Medicaid and healthcare for all Americans

Word Count: 2108 |

Medicaid is a Federal – State entitlement program that pays for medical services on behalf of certain groups of low-income persons. Title XIX of the Social Security Act provides for the medical assistance commonly known as Medicaid. (O’Sullivan, 1990) This means-tested entitlement program became part of federal law in 1965. Medicaid makes direct payments to medical providers for their services to eligible persons. It is the largest health program providing medical assistance to the poor.

Eligibility

In order for one to be eligible for Medicaid, one must meet very strict requirements. These requirements vary from state to state therefore the Federal requirements will be discussed as well as the general state requirements. The correlation between those receiving public assistance and those receiving Medicaid seems to be directly related. “Medicaid has generally been linked to actual or potential receipt of cash assistance under a welfare program. Thus, eligible individuals have to meet the welfare definitions of age, blindness, disability, or membership in a family with dependent children where one parent is absent or incapacitated.” (O’Sullivan, 1990) These stringent requirements leave out part of the population such as singles, childless couples who are not elderly or disabled.

Besides falling into one of the above mentioned categories, they must also meet specified income and resource criteria which vary by State. “While the link to cash assistance has been the primary way to establish eligibility, states have been able to extend coverage to children who meet the income and resources requirements, but do not meet the definition of dependency.” (O’Sullivan 1990).

The other group that is affected by this institutional policy are the providers. Providers can be defined as those who perform services for the Medicaid patients. They include, but are not limited to physicians, hospital, dentists, pharmacies etc. “Low medical fee schedules, relative to physicians’ usual charges to other payers, are a major deterrent to participation.” (O’Sullivan 1990) Recent data suggests that the gap continues to widen between Medicaid and private rates. Virtually all hospitals participate in Medicaid. However, a Medicaid patient will more than likely be transferred to a public hospital for in-patient treatment.

II. CRITICAL CONTEXT

Social Impact

It is merely impossible to try to obtain an actual number of people affected by Medicaid. If the picture was painted with a broad brush you could say that virtually every person in the United States is affected by Medicaid. For example any person who pays taxes is affected, any doctor who accepts Medicaid is directly affected by the low fee schedule that is put into place. Any person receiving public assistance is affected as well. The amount of people who are currently receiving Medicaid will be broken down: 6.2 million or 24.9 percent adults in families with dependent children, 10.4 million or 41.8 percent dependent children, 3.5 million or 14.1 percent aged, .4 million or 13.7 percent disabled or blind, 1.4 million or 5. 6 percent fall into the category of others. (O’Sullivan 1990) The total amount of people on Medicaid is 24.9 million. It’s obvious that practically everyone is affected by this program.

Problems With the System

The Medicaid program was one of many programs designed to help the poor and disadvantaged enjoy the benefits of receiving the type of medical care provided to those who could afford it. According to Karen Davis, author of Achievements and Problems of Medicaid, from its initiation the Medicaid program has had two major objectives: insuring that covered persons receive adequate medical care and reducing the financial burden of medical expenditures for those with severely limited financial resources. Before the introduction of Medicaid most poor persons had little or no private insurance and many went without needed care. Medicaid attempted to alleviate this situation – if not for all poor persons, at least for those on welfare and the medically needy. (Davis, 1996)

A Lack Of Equality

Perhaps the greatest flaw in the Medicaid program is that it does not treat people in equal circumstances equally. Davis goes on to say that the inequitable distribution of Medicaid benefits is caused in part by the joint Federal – State nature of the program and its tie to the Welfare system. As stated previously the Medicaid eligibility is linked to the Welfare system. Therefore Medicaid is working within the complexity of the Welfare system, which, as we all can understand, is virtually impossible to work in conjunction with, due to its own inconsistencies. It is safe to assume that there is a complex set of restrictions that not all low-income persons are not eligible for Medicaid assistance. Given all the holes through which needy family can fall through trying to obtain assistance to meet their medical care costs, it is not surprising that a large number of poor people are not covered by Medicaid.

