Social Security, or more specifically, Medicare, is one of the government's roles in health care today. In this essay I would like to discuss the pros and cons of this system.

In 1935, Franklin D. Roosevelt signed the historic Social Security Act which helped to relieve the poverty in which many elderly found themselves when they could no loner work. Years later, in 1965, Medicare was added to the Social Security system. Medicare enables its participants to obtain health care which is an urgent need of both the elderly and the disabled. The main purpose of Medicare is to protect working people against serious financial problems in case of disablement or retirement, which is basically the same purpose of Society Security. The regular Social Security benefits were not enough because health care costs are so unpredictable and many times exhaust individual and family resources.

Few families could meet the costs of serious illness without some kind of insurance help.

Medicare is divided into two sections, part A and part B. Part A pays back the providers for the reasonable cost of hospitalization, most in-hospital services, and in-hospital drugs. Part A is also known as "hospitalization insurance." In addition, a person hospitalized under hospitalization insurance qualifies for skilled nursing, institution care for a limited period and for home health care for longer periods. All people eligible for Social Security cash benefits and age 65 years or older, qualify.

Part B, also known as "Supplementary Medical Insurance," indemnifies participants for physicians' and surgeons' fees, and in-hospital services. SMI also covers various supportive services, such as ambulance transportation. To qualify for the Supplemental Medical Insurance, a person 65 years and over, or disabled, must choose this coverage and pay a monthly premium.

Concern over the future of Medicare focuses on the growing number(s) of the elderly and the rising prices of hospitalization and medical services. Also there is concern that because doctors are being reimbursed by Medicare that they may overuse hospitalization and call for unneeded services.It is important to remember that medical care has changed greatly since 1966 (Medicare's first year). The current unit of service is no the same as the 1966 unit of service. The daily cost of a hospital room in 1966 was $100 a day and today it is over $500 a day, so it is hard to say that inflation has caused higher hospitaliza- tion rates; medical technology has a higher price tag than most take into consideration.

The combination of rising prices, increased and more expensive services has really increased the cost. Greater numbers of users has also driven the cost of Medicare costs much higher. So how do we fit it?

Cost control is a big factor. In recent years, effort has been concentrated on stopping price increases and discouraging unnecessary hospital-based services. Another method is prepayment in which the providers (hospital doctors) promise to supply services to the participants for a fixed periodic fee. Under this plan, giving services the patient doesn't need increases the providers cost but not the providers' income. Health Maintenance Organizations (HMOs) also attempt to make Medicare work most profitably. HMOs are quite similar to the prepayment plan, but are used by private organizations.

Some might say, "Why not get rid of the whole program." Raising the age of eligibility for Medicare is the major proposal to accomplish that goal.There is some validity in this argument. If the eligibility age would have been raised from 65 to 67 years starting in the mid-80s,it would have saved Hospitalization Insurance almost $75 billion by 1995 and Supplemental Medical Insurance $5 billion by 1989. Since 1966 longevity has increased by more than 3 years, which could be attributed to Medicare. This development, proponents of raising the eligibility age would say, changes the ratio of old to young.

Another proposal would be to limit Medicare to those who have a financial need. This would supposedly reduce the number of participants. This proposal is based on the assumption that a large group of those who receive Medicare benefits could afford other equivalent health insurance.

Given the low incomes of most of the Medicare beneficiaries, the low number of those 65 and older still working, and the rapidly increasing cost of medical care, the basic premise of this proposal is quite inaccurate. With longevity increasing, the number of elderly with chronic conditions and those with a small capacity for independent living will grow. Not all older people are dependent on others. Most can meet their own needs daily and then some. But as they get older, one's capacity to do all the daily tasks does diminish at some point. What we ought to do is explore new arrangements for cooperating living, in the interest of better lives and less expense. Independent living gives human dignity while reducing the need and expense of institutionalization.

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