Medicare reform: social and ethical perspectives

Despite Medicare's success as a social program, its future is in question because of the program's enormous costs. Because the issue of Medicare reform has been forced upon us at this juncture by a crisis of finance rather than by the long-standing inequities in the present system of paying for the health care of the elderly, questions about how best to secure its fiscal integrity have seized the attention of the public. Yet, such questions are hard to contain; they force an examination of broader and more fundamental issues. In this article, we examine the validity of the ultimate moral and social rationales for continuing Medicare in something approximating its present form; the legitimacy of a social entitlement program that is age- rather than means-based; the implications for the future of health care reform if significant changes were to be made in the Medicare program and its underlying rationale; and the possibility that changes in that program may jeopardize the chances for a more rational, just, and systematic approach to the provision of health care to all Americans.     

Medicare program; clarification of Medicare's accrual basis of accounting policy--HCFA. Final rule

This final rule revises the Medicare regulations to clarify the concept of "accrual basis of accounting" to indicate that expenses must be incurred by a provider of health care services before Medicare will pay its share of those expenses. This rule does not signify a change in policy but, rather, incorporates into the regulations Medicare's longstanding policy regarding the circumstances under which we recognize, for the purposes of program payment, a provider's claim for costs for which it has not actually expended funds during the current cost reporting period.     

Medicare program; scope of Medicare benefits and application of the outpatient mental health treatment limitation to clinical psychologist and clinical social worker services--HCFA. Final rule

This rule addresses requirements for Medicare coverage of services furnished by a clinical psychologist or as an incident to the services of a clinical psychologist and for services furnished by a clinical social worker. The requirements are based on section 6113 of the Omnibus Budget Reconciliation Act of 1989, section 4157 of the Omnibus Budget Reconciliation Act of 1990, and section 147(b) of the Social Security Act Amendments of 1994 (SSA '94). This rule also addresses the outpatient mental health treatment limitation as it applies to clinical psychologist and clinical social worker services. This final rule also conforms our regulations to section 104 of the Social Security Act Amendments of 1994. Section 104 provides that a Medicare patient in a Medicare-participating hospital who is receiving qualified psychologist services may be under the care of a clinical psychologist with respect to those services, to the extent permitted under State law. In addition, this final rule requires that clinical psychologists and clinical social workers use appropriate diagnostic coding when submitting Medicare Part B claims.     

Paying for Medicare: benefits, budgets, and Wilbur Mills's policy legacy

Medicare features an unusually complex financing design. The Hospital Insurance Trust Fund pays for Part A of Medicare (hospital stays), while the Supplementary Medical Insurance Trust Fund finances Part B (doctor visits, outpatient care, and certain home health services). At a time when Medicare policy is generating debate, this article takes a new analytical look at the origins and consequences of the program's peculiar bifurcated structure. Addressing historians of the U.S. welfare state as well as contemporary health policy reformers, the article focuses on the crucial role of legendary Ways and Means Committee chair Wilbur Mills in Medicare's enactment in 1965. The central theme of the article is that fiscal conservatism and a commitment to budgetary restraint constitute important elements of Medicare's original political understanding. Contrary to analysts who argue that Medicare's financing design has produced "perverse" effects, we argue that it has served a valuable social function by encouraging policy makers to confront periodically the costs of one of the largest and fastest-growing federal programs. An argument can be made that Medicare's original division requires modification in order to integrate health care delivery changes of the past few decades. It is crucial, however, for reformers not to lose sight of the policy goals, including fiscal rectitude, that motivated the adoption of Medicare's bifurcated structure in the first place.     

实现利益均衡是社会和谐的根本前提——和谐社会利益关系问题的经济学思考

本文着眼于我国社会转型时期收入分配差距拉大、利益关系出现失衡的问题,分析了在社会主义市场经济发展过程中,非市场因素引发的收入差距扩大及分配不公现状,提出收入分配的改革重在体现发展成果应由人民共享,实现利益均衡是社会和谐的根本前提。     

利益均衡共享：调适国家与社会关系的民生基础

当前我国社会利益不均衡的突出表现是收入差距全范围、多层次逐步扩大.利益不均衡源于收入分配秩序混乱及两次分配的制度性缺陷.这种差距的扩大若不能及时解决,社会各阶层在经济发展过程中将产生过多的被剥夺感,其结果可能从经济利益的冲突转化为深刻的社会矛盾.因此,必须通过深化改革,建立起全社会的利益均衡共享机制.     