The Medicaid program has had a major impact on the health care of the poor. Davis feels that “It’s many achievements have gone unheralded and largely unappreciated obscured by an all consuming concern with its unanticipated high cost. Reform is clearly needed.” (Davis, 1996)

The area of reform that will be discussed is the exclusion from the Medicaid program of many poor persons. “The category with restrictions on eligibility, the varying tests for income and assets, and State administrative actions to curtail costs by restricting eligibility have served to exclude many poor persons from the program., Estimates indicate that at any given time from one third to as many as one half below the poverty level does not receive Medicaid benefits.” (Davis, 1996) These poor persons continue to lag behind the rest of the poor in access to health care. It is clear that Medicaid has not achieved its goal of bringing the poor into mainstream medicine and provided them with treatment by the same type of physicians, hospitals and other health facilities as other Americans. In fact it seems as though Medicaid has gone out of its way to discourage many physicians from participating Medicaid accomplished this by low rates of reimbursement for service, tremendous
amounts of paperwork, etc.

There are two theories that would help alleviate many of Medicaid’s short comings. The first one is “Providing Federalization of the Medicaid program with uniform coverage of all the poor and comprehensive benefits.” The second theory is one that is a well known theory these days – “Integrating the financing of health care for the poor into the financing of health services for all Americans through national health insurance.” (Davis, 1996)

The Efficiency of the Medicaid System

The Medicaid policy is not very efficient. This is true for several reasons: Medicaid is regulated by both the Federal and the State government. This in itself should say it all, but for clarification it will be discussed. When Medicaid was first developed most moneys came from the federal budget and there was no limit on what was spent. There were no checks and balances placed in the system. Essentially the state ran the program and took the money from the federal government. The federal government began to limit the astronomical amounts of money spent, so naturally the states were forced to crack down on what money was spent and where it was spent. This takes the Medicaid policy into the realm of eligibility. State governments proceeded to make up there own eligibility requirements. At this point Medicaid progressively became less and less efficient. When all the states have different eligibility requirements and the money funded federally, who puts the checks and !

balances into place? The amount of communication that would have to take place for this policy to run effectively, not even efficiently, would be impossible. It is clear that when the policy makers were planning this institutional policy they clearly were not trouble shooting. In order for this policy to become efficient there needs to be many incremental changes to help repair the present inefficiency. I believe that the way Medicaid will become most efficient is by getting rid of both the Federal and the State’s involvement. It should be either one or the other, not both. It is like the old cliché “To many chefs in kitchen spoil the soup.” (Wolfe, 1993)

The optimality of this policy can be looked at from the several different angles. Every policy does have it’s winners and it’s losers. The winners are definitely those who get to experience the benefits of Medicaid. Those persons who are in fact eligible to receive Medicaid benefit for the obvious reason – they receive health benefits for free. Granted it may not be the top of the line service, but for all intents and purposes they do receive more than many. The losers of this policy clearly are those who do not qualify for Medicaid, but can not afford any form of health care services. Due to the inconsistencies of the eligibility requirements, it makes that harder for those who are in severe need of assistance, but can not seem to be able to crack the system and its bizarre eligibility requirements. Over the past years Medicaid has realized that they do need to do something about there policy to improve its optimality.

Omnibus Budget Reconciliation Act

“In the 1981 Omnibus Budget Reconciliation Act OBRA, Congress mandated what are perhaps the most substantial changes in the Medicaid program since its’ inception in 1965. Aimed at curbing what had previously been uninterrupted and rapid growth in Medicaid costs, the Medicaid provisions of OBRA set new limits on eligibility for the program, reduced the federal share of program costs, and increased the flexibility of the states for managing the program. To provide the ability of the states to finance their share of program costs, and increased the flexibility of the states from managing the program. At the same time, the ability of the states to finance their share of Medicaid costs was constrained by a severe recession and continuing high inflation rates. The outcome of all these phenomena was the first reduction in real spending for Medicaid in the history of the program.” (Wolfe, 1993)

III. INTEGRATIVE CONCLUSION

A Time For Solutions

It seems as though when Medicaid was being developed they did not adequately look at the whole picture. The idea of synthesis was not even considered. Now that Medicaid is costing Americans an astronomical amount of money, people are starting to look at different options. Now they are looking to synthesize the policy. Here are some examples of possible options to help reform Medicaid. Some would like to see the whole policy scraped. “Maintaining the present Medicaid program, with State governments continuing to exercise their current authority to expand or restrict eligibility, benefits, patient charges, and provider reimbursement.” (Cutler, 1995) These are other possible solutions:

• Giving the State governments even broader authority to use Medicaid funds for health services for the poor.

