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Medicare is the name given to public health insurance programs in Canada, Australia, and the United States. In Canada and Australia, the program covers the vast majority of health services for all citizens. The Canadian provinces administer medicare (with a lowercase m) for their inhabitants, and provincial health plans vary in some respects, but in both Canada and Australia, health-care coverage is universal and financed primarily through general tax revenues.
In the United States, Medicare is a public program that provides health insurance for people who are age sixty-five or older, considered disabled by the Social Security Administration (after a two-year wait), or diagnosed with end-stage renal disease. Medicare was enacted in 1965 as Title XVIII of the Social Security Act. In 2005, 42.5 million Medicare beneficiaries were covered at a cost of $330 billion. Despite its primarily elderly clientele, Medicare does not pay for long-term care, except for brief, medically involved stays in a skilled nursing facility.
Medicare is organized into parts A through D, each of which corresponds to a different service type with a different financing scheme. Part A is a program of inpatient hospital insurance available to all Medicare beneficiaries; there is no premium, although beneficiaries are required to pay deductibles and co-payments when they use covered services. Part A is financed through a payroll tax of 2.9 percent, paid half by employers and half by employees. Part B provides coverage for outpatient services, including physician visits, therapies, and laboratory tests. Enrollment is voluntary, and beneficiaries pay a monthly premium for coverage and deductibles and co-payments at the point of service. Part B is financed through premiums and general tax revenues. Part C concerns itself with managed care plans. Part D, passed in 2003, represents the largest expansion of Medicare benefits since 1965; as of January 1, 2006, it covers some of the cost of prescription drugs for beneficiaries who enroll. In a departure from earlier Medicare policy, enrollees receive Part D benefits through private insurance plans that offer coverage for different drugs (within limits set by the government) at different premium amounts. Like Part B, Part D is financed through premiums and general revenue funds. Medicare beneficiaries may also purchase private supplementary, or Medigap, insurance policies to cover deductibles, co-payments, and uncovered services.
Medicare is administered at the federal level by the Centers for Medicare and Medicaid Services. The Medicare program’s passage followed a decades-long attempt to enact national health insurance for all Americans. Medicare proponents hoped and expected that the program would be a first step toward that end; as of 2007, Medicare for all remained just one of many proposals for health-care reform.
Among other strengths, Medicare has substantially lower administrative costs than private insurers and has instituted innovative payment systems in the form of diagnosis related groups (DRGs) for hospitals and the resource-based relative value scale (RBRVS) for physicians. Under DRGs, hospitals are paid on a prospective basis to encourage efficiency. The RBRVS makes it possible to redress payment imbalances between generalist and specialist physicians.
- Henry Kaiser Family Foundation. 2005. Medicare Chartbook. 3rd ed.
- Marmor, Theodore 2000. The Politics of Medicare. 2nd ed. New York: de Gruyter.
- Oberlander, J 2003. The Political Life of Medicare. Chicago: University of Chicago Press.
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