10/22/2012 08:44 pm ET Updated Dec 06, 2017

Medicare: 'Chronicle of a Death Foretold'

In light of the upcoming presidential election, many people are anxious about possible changes that may face Medicare. It is seen as a crucial economic issue within politics; however, one can argue that it is rather a great historical demonstration and opportunity for change in our idiosyncrasy.

First, let's recall how Medicare got started: It is passed into law in 1965 by the administration headed by President Lyndon Johnson in response to a large number of people over 65 that were uninsured and/or underinsured. This was after Congress had introduced its first proposal for mandatory health care insurance, which had been conceived towards the end of President Harry Truman's administration in 1953.

During that time, Truman's vision was somewhat similar to what the Democratic party envisions today as "universal health care", also including the same criticism by conservatives about the risk of running "socialized health care". Nonetheless, we can see how such disputes begin at inception.

It is of public opinion that the reason why Medicare has spiraled out of control is because of bad administration. However, a relevant study published by HealthAffairs, stated that in the year 2000, private insurers spent $391 billion in medical care for their members, whereas Medicare only spent $271 billion, concluding that Medicare was more efficient in cost containment than its private counterparts. Moreover, the study observed that Medicare enrollees were far more satisfied with their care than those with private health insurance.


Based on this research and other information, I think that for many years, both members and health care providers got accustomed to a having a "magical card" that would pay for any medical service, and if it wouldn't, it could be manipulated to do so. It is like having a corporate credit card, to which one would charge everything to, and then fight it out with the billing department the following month.

Some may argue that a significant portion of claims to Medicare for health care services are, in fact, are legitimate -- especially for people strapped for resources, and that such "manipulation" was necessary to provide critical care in a timely manner, given the complexity that the system is infamous for. On the other hand, there have been a vast number of high impact fraud cases over the last couple of decades.

The core problem that Medicare faces cannot be entirely blamed to its first members, but rather understand that a culture of excess and peer pressure, for which we are known, spawned a "perfect storm". The fixes, coming into place very late in the game, after the damage is irreversible. It is the typical "who cares" and "we are too big to fail" attitude that has brought the many perils our society faces today.

With no clear awareness of the possible future impact of such behavior among Medicare enrollees, as time goes on, the solutions become political, rather than tackling the root cause of the problem -- idiosyncrasy.

Another factor to consider is that the reimbursement and claims process is completely outside of the hands of its members, and that because the health care provider itself is fulfilling this process, it is an obvious conflict of interest. This is exacerbated by patient ignorance and lack of interest in such.

Not many people understand that health care services have to be translated to a uniform set of procedure and diagnostic codes, which are again carried out by the provider. Thus, one can argue that this provides opportunities for "coding" services such that a higher reimbursement is attained. Also, note that administrative personnel, rather than health care professionals themselves, often perform such tasks.

Proponents of universal health care are eager to point out success stories in other countries, but the reality is that we cannot compare ourselves to these countries, because our idiosyncrasy is fundamentally different. In addition, such countries have far more years of history behind than us, such that their society could be considered more mature.

As a South American expat, it took me a while to understand how the health care system in the United States works. I thought it was normal to pay first before receiving medical services, and that if one were not able to pay, most likely, one would not receive care -- since public hospitals always lacked resources. On the contrary, in the United States, all medical services are rendered first, and then the hospital figures out how to get paid. If the patient cannot pay, then it becomes a responsibility of the government.

The trillion-dollar question at hand is whether health care is truly a right or a privilege.

In conclusion, the inevitable fall of Medicare will be caused in part by the irresponsible behaviors of members and providers over time, and mostly because of the way the system was designed. As the famous Colombian author Gabriel Garcia Marquez would say, it is a "chronicle of a death foretold".