Medicare is a US federal program that provides compulsory insurance for older people in case they need inpatient treatment. This program currently covers about 55 million US citizens (Altman & Frist, 2015). The program is funded by a payroll tax and provides reimbursement for outpatient care for the elderly. Medicaid is a federal and state program that helps pay for medical expenses for people with limited income and resources who meet specific criteria.
People with Medicaid can ensure services that are not covered or partially covered by Medicare, such as nursing home care, personal care, transportation to healthcare facilities, home and community services, and dental, vision, and hearing services. To obtain Medicare in a state, a person must be a resident of that state and a US citizen or have official immigration status. Each state has different Medicaid eligibility criteria and rules. Patients who are eligible for Medicaid in a particular state are automatically eligible for extra help paying for their Medicare prescription drugs. These insurance programs, there are issues related to their expansion and privatization, which are dual.
Expansion of Programs
Expanding coverage involves many side effects that need to be explored. By expanding insurance coverage, many people can become healthier and more financially secure by saving money on medicines. It can also reduce controversy regarding unfair insurance coverage and racial injustice. Other aspects can be affected by expanding the program. For example, most states can save a significant amount of their financial reserves since the program is funded by the federal budget. At the same time, the program’s expansion provides a greater flow of taxes to the state treasury. Hospital reimbursement and non-reimbursable costs will decrease significantly if the program is expanded.
Medicaid also pays for treating patients with mental disorders, allowing states to spend less money on mental health programs. In some states where treatment plans are taxed, an increase in the number of Medicaid subscribers will cause the state’s revenue to increase again. Taking into account all the above facts, we can conclude that the expansion of the Medicaid program will lead to a significant reduction in the states’ spending on treatment, which will improve their financial situation.
In addition to economic factors, expanding programs will help cover more patients, increasing access to quality medicine. Millions of workers in frontline and essential industries are covered by the Medicaid expansion, including healthcare workers, bus drivers, grocery store workers, food manufacturers, and others on whom millions rely. Expanding programs can make people healthier and provide them with better financial stability. This is achieved primarily through access to preventive medicine and public health programs. Expanding the programs will cover more low-income people.
The global improvement in health is because programs identify problems earlier and, accordingly, treatment begins earlier. This approach works preventively and allows people to get more benefits from treatment programs. In addition, expanding programs also helps prevent premature deaths among the older population or people at risk. Due to the expansion of programs, premature deaths in people aged 55 to 64 have decreased significantly (Rubin et al., 2021). This is another positive factor in the expansion of insurance programs. However, in addition to preventing premature deaths in the elderly, expansion can also help reduce infant mortality rates. This is because programs increase access to medical care throughout pregnancy. Considering all the benefits, it can be concluded that Medicare and Medicaid coverage should continue expanding.
Privatized Administration
Both insurance programs have their divisions, which are managed by private administrations. There are the most prominent funds, Medicaid LTC and Medicare Advantage. However, privatizing health insurance companies without proper regulation can be dangerous for patients. In addition, it violates the fundamental principles of insurance, such as extended access for low-income families. Private administrations can manage insurance programs through different investors. For example, some of the Medicare Advantage insurers are managed by private equity investors (Fieseher, 2022). Themselves companies involved in insurance medicine are already investors, but there is a big difference between them and third-party administrations.
Third-party companies that decide to manage health insurance may not fully understand what such insurance should cover and what should not be covered. Even under the condition of competent management, taking into account consumer needs, remote administration will always be focused on the benefit of its business and not on the provision of essential services. Because of this, private companies may intentionally underreport a patient’s health status in their records to receive more taxes. Private companies can deceive patients and the government with false diagnoses to get more subsidies. According to Abelson & Sanger-Katz (2022), private programs exploit the healthcare system to make more profit. Such actions significantly discredit the entire medical system and are an example of the danger posed by privatized administrations.
Conclusion
Having studied all the available facts on both issues, certain conclusions can be drawn. In the first case, expanding insurance programs to more people has highly positive consequences. This helps to ease the financial cost of insurance programs to states and thus makes them more affordable to the majority. In addition, people will be able to enjoy the benefits of Medicare and Medicaid in areas where they were previously not available, eradicating social injustice. In the second question about whether the administrations of such insurance programs should be privatized, it should be said that they should not. The facts cited as an example of a flagrant violation of medical principles of work appeared precisely through the fault of private institutions. Since their main task is to earn money, they should not be engaged in medical activities.
References
Abelson, R. & Sanger-Katz, M. (2022). ‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions. The New York Times. Web.
Altman, D. & Frist, W. (2015). Medicare and Medicaid at 50 Years Perspectives of Beneficiaries, Health Care Professionals and Institutions, and Policy Makers. American Medical Association. 314(4). 384-395.
Fieseher, J. (2022). Opinion: Privatization is taking the ‘care’ out of Medicare. Concord Monitor. Web.
Rubin, I., Cross-Call, J. & Lukens, G. (2021). Medicaid Expansion: Frequently Asked Questions. Center on Budget and Policy Priorities. Web.