Friday, June 13, 2008

Medicare - America’s Single Payer Healthcare System

Medicare is the single payer system for the approximately 44 million eligible citizens who are 65 years and older. Passed by Congress and signed into law by President Lyndon Johnson in July 1965, it is now in deep financial trouble. This is despite its low administrative overhead which is the proposed great advantage of a single payer system. The lesson to be learned by this experience is that low overhead alone does not guarantee adequate funding if the fundamental flaws in the health care system are not addressed.

There are two fundamental flaws perpetuated by Medicare that have so far escaped correction - the under funding of primary care and the lack of a system to prevent inappropriate care.

1) Since its inception Medicare has under-funded primary care, which has led to the continuous and progressive decline of this specialty. Starting in 1965 Medicare paid what were then the usual and customary fees for physician services. This payment formula emphasized technology and procedures while underpaying primary care. An attempt was made to correct this imbalance by instituting the Resource Based Value System in 1992. This process has also failed to adequately reimburse primary care. The result has been the continued decline of the number of physicians practicing this specialty along with shortened visits and decreased in-hospital follow up. The shortage of primary care physicians has also led to inadequate preventative care for our population. Many authors have stated that if universal coverage would somehow appear tomorrow, with the deplorable state of primary care which is the infrastructure of any nation’s medical system, the health of the nation would not improve. See my posting about the “bank”. We must correct the inadequate reimbursement for primary care.

2) There is no oversight to prevent non-beneficial care. Such unnecessary care consumes approximately one third of Medicare’s budget which translated to our entire medical system equals six hundred billion dollars yearly! See my previous posting on why we need Appropriate Care Committees.

1 comment:

chandra said...

I see there are no comments for this post. its very true indeed. anyways i was surprised to know this facts. Its already 2011 and things have changed a lot. thanks for sharing this with me!

medicare America