Editing Medicare (United States) (section)

==Criticism==
Robert M. Ball, a former commissioner of Social Security under President Kennedy in 1961 and later under Johnson and Nixon, defined the major obstacle to financing health insurance for the elderly: the high cost of care for the aged combined with the generally low incomes of retired people. Because retired older people use much more medical care than younger employed people, an insurance premium related to the risk for older people needed to be high, but if the high premium had to be paid after retirement, when incomes are low, it was an almost impossible burden for the average person. The only feasible approach, he said, was to finance health insurance in the same way as cash benefits for retirement, by contributions paid while at work, when the payments are least burdensome, with the protection furnished in retirement without further payment.<ref name="BALL">{{Cite web |author=Ball |first=Robert M. |title=The role of Social Insurance in preventing economic dependency |url=https://www.ssa.gov/history/churches.html |access-date=2023-01-06 |website=www.ssa.gov}}</ref> In the early 1960s relatively few of the elderly had health insurance, and what they had was usually inadequate. Insurers such as [[Blue Cross Blue Shield Association|Blue Cross]], which had originally applied the principle of [[community rating]], faced competition from other commercial insurers that did not community rate, and so were forced to raise their rates for the elderly.<ref>{{cite journal |title=Perspectives On Medicare: What Medicare's Architects Had In Mind |first=Robert M. |last=Ball |journal=[[Health Affairs]] |date=Winter 1995 |volume=14 |issue=4 |pages=62–72 |doi=10.1377/hlthaff.14.4.62|pmid=8690364 }}</ref>

Medicare is not generally an unearned entitlement. Entitlement is most commonly based on a record of contributions to the Medicare fund.<!-- Unearned entitlement may occur for those that qualify without paying into the system, such as for those receiving SSI for more than one year, or with ESRD --> As such it is a form of [[social insurance]] making it feasible for people to pay for insurance for sickness in old age when they are young and able to work and be assured of getting back benefits when they are older and no longer working. Some people will pay in more than they receive back and others will receive more benefits than they paid in. Unlike private insurance where some amount must be paid to attain coverage, all eligible persons can receive coverage regardless of how much or if they had ever paid in.

===Politicized payment===
Bruce Vladeck, director of the [[Centers for Medicare and Medicaid Services|Health Care Financing Administration]] in the [[Bill Clinton|Clinton]] administration, has argued that lobbyists have changed the Medicare program "from one that provides a legal entitlement to beneficiaries to one that provides a de facto political entitlement to providers."<ref>{{cite web|last1=Pope|first1=Chris|title=Medicare's Single-Payer Experience|url=http://www.nationalaffairs.com/publications/detail/medicares-single-payer-experience|website=National Affairs|access-date=January 20, 2016}}</ref>

===Quality of beneficiary services===
A 2001 study by the [[Government Accountability Office]] evaluated the quality of responses given by Medicare contractor customer service representatives to provider (physician) questions. The evaluators assembled a list of questions, which they asked during a random sampling of calls to Medicare contractors. The rate of complete, accurate information provided by Medicare customer service representatives was 15%.<ref>[http://www.gao.gov/new.items/d011141t.pdf Improvements Needed in Provider Communications and Contracting Procedures] {{Webarchive|url=https://web.archive.org/web/20070710073514/http://www.gao.gov/new.items/d011141t.pdf |date=July 10, 2007 }}, Testimony Before the Subcommittee on Health, Committee on Ways and Means, House of Representatives, September 25, 2001.</ref> Since then, steps have been taken to improve the quality of customer service given by Medicare contractors, specifically the [https://archive.today/20131115022646/http://cms.hhs.gov/Outreach-and-Education/Training/1800medicare/index.html 1-800-MEDICARE] contractor. As a result, [https://archive.today/20131115022646/http://cms.hhs.gov/Outreach-and-Education/Training/1800medicare/index.html 1-800-MEDICARE] customer service representatives (CSR) have seen an increase in training, quality assurance monitoring has significantly increased, and a customer satisfaction survey is offered to random callers.

===Hospital accreditation===
In most states the [[Joint Commission]], a private, [[non-profit organization]] for accrediting hospitals, decides whether or not a hospital is able to participate in Medicare, as currently there are no competitor organizations recognized by CMS.

Other organizations can also accredit hospitals for Medicare.{{citation needed|date=October 2014}} These include the [[Community Health Accreditation Program]], the [[Accreditation Commission for Health Care]], [[the Compliance Team]] and the [[Healthcare Quality Association on Accreditation]].