• Providing for tighter cost control through federal actions.

• Providing for Federalization of the Medicaid program with uniform coverage of all the poor and comprehensive benefits.

• Integrating the financing of health care for the poor into the financing of health services for all Americans through national health insurance.

• Reassessing the current financing services delivery mix of health care programs and using financing mechanisms to promote the development of health services delivery.

Debate on these alternative future directions for the healthcare of the poor should be a key focus in the period ahead. By recognizing the strengths and weaknesses of our current programs, we can build new ones on the past and continue our progress toward the goal of health care for all Americans.

REFERENCES

O’Sullivan, Carol. Poverty San Diego, Ca: Greenhaven Press, 1990.

Davis, Karen. Incremental coverage of the uninsured. V276, n10, p831(2) The Journal of the American Medical Association, Sept 11 1996

Wolfe, John R. The coming health crisis. Chicago Press, 1993.

Cutler, David M. The effect of Medicaid expansions. American Review, 1995

Tenison, James. The Medicaid Dilemma. Washington: Brookings Institution, 1995

You May Also Find These Documents Helpful

Allegory Of American Pie By Don Mc Lean

Ask anyone what was the defining moment in the rock history of the 1960s was and all you will get is a one word answer: Woodstock. The three day rock festival that defined an era was only one of many music festivals of the '60s. But Woodstock has come to symbolize, "an era of peaceful, free- loving, drug- taking hippie youth, carefree before harsher realities hit..." (Layman 40). The Woodstock festival ended a century filled with many metamorphoses of rock'n'roll, from the era of pop music to the rebirth of folk music to the invention of acid rock. But some cynics say that rock'n'roll died with the death of Buddy Holly before the 60s even began. One such person is Don McLean. The poet behind the haunting epic song about the death of 'danceable' music, McLean wrote the ever popular song, "American Pie" (appendix 1). The most important song in rock'n'roll history, "American Pie", is the song about the demise of rock'n'roll after Buddy Holly's death and the heathenism of rock that resulted. Although McLean himself won't reveal any symbolism in his songs, "American Pie" is one of the most analyzed pieces of literature in modern society. Although not all of its secrets have been revealed, many "scholars" of the sixties will agree that the mystery of this song is one of the reasons it has become so successful- everyone wants to know the meanings of its allegories. Proof of "American Pie's" truth lies in the allegory of the song. Many People enjoy the song but have no idea what it means- Who is the Jester? What is the levee? When the deeper story is found, the importance of the song is unearthed. "American Pie" is not only a song, it is an epic poem about the course of rock'n'roll...

Carl Orffs Philosophies In Music Education

While Carl Orff is a very seminal composer of the 20th century, his greatest success and influence has been in the field of Music Education. Born on July 10th in Munich, Germany in 1895, Orff refused to speak about his past almost as if he were ashamed of it. What we do know, however, is that Orff came from a Bavarian family who was very active in the German military. His father's regiment band would often play through some of the young Orff's first attempts at composing. Although Orff was adamant about the secrecy of his past, Moser's Musik Lexicon says that he studied in the Munich Academy of Music until 1914. Orff then served in the military in the first world war. After the war, he held various positions in the Mannheim and Darmstadt opera houses then returned home to Munich to further study music. In 1925, and for the rest of his life, Orff was the head of a department and co-founder of the Guenther School for gymnastics, music, and dance in Munich where he worked with musical beginners. This is where he developed his Music Education theories. In 1937, Orff's Carmina Burana premiered in Frankfurt, Germany. Needless to say, it was a great success. With the success of Carmina Burana, Orff orphaned all of his previous works except for Catulli Carmina and the En trata which were rewritten to be acceptable by Orff. One of Orff's most admired composers was Monteverdi. In fact, much of Orff's work was based on ancient material. Orff said: I am often asked why I nearly always select old material, fairy tales and legends for my stage works. I do not look upon them as old, but rather as valid material. The time element disappears, and only the spiritual power remains. My...

