security Administration).

Thus were established the two programs which play a key role in supporting the two least protected strata of society. Originally Medicare was designed for people aged 65+, with a working experience of minimum of ten years at a job that withheld Social Security from their pay, and partially covered certain medical services, divided into two parts – A and B. Part A, or Hospital Insurance, presupposed coverage of hospital stays including meals, supplies, necessary testing and a semi-private room; physical, occupational and speech therapy when conducted by a Medicare-approved health agency; certain medical equipment and hospice care for terminally ill patients, including drugs and support services for symptom treatment and pain relief.

The eligible for Part A people start getting it automatically without having to pay a monthly premium, because they have already paid into the system with their Social Security withholdings. Part B, or Medical Insurance, was designed to cover necessary doctor’s appointments, including outpatient medical and surgical services, diagnostic tests and some medical equipment. This part of the program is optional and requires a monthly premium from the patients, who must meet an annual deductible as well.

1972 witnessed a bill which extended Medicare to those who have received disability benefits for at least two years and to those with Chronic Renal Disease, thus not limiting the action of this program to elderly strata of society. In 1997 Medicare program was updated and enlarged by Choice or Advantage plans allowing users to fit the program according to their own medical needs, with the drawback of that part being that it was not available in all areas.

One of the most important updates to the Medicare was introduced by President Bush in 2003. Since in extreme medical cases the cost of prescribed drugs can rise up immensely, there were certain additions made to Medicare program, known as Part D, or Prescription Drug Plan, which covers 75 percent of any prescription drugs one purchases from $250 up to $2,250 yearly.

Expenditures up to $250 and between $2,250–3,600 are not repaid, with Medicare resuming its contributions in as much as 95 percent of drug costs one incurs having spent $3,600 per year. Prescription Drug plan is managed by private insurance companies and comprises various individual plans differing in coverage costs and lists of drugs covered by them. The client is free to switch between the plans during the open enrollment period at the end of each calendar year depending on the needed drugs.

Along with Medicare which focused mostly on a specific age group, care should be provided to people who cannot afford financing their own medical treatment. For the purpose of satisfying the needs of a poorer part of the nation, Medicaid program was introduced in the same year, specializing on sponsoring people who meet certain income, resource, age, or disability requirements. Poverty is not a sole criterion for being eligible for Medicaid:

“Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups.” (United States Department of Health and Human Services)

Unlike Medicare which is a federal-based program, Medicaid is a joint federal-state program run according to each state’s policy, thus service delivery, quality, funding, and eligibility standards may differ from state to state. The differences may go as far as to own names for the Medicaid program in each state. Participation in Medicaid is not obligatory for the states, however since 1982 all of them are enrolled in the program and provide up to half of its funding. Being a social protection program, rather than health insurance which is Medicaid, Medicare secures the rights to medical care for the least prosperous strata of the population and ensures a healthier nation on the whole.

Over the years changes have been made by both state and federal governments concerning the eligibility criteria and coverage areas under the Medicaid program. The most prominent recent amendment appears to be The Deficit Reduction Act 2005 designed, inter alia, to reduce the growth in Medicaid spending by nearly $43.2 billion over the decade be way of reducing the expenditures, tightening the eligibility rules and making certain services, such as prescription drugs, optional.

Apparently, in order to be efficient health care delivery system requires certain programs securing adequate medical treatment for the least protected layers of society, with Medicare and Medicaid being classic examples of such programs afoot. With the time, updates and amendments should be introduced in those programs enlarging or shortening the coverage areas depending on the needs of the society and the state of national funds directed at financing the programs. Wise and reasonable management and thorough consideration of multiple aspects that constitute a healthcare program are the essential condition for its successful and efficient functioning.

References

United States Department of Health and Human Services. Centers for Medicare and Medicaid Services. Retrieved September 4, 2009, from http://www.cms.hhs.gov/

U.S. Social Security Administration. (2009, September 3). Historical Background and Development of Social Security. Social Security Online. Retrieved September 4, 2009, from http://www.ssa.gov/history/briefhistory3.html