Accreditation is voluntary and an organization may choose to be evaluated by their State Survey Agency or by CMS directly.<ref>[http://www.vdh.state.va.us/OLC/Laws/documents/HomeCare/Accreditation%20Option%20for%20Medicare%20payments.pdf The Accreditation Option for Deemed Medicare Status], {{Webarchive|url=https://web.archive.org/web/20090716120632/http://www.vdh.state.va.us/OLC/Laws/documents/HomeCare/Accreditation%20Option%20for%20Medicare%20payments.pdf|date=July 16, 2009}}, Office of Licensure and Certification, Virginia Department of Health.</ref>

===Graduate medical education===
Medicare funds the vast majority of [[Residency (medicine)|residency]] training in the US. This tax-based financing covers resident salaries and benefits through payments called Direct Medical Education payments. Medicare also uses taxes for Indirect Medical Education, a subsidy paid to [[teaching hospital]]s in exchange for training resident physicians.<ref>{{cite journal |last=Gottlieb |first=Scott |date=November 1997 |title=Medicare funding for medical education: a waste of money? |journal=[[USA Today (magazine)|USA Today]]}} [http://findarticles.com/p/articles/mi_m1272/is_n2630_v126/ai_20004039 Reprint] by [[BNET]]. {{Webarchive|url=https://web.archive.org/web/20080927212732/http://findarticles.com/p/articles/mi_m1272/is_n2630_v126/ai_20004039|date=September 27, 2008}}.</ref> For the 2008 fiscal year these payments were $2.7 billion and $5.7 billion, respectively.<ref>{{cite journal |url=http://www.aamc.org/newsroom/reporter/feb09/payments.htm |title=Overview: Medicare Direct Graduate and Indirect Medical Education Payments |last=Fuchs |first=Elissa |date=February 2009 |journal=AAMC Reporter |issn=1544-0540 |access-date=November 12, 2009 |archive-url=https://web.archive.org/web/20100613150629/http://aamc.org/newsroom/reporter/feb09/payments.htm |archive-date=June 13, 2010 |url-status=dead }}</ref> Overall funding levels have remained at the same level since 1996, so that the same number or fewer residents have been trained under this program.<ref name="amednews2006-01-30">{{cite news |url=http://www.ama-assn.org/amednews/2006/01/30/prl20130.htm |title=Innovative funding opens new residency slots |last=Croasdale |first=Myrle |date=January 30, 2006 |newspaper=American Medical News |publisher=[[American Medical Association]] }}</ref> Meanwhile, the US population continues to grow both older and larger, which has led to greater demand for physicians, in part due to higher rates of illness and disease among the elderly compared to younger individuals. At the same time the cost of medical services continue rising rapidly and many geographic areas face physician shortages, both trends suggesting the supply of physicians remains too low.<ref>{{cite journal |title=Shortages of Medical Personnel at Community Health Centers |journal=Journal of the American Medical Association |date=March 1, 2006 |volume=295 |issue=9 |first1=Roger A. |last1=Rosenblatt |first2=C. Holly A. |last2=Andrilla |first3=Thomas |last3=Curtin |first4=L. Gary |last4=Hart |pages=1042–49 |pmid=16507805 |doi=10.1001/jama.295.9.1042 |doi-access=free }}</ref>

Medicare thus finds itself in the odd position of having assumed control of the single largest funding source for graduate medical education, currently facing major budget constraints, and as a result, freezing funding for graduate medical education, as well as for physician reimbursement rates. This has forced hospitals to look for alternative sources of funding for residency slots.<ref name=amednews2006-01-30/> This halt in funding in turn exacerbates the exact problem Medicare sought to solve in the first place: improving the availability of medical care. However, some healthcare administration experts believe that the shortage of physicians may be an opportunity for providers to reorganize their delivery systems to become less costly and more efficient. Physician assistants and Advanced Registered Nurse Practitioners may begin assuming more responsibilities that traditionally fell to doctors, but do not necessarily require the advanced training and skill of a physician.<ref>{{cite journal |last=Rovner |first=Julie |date=August 2012 |title=Prognosis Worsens For Shortages In Primary Care |journal=[[Talk of the Nation]]}}. [https://www.npr.org/2012/08/07/158370069/the-prognosis-for-the-shortage-in-primary-care] by [[NPR]].</ref>