Skip to main content

Medicare

  • Chapter
  • First Online:
Chronic Illness Care

Abstract

Medicare plays a central role in American medical care and is enormously important for persons with chronic illnesses. For over 50 years, Medicare has provided health insurance to older Americans, ensuring their access to medical services and a measure of financial security during retirement. Since 1972, the program has additionally insured persons with permanent disabilities and end-stage renal disease. In 2016, Medicare covered over 57 million persons. That number will climb substantially during the next decade as the baby boom generation retires. Medicare also has an enormous role in shaping health-care payment and delivery. Medicare is the single largest purchaser of medical services in the United States and a major source of income for physicians, hospitals, and other medical providers. The decisions that Medicare makes about how to pay providers, and what types of medical care delivery to promote and experiment with, reverberate across American medicine. The future of payment and delivery reform depends in no small part on their fortunes in Medicare.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cubanski J, Neuman T. The facts on Medicare spending and financing. Henry J. Kaiser Family Foundation. Available from: http://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/. Accessed 17th July 2017.

  2. Berenson RA, Horvath J. Confronting the barriers to chronic care management in Medicare. Health Aff. 2003.; web exclusive;W3:w37–53.

    Google Scholar 

  3. Marmor TR. The politics of Medicare. Chicago: Aldine Publishing Company; 1973.

    Google Scholar 

  4. Starr P. The social transformation of American medicine. New York: Basic Books; 1982.

    Google Scholar 

  5. Oberlander J. The political life of Medicare. Chicago: University of Chicago Press; 2003.

    Google Scholar 

  6. Oberlander J, Marmor TR. The road not taken: what happened to Medicare for all? In: Cohen AB, Colby DC, Wailoo KA, Zelizer JE, editors. Medicare and Medicaid at 50: America’s entitlement programs in the age of affordable care. New York: Oxford University Press; 2015. p. 55–74.

    Google Scholar 

  7. Cubanski J, Swoope C, Boccutti C, Jacobson G, Casillas G, Griffin S, Neuman T. A primer on Medicare: key facts about the Medicare program and people it covers. Henry J. Kaiser Family Foundation. Available from: http://files.kff.org/attachment/report-a-primer-on-medicare-key-facts-about-the-medicare-program-and-the-people-it-covers. Accessed 17th July 2017.

  8. Centers for Medicare and Medicaid Services. Medicare & you 2017. Available from: https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf. Accessed 17th July 2017.

  9. Davis PA, Talaga, Binder C, Gopalan SV, Hahn J, Kirchoff SM, Morgan PC, Villagrana MA. Medicare primer. Congressional Research Service. Available from: https://fas.org/sgp/crs/misc/R40425.pdf. Accessed 17th July 2017.

  10. Oberlander J. Medicare. In: Beland D, Howard C, Morgan KJ, editors. The Oxford handbook of U.S. social policy. New York: Oxford University Press; 2015. p. 296–314.

    Google Scholar 

  11. Henry J. Kaiser Family Foundation. Medicare enrollment. Available from: http://www.kff.org/state-category/medicare/medicare-enrollment/. Accessed 17th July 2017.

  12. Henry J. Kaiser Family Foundation. An overview of Medicare. Available from: http://www.kff.org/medicare/issue-brief/an-overview-of-medicare/. Accessed 17th July 2017.

  13. Center for Medicare and Medicaid Services. Chronic conditions among Medicare beneficiaries chartbook: 2012 edition. Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Downloads/2012Chartbook.pdf. Accessed 17th July 2017.

  14. Jacobson G, Damico A, Neuman T, Gold M. Medicare advantage 2017 spotlight: enrollment market update. Henry J. Kaiser Family Foundation. Available from: http://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/. Accessed 17th July 2017.

  15. Yamomoto D, Neuman T, Kitchman Strollo M. How does the benefit value of Medicare compare to the benefit value of typical large employer plans? A 2012 update. Henry J. Kaiser Family Foundation. Available from: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7768-02.pdf. Accessed 17th July 2017.

