Private vs. Public Control

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The major payers in private healthcare (other than government programs) are employers, and this has been true since the inception of health insurance programs. There are several reasons why this is so, but one of the main reasons is employees are a defined risk pool based on the work performed for the company. Healthcare insurance companies are able to predict the financial risk (as in an experience rating) taken by the type of employees. If, for instance, the work is dangerous or injury prone, such as direct care in a nursing facility, then the cost to insure that group would be higher than for employees working at a telecommunications office. Government healthcare programs, such as Medicare and Medicaid, do not measure the cost of healthcare by the experience ratings.

Based on your understanding of the topic, answer the following:

• Can programs like Medicare and Medicaid adopt such methods to defray costs? If yes, how would they implement such methods? If no, what suggestions would you make to defray costs?

Most of those receiving Medicare and Medicaid benefits are not employed.

• How the recipients of these programs be categorized into different risk pools? Explain.

The aging population is a force in healthcare continuing to have a dramatic effect on the direction of healthcare services. Many have discussed the aging population as the reason for the rising cost of healthcare. The pre- and baby-boomer generation (1946–65) were less knowledgeable and informed regarding the health risks and, therefore, engaged in risky behaviors that increased their susceptibility to chronic healthcare issues later in life.

• What does that mean to the viability of Medicare and Medicaid?

Regardless of how many changes are made to Medicare to try to keep it solvent, aren’t the sheer numbers of eligible recipients versus the ever decreasing number of people paying into Medicare the real reason why Medicare will cease to exist in its present form?

• Do you agree with this question? Why or why not?