Johann Sebastian Bach Biography

Throughout the history of music, many great composers, theorists, and instrumentalists have left indelible marks and influences that people today look back on to admire and aspire to. No exception to this idiom is Johann Sebastian Bach, whose impact on music was unforgettable to say the least. People today look back to his writings and works to both learn and admire. He truly can be considered a music history great. Bach, who came from a family of over 53 musicians, was nothing short of a virtuosic instrumentalist as well as a masterful composer. Born in Eisenach, Germany, on March 21, 1685, he was the son of a masterful violinist, Johann Ambrosius Bach, who taught his son the basic skills for string playing. Along with this string playing, Bach began to play the organ which is the instrument he would later on be noted for in history. His instruction on the organ came from the player at Eisenach's most important church. He instructed the young boy rather rigorously until his skills surpassed anyone?s expectations for someone of such a young age. Bach suffered early trauma when his parents died in 1695. He went to go live with his older brother, Johann Christoph, who also was a professional organist at Ohrdruf. He continued his younger brother's education on that instrument, as well as introducing him to the harpsichord. The rigorous training on these instruments combined with Bach?s masterful skill paid off for him at an early age. After several years of studying with his older brother, he received a scholarship to study in Luneberg, Germany, which is located on the northern tip of the country. As a result, he left his brother?s tutelage and went to go and study there. The teenage years brought Bach to several parts of Germany where he...

Michelangelo

Michelangelo was pessimistic in his poetry and an optimist in his artwork. Michelangelo?s artwork consisted of paintings and sculptures that showed humanity in it?s natural state. Michelangelo?s poetry was pessimistic in his response to Strazzi even though he was complementing him. Michelangelo?s sculpture brought out his optimism. Michelangelo was optimistic in completing The Tomb of Pope Julius II and persevered through it?s many revisions trying to complete his vision. Sculpture was Michelangelo?s main goal and the love of his life. Since his art portrayed both optimism and pessimism, Michelangelo was in touch with his positive and negative sides, showing that he had a great and stable personality. Michelangelo?s artwork consisted of paintings and sculptures that showed humanity in it?s natural state. Michelangelo Buonarroti was called to Rome in 1505 by Pope Julius II to create for him a monumental tomb. We have no clear sense of what the tomb was to look like, since over the years it went through at least five conceptual revisions. The tomb was to have three levels; the bottom level was to have sculpted figures representing Victory and bond slaves. The second level was to have statues of Moses and Saint Paul as well as symbolic figures of the active and contemplative life- representative of the human striving for, and reception of, knowledge. The third level, it is assumed, was to have an effigy of the deceased pope. The tomb of Pope Julius II was never finished. What was finished of the tomb represents a twenty-year span of frustrating delays and revised schemes. Michelangelo had hardly begun work on the pope?s tomb when Julius commanded him to fresco the ceiling of the Sistine Chapel to complete the work done in the previous century under Sixtus IV. The overall organization consists of four large triangles at...