  16. Schlesinger M, Wetle T. Medicare’s coverage of health services. Renewing the promise: medicare and its reform. New York: Oxford University Press; 1988. p. 58–89.

    Google Scholar 

  17. Cubanski J, Boccuti C. Medicare coverage, affordability, access. Generations. 2015;39(2):26–34.

    Google Scholar 

  18. Center for Medicare and Medicaid Services. NHE fact sheet. Available from: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html. Accessed 17th July 2017.

  19. 2016 Annual report of the boards of trustees, federal hospital insurance and federal supplementary medical insurance trust funds. Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2016.pdf. Accessed 17th July 2017.

  20. Davis K, Guterman S, Bandeall F. The affordable care act and medicare. The Commonwealth Fund. Available from: http://www.commonwealthfund.org/~/media/files/publications/fund-report/2015/jun/1821_davis_aca_and_medicare_v2.pdf. Accessed 17th July 2017.

  21. Cutler DM, Davis K, Stremikis K. The impact of health reform on health system spending. The Commonwealth Fund. Available from: https://cdn.americanprogress.org/wp-content/uploads/issues/2010/05/pdf/system_spending.pdf. Accessed 17th July 2017.

  22. Oberlander J, Morrison M. Failure to launch? The independent payment advisory board’s uncertain prospects. N Engl J Med. 2013;369(2):105–7.

    Article  CAS  PubMed  Google Scholar 

  23. Feder JM. Medicare: the politics of federal hospital insurance. Lexington: D.C. Heath; 1977.

    Google Scholar 

  24. Laugesen MJ. Fixing Medicare prices: how physicians are paid. Cambridge, MA: Harvard University Press; 2016.

    Book  Google Scholar 

  25. Nixon R. Special message to the congress proposing a national health strategy. Available at: http://www.presidency.ucsb.edu/ws/?pid=3311. Accessed 17th July 2017.

  26. Mayes R, Berenson RA. Medicare prospective payment and the shaping of U.S. health care. Baltimore: Johns Hopkins University Press; 2006.

    Google Scholar 

  27. White C. Why did Medicare spending growth slow down? Health Aff. 2008;27(2):793–802.

    Article  Google Scholar 

  28. White C, Ginsburg PA. Slower growth in Medicare spending—is this the new normal? N Engl J Med. 2012;366(12):1073–5.

    Article  CAS  PubMed  Google Scholar 

  29. White C, Cubanski J, Neuman T. How much of the Medicare slowdown can be explained? Insights and analysis from 2014. Henry J. Kaiser Family Foundation. Available from: http://www.kff.org/medicare/issue-brief/how-much-of-the-medicare-spending-slowdown-can-be-explained-insights-and-analysis-from-2014/. Accessed 17th July 2017.

  30. Reinhardt UE. Medicare innovations in the war over the key to the US treasury. In: Cohen AB, Colby DC, Wailoo KA, Zelizer JE, editors. Medicare and Medicaid at 50: America’s entitlement programs in the age of affordable care. New York: Oxford University Press; 2015. p. 169–89.

    Google Scholar 

  31. Miller ME. Improving care for Medicare beneficiaries with chronic conditions. Statement before the Committee on Finance, U.S. Senate. Available from: http://www.medpac.gov/docs/default-source/congressional-testimony/testimony-improving-care-for-beneficiaries-with-chronic-conditions-senate-finance-.pdf?sfvrsn=0. Accessed 17th July 2017.

  32. Center for Medicare and Medicaid Services. Readmissions reduction program (HRRP). Available from: https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html. Accessed 17th July 2017.

  33. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418–28.

    Article  CAS  PubMed  Google Scholar 

  34. Mechanic R. Medicare’s bundled payment initiatives: considerations for providers. American Hospital Association. Available from: http://www.aha.org/content/16/issbrief-bundledpmt.pdf. Accessed 17th July 2017.

