1 AMERICAN VALUES; PLAN TO SAVE MEDICARE

American Values; Plan to Save Medicare

Pamela A. Casey The Sage Colleges GNT 504 Spring 2012

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The two dyads from Gerda Lerners essay, American Values that Ive chosen to discuss and apply as frameworks to save Medicare are:

1. Equality versus Racism 2. Open Access to Opportunity versus Elitism

In considering Lerners view on equality versus racism, Lerner discusses that the American value of equality is based on all men being created equal, the United States Constitution also echos this same concept that all citizens are equal and should be treated fairly. The reality is that when this country was founded by white men, racism began for the AfricanAmericans, and Native-Americans. Native-Americans, who were here first, and are true Americans, had their land taken away from them. They were placed and confined on reservations, and had their rights taken away from them too. This was a form of slavery just like the black man suffered under white supremacy. The Civil War was a pivotal moment in United States (US) history for the issue of slavery as the northern and southern states fought this issue. This conflict of racism continued to permeate US history from legislation enacted in 1875 until the Civil Rights Act of 1964. Black Americans fought in the Spanish-American War and two subsequent World Wars. They were physically segregated from white men fighting the same war. They were not considered equals and/or treated as equals even though they fought for the same thing. They fought for America though was denied equality in the same country that they were fighting for. This is not equality or fair treatment. America, who stands for freedom for

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all, who crys out, per the US Constitution equality and justice for all was really the white supremacists idea of equality. Inequality and racism has persevered from the founding of this country and for every ethnicity that entered this country during the mass migrations of the late 1800s and early 1900s. Blacks, Germans, Italians, Irish, Jews, and Chinese all faced similar plights as they came to America for freedom and equality. Lerner also points out that women have also been subjected to inequality from men for the past 200 years. Women couldnt even vote until the 1900s. Women still suffer today under the concept of male superiority in the arena of equal pay for equal jobs as well as in leadership positions in government, church, corporate, and academic arenas. In America, today racism and inequality continue. Every new group that enters the US is on the bottom rung of the ladder fighting for acceptance and equality. This can be observed with the situation of Mexican immigrants both legal and illegal coming into this country today. Regardless of the way they enter, they are viewed in a position of inferiority and inequality. In looking at a way to apply Lerners framework for equality versus racism as a solution to fix Medicare lets first look at the current issues of Medicare. Medicare is a government insurance plan that was created in 1965 to provide affordable health care for seniors, 65 and older and the disabled. Since its creation, Medicare has provided universal, reasonably affordable healthcare to millions of seniors. Medicare is also subject to the same cost inflation that is making healthcare unaffordable to millions (Policy, 2009). During the 1960s America enjoyed prosperity and there was a concern for the poor and the elderly in terms of catastrophic illness (Mason, Leavitt, & Chaffee, 2012). Medicaid was also established at the same time, both

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are amendments to the Social Security Act and are entitlement programs. Medicaid is a program for the poor and is a government health program run by the states. The Medicare entitlement program allowed seniors to collect benefits at age 65. At this time life expectancy in the US was around 70. What has become a major concern today, is the monies to continue to run these entitlement programs in a time when the rising costs of health care cannot keep up with funding these programs. The aging population and demands for chronic care are having a major impact on increasing costs for this care (Mason, Leavitt, & Chaffee, 2012). Seniors are living much longer than expected, life expectancy is now in the late 80s. At this time there is not enough money going into these programs to fund them. The amount of people uninsured in America has increased over the past several years due to the recession of 2008. Since so many people are not working, unemployment nationwide has topped 10%. Subsequently, there has been a decrease in employee contributions to fund these entitlement programs. The US has a pay-as-you go insurance program, where the current working generation funds the costs of retirees (Altman & Shactman, 2002). The majority of funding health care costs has fallen on lower income people exacerbating the problem of inequities (Mason, Leavitt, & Chaffee, 2012). The number of uninsured has risen to 52 million, the population is aging and the number of Medicaid enrollees has significantly increased. Health care costs are skyrocketing secondary to increasing life expectancy and as the baby boomers age and need more health care services. The funding of these entitlement programs is challenging. It is predicted that by 2030 these entitlement programs will utilize 68 percent of the Federal budget (Altman & Shactman, 2002). The US cannot afford to keep up with the escalating inflation in this downward economy.

