Medicare was born in 1965, however, the events leading to its inception and adoption date back to 1935. The then U.S President, Franklin D. Roosevelt, made and rallied for a Social Security system for Americans. His government was successful in passing the Social Security Act but the universal health insurance element was dropped. The reason being insurmountable opposition from conservative Democrats, Republicans, and medicine professionals. The same opposition was also faced by President Harry Truman in 1948 (“50 Years Of Medicare: How Did We Get Here?” n.d.). His government tried to unsuccessfully legislate an unreserved national insurance health policy. The main source of his opposition was organized medicine who saw his proposal as socializing medicine. The path to success for Medicare was started by President John F. Kennedy during his regime.
President Kennedy pursued more modest Social Security plans and championed for them in a diplomatic manner. He managed to gain traction in the public eye and convince a good number of legislators to support the plan. Nevertheless, his proposal failed to gunner enough support in the legislative arm of the government and as such stalled in Capitol Hill. It was President Lyndon Johnson who, building on Kennedy’s mishaps, managed to successfully champion for and sign the Social Security Amendments of 1965 into law (DeWitt, Béland & Berkowitz, 2008). These Amendments expressly created both Medicare and Medicaid. The former covered hospital and physician services for persons 65 years of age and older while the latter catered for low-income kids together with their caretaker relatives.
Amendments were made to the Social Security Act in 1972. These amendments saw the Medicare eligibility expanded. Formerly, only persons aged 65 years and above were eligible for Medicare. The new amendments allowed persons with end-stage renal sicknesses and long-term disabilities eligible for Medicare. Moreover, the Professional Standards Review Organizations was set up to determine appropriateness for Medicare. Other improvements to Medicare came in 1982, 1983, 1988, 1997, 2003, and 2010. The Medicare Hospice Benefit was added in 1982 followed by a new payment system in 1983. 1988 saw the addition of new benefits to the Medicare scheme. The year 1997 saw the expansion of payment changes while a lasting drug benefit was added in 2003. Lastly, an amendment was passed in 2010 which improved Medicare to provide better care, better coverage, and lower costs.
Medicare currently uses several prospective payment systems (PPS) to pay for Medicare services and products. These systems include acute inpatient, all fee-for-service providers, FQHC, home health, skilled nursing facility, long-term care hospital, inpatient rehabilitation facility, and inpatient psychiatric facility. Acute inpatient PPS caters for events classified into a diagnosis-related group with every segment having an assigned payment weight that corresponds to the average resources utilized (“Centers for Medicare and Medicaid Services (CMS), HHS,” n.d.). All fee-for-service involves the use of fee schedules that list maximum fees for fee-for-service basis. Federally Qualified Health Centers (FQHC) receive Medicare payments based on a national rate. Home Health involves pre-determined base payments that are adjusted for health condition and care needs.
Inpatient Psychiatric Facility involves the use of a standardized federal per diem rate. This rate is based on national average routine capital costs, ancillary costs, and operating costs per patient at the rehabilitation facility. Inpatient Rehabilitation Facility is made for rehabilitation hospitals and rehabilitation units (“Inpatient Rehabilitation Facility PPS,” n.d.). Long-term care hospitals use a per discharge system with a diagnosis-related group patient categorization system. Lastly, the skilled nursing facility system offers a per diem payment system for skilled nursing facilities that covers all costs associated with the service rendered. The whole Medicare system is an example of biblical integration to help uplift the poor and less fortunate. The Bible in Romans 13:10 admonishes us to do good to everyone. The US is able to provide quality healthcare to all its citizens. Medicare is a suitable example of the US doing good to every citizen regardless of race, status, age, color, and religion.
50 Years Of Medicare: How Did We Get Here? (n.d.). Retrieved from https://interactives.commonwealthfund.org/medicare-timeline/
Centers for Medicare and Medicaid Services (CMS), HHS. (2013). Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules. Federal Register, 78(160), 50495.
DeWitt, L. W., Béland, D., & Berkowitz, E. D. (2008). Social Security: A documentary history.
Inpatient Rehabilitation Facility PPS. (n.d.). Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/InpatientRehabFacPPS