  35. Bodenheimer T, Gurmbach K. Understanding health policy: a clinical approach. 6th ed. New York: McGraw Hill; 2012.

    Google Scholar 

  36. Center for Medicare and Medicaid Services. Bundled payments for care improvement (BPCI) initiative: general information. Available from: https://innovation.cms.gov/initiatives/bundled-payments/. Accessed 17th July 2017.

  37. Berenson RA, Burton RA. Next steps for ACOs. Health Affairs Policy Brief. Available from: http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_61.pdf. Accessed 17th July 2017.

  38. Centers for Medicare and Medicaid Services. Medicare shared savings program quality measure benchmarks for the 2016 and 2017 reporting years. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/MSSP-QM-Benchmarks-2016.pdf. Accessed 17th July 2017.

  39. Rosenthal MB. Physician payment after the SGR-the new meritocracy. N Engl J Med. 2015;373(13):1187–9.

    Article  PubMed  Google Scholar 

  40. Oberlander J, Laugesen MJ. Leap of faith—Medicare’s new physician payment system. N Engl J Med. 2015;373(13):1185–7.

    Article  PubMed  Google Scholar 

  41. Burwell SM. Setting value-based payment goals—HHS efforts to improve US health care. N Engl J Med. 2015;372(10):897–9.

    Article  CAS  PubMed  Google Scholar 

  42. HSS just hit a big value-based payment milestone: here’s what happens next. The Advisory Board. Available from: https://www.advisory.com/daily-briefing/2016/03/04/obama-administration-reaches-2016-value-based-payments-goal. Accessed 17th July 2017.

  43. Zuckerman RB, Sheingold SH, Oray EJ, Ruther J, Epstein AM. Readmissions, observation, and the hospital readmissions reduction program. N Engl J Med. 2016;374(16):1543–155.

    Article  CAS  PubMed  Google Scholar 

  44. Baseman S, Boccuti C, Moon M, Griffin S, Dutta T. Payment and delivery system reform in Medicare: a primer on medical homes, accountable care organizations, and bundled payments. Henry J. Kaiser Family Foundation. Available from: http://files.kff.org/attachment/Report-Payment-and-Delivery-System-Reform-in-Medicare.pdf. Accessed 17th July 2017.

  45. Doran T, Maurer KA, Ryan AM. Impact of provider incentives on quality and value of health care. Ann Rev Public Health. 2017;38:449–65.

    Article  Google Scholar 

  46. Song Z, Fisher ES. The ACO experiment in infancy. JAMA. 2016;316(7):705–6.

    Article  PubMed  Google Scholar 

  47. McWilliams JM. Savings from ACOs—building on early success. Ann Intern Med. 2016;165(12):873–5.

    Article  PubMed  PubMed Central  Google Scholar 

  48. McWilliams JM, Hatfield LA, Chernew ME, Landon BE, Schwartz AL. Early performance of accountable care organizations in Medicare. N Engl J Med. 2016;374(24):2357–66.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Navathe AS, Troxel AB, Liao JM, Nan N, Zhu J, Zhong W, Emanuel E. Cost of joint replacement using bundled payment models. JAMA Intern Med. 2017;177(2):214–22.

    Article  PubMed  Google Scholar 

  50. Marmor TR, Oberlander J, White J. The Obama administration’s options for health care cost control: hope versus reality. Ann Intern Med. 2009;150(7):485–9.

    Article  PubMed  Google Scholar 

  51. Marmor TR, Oberlander J. From HMOs to ACOs: the quest for the holy grail in U.S. health policy. J Gen Intern Med. 2012;27(9):1215–8.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Vladeck B. Roundtable on Medicare physician payments: understanding the past so we can envision the future — statement before the Committee on Finance, U.S. Senate, May 10, 2012.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jonathan Oberlander .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Oberlander, J. (2018). Medicare. In: Daaleman, T., Helton, M. (eds) Chronic Illness Care. Springer, Cham. https://doi.org/10.1007/978-3-319-71812-5_39

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-71812-5_39

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71811-8

  • Online ISBN: 978-3-319-71812-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics