Medicare

As Chapter 11 in your textbook notes, the costs for health care have risen dramatically and are expected to continue to rise. While Medicare is a public insurance program that provides coverage to almost everyone who is 65 and older, it only covers a portion of health care expenses. In fact, the authors of your textbook note that “if current trends continue, by 2030 half of those aged 65 and older will spend more than 25% of their income on medical bills and insurance premiums” (Markson & Stein, 2012).

After reading Chapter 11 in your textbook and watching Aging America and Healthcare Reform, please address each of the following:

Compare and contrast the services provided to older individuals under Medicare Part A and Medicare Part B.
Compare and contrast the health care services provided under Medicare versus Medicaid. Be sure to address how each program is funded, what they cover, who qualifies for them, and what role each plays in paying for health care of the elderly population.
Discuss the current funding for Medicare and why there is debate regarding the program.
What changes (if any) do you think that there will be in the Medicare program over the next 20 years?
Do you believe that the eligibility requirements should be changed in order to receive the health services provided by Medicare? Why or why not?

Rising Costs of Health Care
A third economic challenge is the rising cost of health care. Medical care costs in 2008 accounted for about 16% of the GDP of the United States (Henry J. Kaiser Family Foundation, 2012). Taken as a group, those aged 65 and older—about 13% of all Americans—account for about 36% of total national health expenditures—more than 4 times the amount spent on younger people. This reflects not only the greater prevalence of chronic disease and longer hospital stays among older people but also the high cost of multiple illnesses that typically afflict a small segment of the population during the last part of their lives. As you recall from previous chapters, Medicare only covers a portion of elders’ health care costs. Even with Medicare, out-of-pocket health care costs are likely to rise. If current trends continue, by 2030 half of those aged 65 and older will spend more than 25% of their income on medical bills and insurance premiums.
A woman argues with another woman in a wheelchair who carries a sign that reads, “Moving forward. Protecting our care.”
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Medicare covers only a portion of elders’ health care expenditures. Americans are divided about what Medicare should cover and how it should be funded.
The aging population is not alone in bearing responsibility for skyrocketing health care costs, however; increased spending on prescription drugs and new medical technology also raise costs. Modern health care is defined by information processing systems, diagnostic devices, and new modes of high-tech therapy, all of which cost money. For example, the computed tomography (CT) scanner, a diagnostic device that combines X-ray equipment with a computer and a cathode ray tube to produce images of cross-sections of the body, allows physicians greater diagnostic and treatment precision. Technology and pharmaceuticals generate demand for more costly (but not necessarily cost-effective) services, which changes the shape of medicine and the profit structure in health care (Moody, 2010). Technological changes that can improve the quality of life for people of all ages, especially older people, are summarized in the “Future Medical Technology” box. Lifesaving technology is, of course, not cheap; how to pay for these technological advances in an equitable and affordable way remains unclear.
The Challenge of Long-Term Care
Long-term care poses another economic challenge. About 1 in 8 people aged 65 and older has a disability and needs help with basic personal care or household tasks (National Center for Health Statistics, 2011a, Table 54). In addition, an estimated two thirds of Americans are likely to need long-term care at some point in their lives, whether at home or in a nursing facility (Greenhalgh-Stanley, 2012). Greater labor force participation by women coupled with smaller family sizes (Johnson & Wiener, 2006) has resulted in fewer relatives who are available to provide unpaid care. Medicare covers only a very limited portion of long-term care, however, and paid long-term care is expensive.
Long-term-care insurance generally covers services that may not be covered in general health insurance plans, such as extended or lifetime home care, assisted living, adult daycare, hospice care, and nursing home facilities. Very few Americans have purchased such insurance, however. Although 5..2 million Americans aged 65 and older need long-term care, only about 1 in 10 has long-term-care insurance (Johnson & Park, 2011; Morgan, Stein, Farrar, & Jason, 2012). Estimates indicate that elderly long-term-care spending will triple by 2040 (Laursen, 2012).

 
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