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 # 347  

 July 2001




Medicare: An Alphabet Soup of Programs Lacking Proper Nutrition For Patients

by David Ridenour

 

Most good cooks don't start with a recipe, just a goal. In 1965, President Lyndon Johnson was the chief cook for Medicare. His goal was to provide quality health care coverage to an aging U.S. population.

Unfortunately, his best intentions went astray. Medicare, financed by taxpayers and monitored by the government, has become a soup with everything but the kitchen sink in it. There are more than 130,000 pages of federal regulations and the recipe simply hasn't worked.

Congress, having the power to dictate a large federal bureaucracy, has messed up the Medicare recipe.

Let's take a look.

Created originally to cover treatments for acute illnesses, Medicare Part A covers all U.S. citizens over the age of 65, but only for costs incurred during overnight hospital stays.

Congress, however, quickly discovered that most senior citizens and disabled Americans required treatment and long-term care outside of hospital walls. Adding to the recipe, the federal government established Medicare Part B to help pay for medical equipment and doctor services.

Congress believed that Medicare Parts A and B would meet the health care needs of senior citizens. However, there was an important ingredient that did not get added - prescription drug coverage.

Medicare dependents are now left with only half a menu. As seniors are able to live longer, healthier lives often with the assistance of new medicinal therapies and technical medical advances, these costs are not covered.

So this is what Americans over 65 and the disabled are left with - a watered-down alphabet soup. Consider a few of Medicare's more obvious shortcomings:

* Medicare Part A covers in-hospital stays, their length determined by Congress, not the doctor.

* Medicare Part B covers medical equipment and doctor visits, but not prescriptions, even if they could avoid the need for an expensive hospital stay.

* Medigap Plan A, B, C, D, E, F, G, H, I or J covers prescriptions, but wait...

* Medigap does not apply in Minnesota, Wisconsin or Massachusetts, where the rules are different.

But there's still one more step in the recipe: you must have enrolled in Medigap between January and March or wait another nine months to join with a possible premium increase, and you still have little or no coverage for home, dental, preventative and vision care.

This is not only confusing for Medicare recipients but doctors as well, who are responsible for following the recipe.

According to a recent American Medical Association study, 30% of physicians spend 20 hours or more completing Medicare forms each week. Frustrated by the federal system, almost 52% of the doctors surveyed by the American Medical Association say they are less willing to examine Medicare patients as a result.

More than 39 million Americans depend on some form of Medicare. The number will only increase in the coming years, when the 77 million baby boomers are expected to retire.

How can we continue to follow this complex and confusing recipe that fails to provide senior citizens with what they need?

While some in Congress are cooking up more ways to complicate the recipe, there is a proposal to simplify and deliver health care benefits to those who need them most.

A bipartisan approach, such as that proposed by the recent bipartisan Medicare reform commission chaired by Senators John Breaux (D-LA) and Bill Frist (R-TN), would strengthen and improve Medicare. The Bush plan, which includes plenty of bipartisan seasoning from Senator Breaux and others - is just that. The plan would simplify the Medicare recipe and deliver more and better health care as a result.

For the common good, Congress should move quickly to deliver true Medicare reform to a hungry health care public.

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David Ridenour is vice president of The National Center for Public Policy Research, a Washington, D.C. think tank. Comments may be sent to [email protected].



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