The primary goal of the Medicare Catastrophic Coverage Act of 1989 was improved access to health care services for the elderly afflicted with chronic, catastrophic ailments.1 The Act did not provide coverage for age groups other than the elderly. Indigent persons receive catastrophic care coverage through the Medicaid program, and major medical health insurance policies provide some degree of catastrophic coverage for the majority of other Americans. Nevertheless, approximately 30 million Americans have no catastrophic health care coverage of any kind.2 Catastrophic health care coverage is essential for a number of reasons. Changes on either the funding side or the treatment side of the health care equation may easily lead to a situation wherein a patient may be denied access to a specific treatment therapy. A serious implication of this situation is the potential denial of access to necessary health care services for a large proportion of the elderly segment of the population. Mushrooming medical technology also threatens access to catastrophic care for many individuals.3 The high
1Julie Rovner, "Senate Finance Tries Revision of Catastrophic Costs Law." Congressional Quarterly, 1989, 2316 2317.
2John L. Hess, "The Catastrophic Health Care Fiasco," The Nation, 21 May 1990, 698 701; S. M. Rosen, D. Fanshel, and M. E. Lutz, (Eds.), Face of the Nation: Statistical Supplement to Encyclopedia of Social Work (Silver Spring, Maryland: National Association of Social Workers, 1990), 314.
3M. K. Pera, and E. J. Gould, "Home Health Care Nursing: Integration of Politics and Nursing," Holistic Nursing Practice, 3 (February 1989): 9 17. costs associated with this technology places it outside the reach of millions of individuals.4 Kidney dialysis machine technology provided a major impetus for the development of major medical plans to cover catastrophic health care costs two decades ago.
The access dilemma is, in the 1990s, d...