House Health Legislation – Health System Example

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'House Health Legislation' is a delightful example of a paper on the health system.   Medicare is a national health insurance program designed for local citizens of more than 65 years of age and people with disabilities (Social Security Online, 2008). As of 2004, as much as 13% of the tax payment the federal government receives from the people goes directly to medicare (msn Encarta, 2008).   Despite the federal taxes that go directly to Medicare, as much as 5 million children remain uninsured (Park, 2007). For this reason, the article entitled “ House Health Legislation would Curb Medicare Overpayments to Private Plans while Aiding Medicare Beneficiaries Overall” which was written by Park (2007) discussed the need for major health legislation to reauthorize the State Children’ s Health Insurance Program and extend health care coverage to as much as 5 million uninsured children by strengthening the finances of Medicare. Dilemma on the Current Medicare Program Aside from the traditional Medicare coverage, Medicare is aggressively promoting the marketing and selling of Medicare Private Fee-for-Service (PFFS) plan or a private plan which is basically a type of Medicare Advantage Plan such as the HMO or PPO (Centers for Medicare & Medicaid Services, 2008).

The problem with the Medicare private plan is that its premium cost is relatively much higher than the actual cost of the traditional Medicare plan in exchange with the promise to receive extra benefits as compared with the traditional plan. As a result of aggressively pushing its marketing and sales strategies, a lot of Medicare private plan holder was not properly informed that the plan can be used only with Medicare accredited hospitals and doctors (The New York Times, 2007). Part of the terms and conditions for using the Medicare private plan is to require the insured individuals to show the plan ID to doctors since it includes how much the physicians and hospitals will receive for extending the medical services to Medicare plan holders.

Despite the extra benefits attached to the private plan, licensed doctors still have the right not to accept the plan or render his medical services for certain reasons (Centers for Medicare & Medicaid Services, 2008). Therefore, there is a ‘ fairness gap’ between the Medicare traditional and private plan holders. Proposed Solutions To reduce the ‘ fairness gap’ between the two types of Medicare holders, MedPAC recommends that the house bill should include: (1) reduce the payments for private plans over the next 4 years; (2) prohibit double payments caused by indirect medical education; and (3) eliminate Medicare ‘ stabilization fund’ in order to promote fair competition within the health care industry (Park, 2007). By eliminating the overpayments on Medicare’ s private plan, Medicare beneficiaries especially the low-income beneficiaries will have more advantages in terms of equally being able to receive the same quality health care services from their preferred health care institutions.

On the other hand, Medicare enrollees will not have to pay an extra amount of money for their health care plan. Conclusion Considering that the promotion of Medicare private plan requires a lot of unnecessary operational costs related to marketing and operational expenses, Medicare was left with no choice but to increase the premium cost of this plan. Basically, the differences between the use of the traditional Medicare and private plan indirectly promote discrimination between the two types of beneficiaries, there is a need to narrow down the ‘ fairness gap’ to avoid injustice towards the low-income beneficiaries.

References

Centers for Medicare & Medicaid Services. (2008, July). Retrieved September 10, 2008, from Marketing Rules for MedicarePrivate Fee-for-Service Plans: http://www.medicare.gov/Publications/Pubs/pdf/11327.pdf

MSN Encarta(R). (2008). Retrieved September 10, 2008, from Where Your Tax Dollar Goes: http://ca.encarta.msn.com/guide_incometaxguide/where_does_your_tax_dollar_go.html

Park, E. (2007, August 8). Center on Budget and Policy Priorities. Retrieved September 10, 2008, from Journal Summary Review: House Health Legislation would Curb Medicare Overpayments to Private Plans while Aiding Medicare Beneficiaries Overall: http://www.cbpp.org/7-25-07health2.htm

Social Security Online. (2008, May). Retrieved September 10, 2008, from Medicare: http://www.socialsecurity.gov/pubs/10043.html#part2

The New York Times. (2007, December 26). Retrieved September 10, 2008, from Medicare Private Plan Abuses: http://www.nytimes.com/2007/12/26/opinion/26wed3.html?_r=1&ref=opinion&oref=slogin

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