MEDICARE AND EQUITY IN HEALTH CARE

Medicare was enacted in 1965 as a uniform health care services financing program for individuals eligible for federal benefits under the social security program (Cockerham, 1992, p. 253). All persons, regardless of financial situation, are eligible for participation in the Medicare program at age 65. Certain other persons afflicted by specified medical problems and disabilities are eligible for participation in Medicare regardless of age or financial condition. This research will focus on the primary objective of Medicare, which is the financing of health care services for elderly persons.

It is important to understand that the Medicare program does not provide any health care services. Rather, the program provides funding for such services. Funding is through two separate provisions of the Medicare Act. Hospital services for medical conditions covered by the Act are funded under Part A at no cost to the recipient. Physicians' services and other covered procedures are funded under Part B. Funding for services under Part B is a coinsurance scheme under which recipients are required to pay an annual fee plus 20 percent of the fee levels approved by Medicare (Phelps, 1992, p. 345). The level of the annual Part B fee was raised to $24.80 per month in 1988.

It is also important to note that Medicare was designed as a program to provide coverage for acute illnesses, as opposed to chronic ailments requiring extensive longterm care (Min

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cipal objective of the program. The access objective of the Medicare Act has also been compromised by the omission of funding for health care services for chronic illness and other chronic health conditions. An effort was made in the late1980s through the enactment of the Medicare Catastrophic Coverage Act to correct the access deficiencies of the Medicare program. This act provided funding for chronic conditions, and this act placed a cap on the outofpocket costs for all health care services received by an individual covered by the Medicare program (Rovner, 1989, pp. 2463, 2465). This act quite likely would have cured the access deficiencies of the original Medicare program. Unfortunately, the financing provisions for the Medicare Catastrophic Coverage Act proved to be highly unpopular with a very large and very influential minority of the individuals participating in the Medicare program. These individuals brought enormous pressures to bear on the Congress and on the Bush Administration, and the act was rescinded. Thus, the provisions of the original Medicare act remain largely in place. The controversial aspect of the Medicare Catastrophic Coverage Act concerned the way in which the Act's benefits were funded. Be

Category: Medical - M