The Medicare approach: political choice and American institutions

The most significant health reform in American history was the passage of Medicare in 1965, but this was an accomplishment born of defeat. Medicare was designed and understood by its early promoters as an approach to health reform, not simply as a discrete program for a distinct target population. Although Medicare incrementalism has tended to be shunted aside when the opportunities for health reform are most promising, the final years of the Johnson administration reveal previously underappreciated efforts to expand Medicare eligibility to large new population groups and offer insights into the continuing potential of Medicare incrementalism in our own time.     

TRICARE; constructive eligibility for TRICARE benefits of certain persons otherwise ineligible under retroactive determination of entitlement to Medicare Part A hospital insurance benefits. Final rule

The Department is publishing this final rule to implement section 706 of the National Defense Authorization Act (NDAA) for Fiscal Year 2010, Public Law 111-84. Specifically, section 706 exempts TRICARE beneficiaries under the age of 65 who become disabled from the requirement to enroll in Medicare Part B for the retroactive months of entitlement to Medicare Part A in order to maintain TRICARE coverage. This statutory amendment and final rule only impact eligibility for the period in which the beneficiary's disability determination is pending before the Social Security Administration. Eligible beneficiaries are still required to enroll in Medicare Part B in order to maintain their TRICARE coverage for future months, but are considered to have coverage under the TRICARE program for the retroactive months of their entitlement to Medicare Part A. This final rule also amends the eligibility section of the TRICARE regulation to more clearly address reinstatement of TRICARE eligibility following a gap in coverage due to lack of enrollment in Medicare Part B.     

Considerations in Medicare reform: the impact of Medicare preemption on state laws

This article explores the key issues involved in understanding the impact of Medicare preemption on state laws affecting the federal purchase of managed care products, as a consideration in future Medicare reform. Author Commander Jackonis argues that any further Medicare reform must address the impact of federal preemption on quality and quantity of care purchased in order to ensure the existence of a market of product providers, as well as to ensure protection of patient rights and benefits.     

The Medicare secondary payor provisions: possible rewards and pitfalls

A 1990 report prepared by the Office of Inspector General estimated that as much as $1 billion is lost to the Medicare program annually because (i) secondary payor situations are not detected and (ii) insurance companies often do not pay when they are required to be the primary payors. Office of Inspector General, No. A-09-98-00151, April 1990, Medicare and Medicaid Guide (CCH) [symbol: see text] 39,112, at 25,649. In order to better enforce the MSP provisions, suggestions have been made at the Congressional level to impose sanctions against providers who demonstrate a pattern of inappropriate billing practices such as double billing, repeated failures to screen beneficiaries for other insurance coverage, and the repeated submission to Medicare of bills that should be submitted to another payor. (See the Subcommittee Report on erroneous payments under the MSP program, supra.) Although authority for such sanctions has yet to be adopted, given the fiscal problems currently plaguing the federal government, providers can expect increased enforcement of the MSP provisions as a means of reducing Medicare costs, and should review their screening and billing practices accordingly.     

膝关节侧副韧带损伤MRI影像诊断的比较研究

目的研究膝关节侧副韧带损伤的MRI诊断与法医学鉴定意义。方法对经手术或临床证实的11例共13条损伤的侧副韧带与12例正常膝关节进行回顾性MRI对比研究。结果正常胫、腓侧副韧带在T1WI和T2WI上均呈扁平条状低信号结构,平均长度分别为6.8cm和5.7cm;13条侧副韧带损伤,单纯胫侧副韧带损伤6条,单纯腓侧副韧带损伤3条,两侧侧副韧带同时损伤2例4条;其中I级侧副韧带损伤5条,II级侧副韧带损伤5条;III级侧副韧带损伤3条;7例(63.6%)出现并发症,其中前交叉韧带损伤3条,后交叉韧带损伤4条,半月板损伤2个。结论MRI能清晰显示膝关节侧副韧带解剖结构,能准确诊断侧副韧带损伤并进行分级,还能发现多种并发症,对法医学鉴定有重要意义。     

The ongoing debate over Medicare: understanding the philosophical and policy divides

This Article examines the evolution and status of Medicare, as well as the myriad current efforts to reform this longstanding entitlement. The author analyzes why healthcare financing for the elderly follows an administered pricing, fee-for-service model, while the working population generally obtains its insurance under a competitive market model. As a non-means-tested program modeled after Social Security, Medicare embraces both a universal entitlement philosophy of government-provided basic health services, and a need-based entitlement philosophy of caring for the Medicare-eligible elderly.