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How can we pay for health care for our aging baby boomer population? I do agree with Lerner that in America we should all be equal and treated fairly. I also believe that all Americans are entitled to health care. We need to think bigger than Medicare. We need to look at these three entitlement programs, Social Security, Medicare, and Medicaid. We need to equally share in the responsibility of continuing these programs. We need to change the way we think about getting old. This problem is multifaceted. We need to all pitch in. The Medicare population will soon double as baby boomers age and advances in costly new technology will increase too. This is great news for baby boomers though not for the economy. The research and treatments for this better lifestyle will be astronomical. The present Medicare system cannot pay for this. Social Security is in trouble since those in their 30s and 40s who are contributing to those retired will not be enough to sustain future retirees. I feel one solution would be for us to change the way we think about getting old. We need to change the retirement age to 70. Aging America needs to stay in the workforce longer to help fund entitlement programs. It is not fair and/or equal for seniors to retire and have the next 30 or 40 years of leisure time being funded by others when these same seniors are still capable to be a part of the current workforce. Health care reform needs to be a shared responsibility for all. Seniors can also add to the American experience by volunteering to help pass on their knowledge for future generations. Lerners dyad of Open access to Opportunity versus Elitism takes on a further injustice to current American values in this country. In Lerners essay, the focus open access is based on equal access and opportunity for all. Equal access to property, education, credit, capital and economic opportunity was mainly for the white male, again white supremacy was the order of

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the day (Lerner, 1997). Elitism is based on minimizing open access to those whom are considered less deserving. Elitists considered themselves the privileged few. Many were educated in England and in the 17th and 18th centuries schools for ministers were set up in the new colonies. Womens education as well as non-elitist children had limited schooling opportunities with the exception of basic skills. Again, African-Americans and women were denied open access to voting, property ownership, and educational opportunities (Lerner, 1997). This struggle can be seen today in employment opportunities for minorities despite affirmative action endeavors for open access and opportunity. Affirmative action was enacted to help the underprivileged and disadvantaged groups. Many feel today that affirmative action now has reverse discriminatory issues attached to it. This is a whole other topic in itself. Meritocracy has replaced Elitism in todays society. Meritocracy is the concept of equal access based on standards from supposedly objective testing. Many government and public employment opportunities are based on this standard. Currently, hiring and salary differentials continue to dominate open access for women versus men for employment opportunities. As America grew with the mass migrations of immigrants during the 17th through early 19th century each new minority group was pitted against each other as they rose up the career ladder (Lerner, 1997). Today we see this in the newest Mexican minority populations entering into this country with open access to medical and employment opportunities. The Mexicans are working in the fields, quarries, orchards and doing what many others consider menial work, beneath them. I see a current philosophy being, I would rather collect unemployment or Medicaid and not work than do menial labor, let the Mexicans do that work, at least it will get done.

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In thinking about Lerners essay and the dyad of open access to opportunity versus Elitism I cant help but think of an article that was in the Post Star Newspaper (Schoenberg, 2011), recently on concierge care. Concierge care is a type of medical care that raises questions regarding medical care in America. Who is this care for and who can afford it. Concierge care is a plan where physicians limit their practice to roughly 400 patients as opposed to in todays standard of 4000 patients. To have this 24/7 care, patients pay a yearly fee for this service. This type of care can cost anywhere from $1,500 to upwards of $75,000 per year for this service. Health insurance plans are also an additional expense and are billed by the physician for all services provided. I feel this plan is targeted for the wealthy, or elite that has the money to afford this around the clock care. This raises several questions pertaining to open access to care, who can afford this level of care? Is this fair and ethical for physicians to be doing this? Is concierge care diminishing access to care for everyone else except the wealthy? This is also a fairness issue (Sullivan, 2011). In concierge care, your personal physician may be able to move you to the head of the list for specialized procedures by just making a phone call to another physician. Not everyone has this access to care. Most of us have to wait, sometimes months to see a specialist. Physicians practice under an ethical code to provide care for people in need. When a physicians practice is limited to small groups of wealthy people this in itself demonstrates that concierge care is not open access for all but caters to the elite (Stroud, 2011). This is not equitable and open access for all. Another issue of access to care are those patients currently on Medicaid. Their access to care is limited to physicians who provide care to that group. Physicians get reimbursed at a much lower level for services provided to this group.

