Health Care for Seniors (Geocities Rescue)
A large portion of the looming budget crisis is the health care of seniors. While recent budgetary projections show a delay in the day of reckoning, crisis still looms in both the Medicare and Medicaid programs in the out years.
Budgetary balance in this area has been sought through the cutting of cost, with no action on the revenue side. In response, HMO providers have been leaving the Medicare program, which is an indication that the limits of cost-reduction have been achieved, if not exceeded. This has caused hospitals to cut costs in ways that do not serve patients well, especially in the area of nursing care. Nurses know when they are over-worked and under-paid, and when they are they leave the profession. The situation has grown so bad that the recent Medicare Prescription Drug Bill included massive payments to HMOs and to rural hospitals to redress the balance. It is hoped that this will end the nursing shortage, as hospitals expand their nursing staffs so that the workload is no longer crushing. While correcting the spending side was essential, doing so without addressing revenue merely worsens the budgetary problem our children face.
Recent Medicaid initiatives have focused on coverage for uninsured children, with proposals to cover entire families. While this approach has merit in dealing with the problem of poor families, it ignores the senior health care side, which is the major cause of program growth.
Medicare Part E
To better address Medicaid for indigent seniors, it is recommended that these costs be segregated into a separate program, designated as Medicare Part E. This allows policy makers to give this facet of the program the attention that it deserves and consider it in concert with the remainder of Medicare, including the new drug benefit. One way to more cheaply provide such a benefit is the use of medical lines of credit, which are discussed in the next essay. Undertake both the current program and the new benefit on a state-by-state basis, allowing for the creation of state-wide purchasing pools for program recipients and for the targeting of extra resources to states with larger elderly populations. This also allows separate reforms for the remainder of the Medicaid program and lowers the cost base of any purchasing pool created to provide services to the poor and uninsured.
Funding Levels
There remains the problem of overall fund balance. Segregation of senior Medicaid, more than ever, points to the need for increased funds. Seniors, their families and providers have so far born the entire cost of programmatic savings. A more honest approach is to increase the Medicare withholding tax and channeling some portion of it to Medicare Part E. Such an approach also serves the cause of equity. Currently, some childless seniors are in danger of being driven back into poverty by further cuts and premium increases. The children of seniors, who in many cases are seniors themselves, also bear the brunt of cost cutting measures. As previously stated, providers are leaving the senior health care system, reducing the quality and quantity of available care. Additionally, taxpayers whose parents have already passed gain an unearned benefit from further cuts. Clearly the most equitable solution to fund the existing Medicare program, prescription drug coverage and senior Medicaid is an increase in the Medicare Withholding Tax phased in over a period of years, or if strurctural tax reforms proposed in later essays are enacted, absorbing the additional revenue requirements in a higher Business Income Tax rate.
Long Term Care
Long term care a major component of health care for the aged, as well as for the victims of catastrophic accidents or disease. Address these costs separately through a Federally guaranteed Line of Credit of up to $5 million. Set asset exposure at 90% for individuals and 45% for families (with the federal government covering any defaulted amounts above asset exposure). This allows people to afford the care that they need.
Single-Payer Option
Smaller states and the District of Columbia often lack enough insurers to ensure competitive pricing of health care services for both seniors and the poor. A single-payer option is possible for these states. When this option is taken, include cost control measures, such as deductibles, co-payments, medical lines of credit, and medical savings accounts.
Budgetary balance in this area has been sought through the cutting of cost, with no action on the revenue side. In response, HMO providers have been leaving the Medicare program, which is an indication that the limits of cost-reduction have been achieved, if not exceeded. This has caused hospitals to cut costs in ways that do not serve patients well, especially in the area of nursing care. Nurses know when they are over-worked and under-paid, and when they are they leave the profession. The situation has grown so bad that the recent Medicare Prescription Drug Bill included massive payments to HMOs and to rural hospitals to redress the balance. It is hoped that this will end the nursing shortage, as hospitals expand their nursing staffs so that the workload is no longer crushing. While correcting the spending side was essential, doing so without addressing revenue merely worsens the budgetary problem our children face.
Recent Medicaid initiatives have focused on coverage for uninsured children, with proposals to cover entire families. While this approach has merit in dealing with the problem of poor families, it ignores the senior health care side, which is the major cause of program growth.
Medicare Part E
To better address Medicaid for indigent seniors, it is recommended that these costs be segregated into a separate program, designated as Medicare Part E. This allows policy makers to give this facet of the program the attention that it deserves and consider it in concert with the remainder of Medicare, including the new drug benefit. One way to more cheaply provide such a benefit is the use of medical lines of credit, which are discussed in the next essay. Undertake both the current program and the new benefit on a state-by-state basis, allowing for the creation of state-wide purchasing pools for program recipients and for the targeting of extra resources to states with larger elderly populations. This also allows separate reforms for the remainder of the Medicaid program and lowers the cost base of any purchasing pool created to provide services to the poor and uninsured.
Funding Levels
There remains the problem of overall fund balance. Segregation of senior Medicaid, more than ever, points to the need for increased funds. Seniors, their families and providers have so far born the entire cost of programmatic savings. A more honest approach is to increase the Medicare withholding tax and channeling some portion of it to Medicare Part E. Such an approach also serves the cause of equity. Currently, some childless seniors are in danger of being driven back into poverty by further cuts and premium increases. The children of seniors, who in many cases are seniors themselves, also bear the brunt of cost cutting measures. As previously stated, providers are leaving the senior health care system, reducing the quality and quantity of available care. Additionally, taxpayers whose parents have already passed gain an unearned benefit from further cuts. Clearly the most equitable solution to fund the existing Medicare program, prescription drug coverage and senior Medicaid is an increase in the Medicare Withholding Tax phased in over a period of years, or if strurctural tax reforms proposed in later essays are enacted, absorbing the additional revenue requirements in a higher Business Income Tax rate.
Long Term Care
Long term care a major component of health care for the aged, as well as for the victims of catastrophic accidents or disease. Address these costs separately through a Federally guaranteed Line of Credit of up to $5 million. Set asset exposure at 90% for individuals and 45% for families (with the federal government covering any defaulted amounts above asset exposure). This allows people to afford the care that they need.
Single-Payer Option
Smaller states and the District of Columbia often lack enough insurers to ensure competitive pricing of health care services for both seniors and the poor. A single-payer option is possible for these states. When this option is taken, include cost control measures, such as deductibles, co-payments, medical lines of credit, and medical savings accounts.
posted by Michael Bindner at 10:43 PM
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