Oscar Wilde

Oscar Fingal O'Flahertie Wills Wilde was born in Dublin Ireland on October 16, 1854. He is one of the most talented and most controversial writers of his time. He was well known for his wit, flamboyance, and creative genius and with his little dramatic training showing his natural talent for stage and theatre. He is termed a martyr by some and may be the first true self-publicist and was known for his style of dress and odd behavior. Wilde, 1882 His Father, William Wilde, was a highly accredited doctor and his mother, Jane Francesca Elgee, was a writer of revolutionary poems. Oscar had a brother William Charles Kingsbury along with his father's three illegitimate children, Henry, Emily, and Mary. His sister, Isola Emily Francesca died in 1867 at only ten years of age from a sudden fever, greatly affecting Oscar and his family. He kept a lock of her hair in an envelope and later wrote the poem 'Requiescat' in her memory. Oscar and his brother William both attended the Protora Royal School at Enniskillen. He had little in common with the other children. He disliked games and took more interest in flowers and sunsets. He was extremely passionate about anything that had to do with ancient Greece and with Classics. Wilde during school years In 1871, he was awarded a Royal School Scholarship to Trinity College in Dublin and received many awards and earned the highest honor the college offered to an undergraduate, the Foundation Scholarship. In 1874, he also won the College's Berkley Gold Medal for Greek and was awarded a Demyship to Magdalen College, Oxford. After graduating from Oxford, Oscar moved to London with his friend Frank Miles, a well-known portrait painter of the time. In 1878 his poem Ravenna was published, for which he won the...

The History Of Greek Theater

Theater and drama in Ancient Greece took form in about 5th century BCE, with the Sopocles, the great writer of tragedy. In his plays and those of the same genre, heroes and the ideals of life were depicted and glorified. It was believed that man should live for honor and fame, his action was courageous and glorious and his life would climax in a great and noble death. Originally, the hero's recognition was created by selfish behaviors and little thought of service to others. As the Greeks grew toward city-states and colonization, it became the destiny and ambition of the hero to gain honor by serving his city. The second major characteristic of the early Greek world was the supernatural. The two worlds were not separate, as the gods lived in the same world as the men, and they interfered in the men's lives as they chose to. It was the gods who sent suffering and evil to men. In the plays of Sophocles, the gods brought about the hero's downfall because of a tragic flaw in the character of the hero. In Greek tragedy, suffering brought knowledge of worldly matters and of the individual. Aristotle attempted to explain how an audience could observe tragic events and still have a pleasurable experience. Aristotle, by searching the works of writers of Greek tragedy, Aeschulus, Euripides and Sophocles (whose Oedipus Rex he considered the finest of all Greek tragedies), arrived at his definition of tragedy. This explanation has a profound influence for more than twenty centuries on those writing tragedies, most significantly Shakespeare. Aristotle's analysis of tragedy began with a description of the effect such a work had on the audience as a "catharsis" or purging of the emotions. He decided that catharsis was the purging of two specific emotions, pity and...

Scholarship Essay About Goals

Ever since I was a young kid I have always been interested with aircraft. I was so curious of how airplane's fly. I remember taking my toys apart to see how it works. As a kid I wanted to go to the airport to watch the airplanes land and fly and pondered how this happens. Other kids wanted to go to the amusement places. As I grew older I became more and more interested in aircraft and the technology behind it. I always involved myself with aviation early on. I read books and magazines on aviation, took museum tours, built model airplanes. When I was younger my father would take me to aircraft repair facilities where I would watch in great fascination. In my teens, went up to the military bases and befriended many soldiers involved with aircraft and asked them numerous questions. I got to meet many aeronautics engineers and borrowed their old textbooks and read them till the wee hours of the morning. As technology improved with information superhighway, I logged on the web. Stayed up for hours and hours searching through web pages and web pages of information about aircraft and technology. I started my elementary school in the Philippines, then we moved to U.S. and continued my high school education and graduated. Enrolled at the CCSF to pursue my college education and now I am in the 2nd year in CCSF taking aeronautics. My goal now is to obtain my AS degree from the City College of San Francisco (CCSF) so I can transfer to a University and get a Bachelors degree and to continue for my Masters degree in Aeronautics Engineering. I will strive hard to reach the peak level of my career which is a Professor and hopefully to be an aeronautic professor so...