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Many physicians limit their patient practice to a small number of Medicaid patients. Subsequently, many Medicaid patients are subjected to minimal care in clinics where they may only see a nurse practitioner and /or get minimal treatment for health care issues. Without a primary physician many of these Medicaid patients utilize emergency room care for basic and preventative medical care. This in turn raises health care dollars for all. In looking at a way to fix Medicare in the arena of open access to opportunity for healthcare for all Americans equally, I feel we must first look at who is paying for this care. Well, the entire working population in America pays for the healthcare of all. People on Medicaid and Medicare are not part of the tax base that supports the Social Security, Medicare, and Medicaid programs. Contributions via taxes from the American workforce paychecks pay for these supportive trust funds. Currently, my paycheck is taxed at the rate of roughly 1% biweekly for Medicare, Social Security, as well as Federal and State taxes. I propose that we look at equality and fairness and enact a change in taxation. I feel that anyone receiving Medicaid, Social Security and Medicare have these entitlements taxed as well. I feel that the percentage levied may not be the same as those currently in the work force, but that we all need to contribute. I also feel that I am in favor of a Federal flat tax plan such as the one introduced by Cain in the Republican debates, the 9- 9- 9 plan. This plan makes a flat tax of 9 percent for individuals, 9 percent for corporations, and 9 percent national sales tax. My idea would be to lower corporate taxes to possibly keep corporations here in the US. This would bring back jobs for the unemployed, decrease unemployment, and increase funds going back into these entitlement programs. I would also hope that maybe those recipients on Medicaid might be

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inspired to seek out work in lieu of collecting welfare benefits that are sometimes generational in nature. President Obama is pro raising taxes, especially on the people who make more than $1 million dollars per year. This would shift the tax burden off of the middle class. Many Republicans, such as Ron Paul, Rick Perry, Newt Gingrich, Mitt Romney, and Rick Santorum are against raising Federal taxes. I am not surprised that taxes have stirred much political debate especially since we are in an election year (Con.org, 2012). As Americans we must also remember that in many other countries such as Canada, and in most European countries the citizens pay roughly 40 to 60 percent of their income directly to their government for their socialized government programs (Fowler, 2010). In America we pay roughly around 30 percent of our income through taxes, deductibles, co-pays, and premiums. There are some countries such as Switzerland who pay much less and still have a prosperous economy (Fowler, 2010). As a nation we need to look at the many facets to devise a plan for health care reform to ensure viability of our economy and future livelihood. We need to look at the role of all of the stakeholders in America. This includes government, pharmaceutical companies, corporations, entitlement programs, and possible privatization of Medicare, technology, physicians, tort reform, citizens, taxation, and retirement. There needs to be health care reform, change and cuts in many programs as well as a shared responsibility for equality, and open access to healthcare for all. There will continue to be arguments between the Democrats who want to increase taxes for the wealthy and the Republicans who dont want to. We need to look at who we put in office and what they stand for. There will be discussions of privatizing Medicare and socialized medicine and end-of-life issues. One thing is for sure. We need to figure this out and soon!

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In closing, the goal of health care reform is to provide quality, affordable health care for all Americans (Policy, 2009). There is no one answer to a way to fix Medicare. The Medicare debate is about social justice and equality for all Americans. We must all look at what equality means for all as well as ethics in providing medical care for the elderly amid new technology that continues to lengthen and improve the quality of our lives as we age. What is our definition of quality of life? How will we pay for this technology and at what cost? Medicare cannot continue to pay for this new medicine thats just beyond the horizon. We need to fix who will, and soon. I am a baby boomer and I thought my retirement was just around the corner. Now I know that retirement may be a thing of the past for many of us.

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References

Altman, S. H., & Shactman, D. I. (2002). Policies For An Aging Society. Baltimore & London: The Johns Hopkins University Press. Con.org, P. (2012, January 19). Should any federal taxes be increased? 2012 Presidential Election. Retrieved from Pro Con.org: http;//2012election.procon.org/view.answers.election.php?questionID Fowler, J. (2010, February 4). 12 Countries With the Highest and Lowest Taxes. Retrieved from Business Pundit: http://businesspundit.com/12-countries-with-lowest-taxes/ Lerner, G. (1997). Why History Matters. Oxford University Press. Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2012). Policy & Politics In Nursing And Health Care. St. Louis: Elsevier. Policy, G. R. (2009, August). The Truth about Medicare and Health Care Reform. Retrieved from National Committee to Preserve Social Security and Medicare: http://www.ncpssm.org/news/archive/qa_reform/ Schoenberg, N. (2011, February 11). Some pay for more doctor access. The Post Star. Stroud, M. (2011, July 19). Is a concierge doctor worht the cost? Retrieved from Reuters Money: http://blogs.reuters.com/reuters.com/reuters-money/2011/07/18/ia-a-concierge-doctor-worhtthe-cost/ Sullivan, P. (2011, April 29). Putting Your Doctor, or a Whole Tean of Them, on Retainer. Retrieved from The New York Times: http://www.nytimes.com/2011/04/30/your-money/30wealth.html