Text 2: Medicaid and Medicare

Although most families have some form of private health insurance, some citizens cannot afford such insurance. These people receive medical coverage through two major social programs enacted in 1965.

Medicaid is a joint federal-state program which funds medical care for the poor people. The requirements for receiving Medicaid, and the scope of the medical care available, vary widely from state to state. Medicaid has proved more costly than expected, and has been exploited for unjustified gain by some physicians. As a result, the government has decreased Medicaid services by making the requirements for those entitled to participate in the program more strict. Nonetheless, Medicaid has greatly increased the use of health care services by the poor.

Medicare is a federal program financed through the Social Security Administration, which provides a national system of retirement and other benefits. Medicare pays a substantial part of the medical bills of Americans who are over 65 years or are disabled. Medicare is not a poverty program, but is rather a form of federally administered and supported health insurance. One part of Medicare covers a major portion of hospital bills for the elderly and is financed by a portion of the Social Security tax. Another part is financed by premiums paid by Medicare recipients, as well as from direct federal funds. Everyone who collects Social Security is covered by Medicare.

As is the case with the rest of the health care system in the United States, Medicare has felt the pressure of rising costs. In response, the government has taken two steps, First, Medicare has raised the amount of the deductible that patient must pay before insurance benefits begin. Second, it has changed its method of paying hospitals. Instead of paying hospitals through a vague formula called "reasonable charges", Medicare now pays according to the patient's diagnosis. This provides an incentive for the hospital to keep costs down. If, for example, the hospital can treat a patient who needs gall bladder surgery for less than Medicare pays to treat such an illness, the hospital makes a profit. If the patient's treatment costs more than Medicare pays, the hospital loses money.

In addition to controlling costs, the United States confronts the problem of those who cannot afford private health insurance and yet are not eligible for either Medicaid or Medicare. One estimate is that more than 30 million people or 1 in 7 Americans have no health insurance during at least part of the year. These may be individuals who are unemployed for a time, families close to the poverty line or those living in remote rural areas. Such individuals can go to public hospitals, where they can always receive treatment in an emergency, but they often fail to obtain routine medical care that could prevent later chronic or serious illness.

Дата добавления: 2015-11-16