Circus Circus Enterprises Case Studies

Executive Summary: Circus Circus Enterprises is a leader and will continue to be in the gaming industry. In recent years, they have seen a decline in profit and revenue; management tends to blame the decrease on continuing disruptions from remodeling, expansion, and increased competition. Consequently, Circus has reported decreases in its net income for 1997 and 1998 and management believes this trend will continue as competition heightens. Currently the company is involved in several joint ventures, its brand of casino entertainment has traditionally catered to the low rollers and family vacationers through its theme park. Circus should continue to expand its existing operations into new market segments. This shift will allow them to attract the up scale gambler. Overview Circus Circus Enterprises, Inc founded in 1974 is in the business of entertainment, with its core strength in casino gambling. The company?s asset base, operating cash flow, profit margin, multiple markets and customers, rank it as one of the gaming industry leaders. Partners William G. Bennett an aggressive cost cutter and William N. Pennington purchased Circus Circus in 1974 as a small and unprofitable casino. It went public in 1983, from 1993 to 1997; the average return on capital invested was 16.5%. Circus Circus operates several properties in Las Vegas, Reno, Laughlin, and one in Mississippi, as well as 50% ownership in three other casinos and a theme park. On January 31,1998 Circus reported net income of 89.9 million and revenues of 1.35 billion, this is a down from 100 million on 1.3 billion in 1997. Management sees this decline in revenue due to the rapid and extensive expansion and the increased competition that Circus is facing. Well established in the casino gaming industry the corporation has its focus in the entertainment business and has particularly a popular theme resort concept....

Effect Of Civil War On American Economy

The Economies of the North and South, 1861-1865 In 1861, a great war in American history began. It was a civil war between the north and south that was by no means civil. This war would have great repercussions upon the economy of this country and the states within it. The American Civil War began with secession, creating a divided union of sorts, and sparked an incredibly cataclysmic four years. Although the actual war began with secession, this was not the only driving force. The economy of the Southern states, the Confederacy, greatly if not entirely depended on the institution of slavery. The Confederacy was heavily reliant on agriculture, and they used the profits made from the sale of such raw materials to purchase finished goods to use and enjoy. Their major export was cotton, which thrived on the warm river deltas and could easily be shipped to major ocean ports from towns on the Mississippi and numerous river cities. Slavery was a key part of this, as slaves were the ones who harvested and planted the cotton. Being such an enormous unpaid work force, the profits made were extraordinarily high and the price for the unfinished goods drastically low in comparison; especially since he invention of the cotton gin in 1793 which made the work all that much easier and quicker. In contrast, the economical structure of the Northern states, the Union, was vastly dependent on industry. Slavery did not exist in most of the Union, as there was no demand for it due to the type of industrial development taking place. As the Union had a paid work force, the profits made were lower and the cost of the finished manufactured item higher. In turn, the Union used the profits and purchased raw materials to use. This cycle...

Evaluation Of The Effectiveness Of Trade Embargoes

Although I am a strong critic of the use and effectiveness of economic sanctions, such as trade embargoes, for the sake of this assignment, I will present both their theoretical advantages and their disadvantages based upon my research. Trade embargoes and blockades have traditionally been used to entice nations to alter their behavior or to punish them for certain behavior. The intentions behind these policies are generally noble, at least on the surface. However, these policies can have side effects. For example, FDR's blockade of raw materials against the Japanese in Manchuria in the 1930s arguably led to the bombing of Pearl Harbor, which resulted in U.S. involvement in World War II. The decades-long embargo against Cuba not only did not lead to the topple of the communist regime there, but may have strengthened Castro's hold on the island and has created animosity toward the United States in Latin America and much suffering by the people of Cuba. Various studies have concluded that embargoes and other economic sanctions generally have not been effective from a utilitarian or policy perspective, yet these policies continue. Evaluation of the effectiveness of Trade Embargoes Strengths Trade embargoes and other sanctions can give the sender government the appearance of taking strong measures in response to a given situation without resorting to violence. Sanctions can be imposed in conjunction with other measures to achieve conflict prevention and mitigation goals. Sanctions may be ineffective: goals may be too elusive, the means too gentle, or cooperation from other countries insufficient. It is usually difficult to determine whether embargoes were an effective deterrent against future misdeeds: embargoes may contribute to a successful outcome, but can rarely achieve ambitious objectives alone. Some regimes are highly resistant to external pressures to reform. At the same time, trade sanctions may narrow the...