Good Example Of Health Policy Essay
Part One The Health Reform Proposal of 1993 by President Clinton and the Affordable Care Act are health reform efforts that have been conceived in the United States of America in the recent past. The two reform efforts have inherent differences and similarities. One of the differences in the two proposals is that the Obama Plan was designed to create insurance exchanges for people who are not covered, owners of small businesses and people in individual markets. Unlike the Obama plan, the Clinton Plan formed regional alliances. Another difference in the two plans is that the Obama Plan does not place a requirement on all people to join. Instead, it gives people autonomy in determining their coverage and usage. The Clinton Plan on the other hand required all people to join and not to be allowed to enroll unless they were covered in another medical plan. The two plans were similar in that their aim was to increase insurance coverage and reduce the cost of healthcare (White, 2012). One of the chief reasons why the Clinton Plan was not successful is the requirement that all employees and employers male payments into insurance pools that were run by the government. The perception was that this amounted to a form of taxation and also a significant expansion to the revenue of the federal government. Traditionally, the government has been relatively aloof in the organization and delivery of healthcare. It is for this reason that the country does not have a universal health insurance that is enjoyed by citizens of other countries with similar life expectancy (White, 2012). The organization was left to market forces. In the contemporary society, this has changed significantly, especially with the increasing desire to curtail the increasing healthcare costs. Consequently, the government has come up with parallel insurance programs that are publicly-funded. Additionally, the Affordable Care Act has exerted the government’s influence in the organization of healthcare with the creation of insurance exchanges. These, among other changes have positively affected healthcare management (White, 2012).
White, M. J. (2012). The presidency of Bill Clinton: The legacy of a new domestic and foreign policy. London: I.B. Tauris.
Part TwoSummary of the Witness Testimony From the testimony of the witnesses, several principles towards the improvement and strengthening of Medicare can be derived. The Congress should consider comprehensive Medicare modernization that is market based. This is viable mechanism for increasing access and coverage to prescription medicine. This is in order to extend the benefits of prescription drugs to all the beneficiaries of Medicare. Secondly, when considering additional benefits and reforms on the Medicare program, the Congress should guarantee the solvency and financial integrity of the Medicare program in the long term. This is important in order to prop the structural and financial systems of the program so as to whether the challenges that will crop when the baby boom generation retires, expectedly from 2013 (Bettelheim, 2003). Thirdly, the Congress should establish a sturdy foundation for the creation of an improved Medicare program. This is important in order to solve the financial crisis that is affecting health care providers and health plans. Inadequate reimbursement is a problem crippling patient care. The effect of this was an impeded progress towards the modernization of Medicare. This is especially important for the prescription drug program, where effective management tools are required to supplement the financial systems in place in order to ensure effectiveness and success in the long run. Fourthly, there was a need for improved coverage options. In their testimony, the witnesses contended that health plan competition and an increase in the choices of the consumers would achieve improved coverage options. It was their testimony that the beneficiaries of Medicare needed a variety of coverage options (Subcommittee on Health, 2003). The fifth element that can be derived from their testimony was the need for improved coordination of care through the creation of a modernized Medicare program. Such a program would also include efforts towards disease prevention, the aim of which would be to stem the increasing expenditure of health care. This is in response to realities that the traditional Medicare program does not feature benefits such as disease management, screening measures preventive care and other measures that are incorporated into plans that are vended by the private sector. The final element from the testimony of the witnesses was the need for replacing the outdated and rigid benefit structure that operated at the time with a robust and improved Medicare program that was flexible enough to allow innovations in health care to be accessible to the beneficiaries (Subcommittee on Health, 2003).Recent Legislation related to Medicare One of the most recent legislations related to Medicare is the Health Reform Law of 2010. This law provides for many changes, most of which have a positive effect on the stakeholders. For instance, one of the changes provided by the law is the bridging of the benefit coverage gap for Part D drug. Under the new changes, enrollees of Part D who have expenditures in the coverage gap will be giver a rebate of 250 dollars. Additionally, a 50% discount will be offered for brand-name drugs that are manufactured by local pharmaceuticals. Another change emanating from this legislation is the improvement in the coverage of prevention benefits (Kaiser Family Foundation, 2013). Effective after the health reform law was enacted, deductibles and coinsurance were eliminated from the traditional Medicare, especially for those preventive services which are rated A or B. Additionally, comprehensive wellness visits will be provided annually and without charge, as well as personalized prevention plans under Medicare. The new legislation is also sensitive to contemporary perspectives in health care. Recently, there have been concerns regarding the bulging budget on health care. In response to these concerns, an Independent Payment Advisory Board was created under the new health reform law (Kaiser Family Foundation, 2013). The mandate of this federal body was to make recommendations on ways through which Medicare spending can be reduced. This is important when the per capita growth for Medicare exceeds established targets. This is beneficial for the economy in that increase health care expenditure. Additionally, this is beneficial for insurance providers and the as any measures recommended do not include increased taxes, reduced payment reductions, modification of benefits or rationing of care. Changes resulting from this law also encourage quality in health care delivery. For instance, as a result of the new legislation, the federal payments that are made to Medicare Advantage plans will reduce over time. Additionally, bonus payments will be made to advantage plans that receive high quality ratings. This is a move towards sustainability while at the same time encouraging the delivery of quality care (Kaiser Family Foundation, 2013).Forecast for Medicare Reform In 2003, it was predicted that Medicare would be insolvent by 2026. This is because at the rate the Medicare Fund was being utilized, and the increasing costs of health care, Medicare would have to make out more payments with time. The Medicare program would further result into its trust fund after 2013 when the baby boom generation is expected to retire, and as such become eligible for Medicare. The confluence of the retirement of baby boomers and the ever increasing costs of health care would imply that the Medicare program would be making more payments in health care expenditure than they were taking in from payroll taxes (Bettelheim, 2003). However, I predict that the new legislation will significantly improve the lifespan of the Medicare program. Firstly, the new legislation has created an Independent Payment Advisory Board to explore ways through which Medicare spending can be reduced without altering the benefits, reducing payments or rationing care. This is the gist of the witness testimony where a market-based system is encouraged so that the private sector can compete with Medicare by offering better benefits at reduced costs (Bettelheim, 2003).
In order to ensure that the Medicare program is sustainable past 2026, it is necessary to modernize the Medicare program in order to increase the role of private institutions that offer health plans. Competition is important in reducing the cost of health care. If private institutions can offer improved benefits at reduced costs, this will reduce the costs of the Medicare program. This will in turn make the program viable to 2026 and past this time. This change is important, especially with the increase in the number of people of the baby boomer generation who are retiring and viable for Medicare (Bettelheim, 2003).
Bettelheim, A. (2003). Will policy makers agree on prescription-drug benefits? Medicare Reform, 13(28), 1-31.
Subcommittee on Health (2003). Strengthening and improving Medicare. Retrieved from http://www.gpo.gov/fdsys/pkg/CHRG-108hhrg87482/html/CHRG-108hhrg87482.htm
Kaiser Family Foundation. (2013). Summary of key changes to Medicare in 2010 Health Reform Law. Retrieved from https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7948- 02.pdf