Future of the United States Medicare


The U.S. healthcare system has contributed considerably to the improvement in life expectancy and quality of life. In spite of its improvements, the health care delivery system faces important challenges in cost, accessibility as well as quality. In recent years, hundreds of conventions and workshops have been organized to find out problems and recommend solutions. Suggested solutions lacked indications of success in practice or have been delayed due to dissatisfaction of stakeholders. Consequently, valuable system advances have never been defined clearly which is why it is expected that the healthcare-delivery system is not ready enough for changes.

The present healthcare-delivery system is in equilibrium based on analysis of studies and has been indicated that each of its subsystems has established a way to function within the dysfunction and illogicality of the whole system. Therefore, efforts to repair one subsystem predictably fail because the change is unsuited with other subsystems (RCHE Publications, 2006).

Health policy in the United States began in earnest with the passage of Medicare and Medicaid in 1965. According to Jennings (2009), there will be no Medicare and Medicaid without its problems and negative consequences, like increasing costs, bureaucratic inflexibility, unnecessary regulation, red tape and paperwork, arbitrary and, at times, conflicting public directives, contradictory enforcement of rules and regulations, deception and cruelty, insufficient reimbursement schedules, insensitivity to local needs, and consumer and provider frustration. The current trend of the health care delivery system is that Medicare offers health insurance to all citizens over the age of 65 and to those who have disabilities. Medicaid was made as a joint business venture between the states and the federal government to give medical assistance to the unprivileged. Centralized contributions to state Medicaid programs differ and associate with the capital income of the state that links to the national average (Jennings, 2002). Medicare and Medicaid are seen to have contributed a new political aspect to health care policy deliberations. Sustenance of these privilege programs needed tough fiscal control and resource adjustments in different parts of public life. The involvement of politics and change of health care is a trend that has developed and sustained up to the current time. The political facet of the U.S. health care delivery system is often tackled in the direction of the administration party’s related health focus. Likewise, the government needs to balance the demand and supply of medical personnel, benefits and services.

Medicare and Medicaid started as open-ended, fee-for-service programs, and this led to a fascination with cost containment throughout the past decades. Moreover, there has been a growing public concern to decrease the number of persons who are uninsured or underinsured.

Current as well as future trends seize the promise of giving better tools to practitioners and policymakers to direct change and increase quality and access while decreasing costs. At this time, the American health care system is becoming more directed and united; it has become more cost and quality responsible; it is more consumer-focused as well as more communication and information technology-oriented. According to the study of Jennings (2002), the U.S. health care delivery system has undergone vast changes in the past 100 years. Scientific improvements together with the increased difficulty of the health care workforce have added to a health care delivery system with a worldwide standing for excellence in physician and nurse education programs and biomedical research that other industrialized countries have long desired. Deficiencies attributed to the existing system include a lack of widespread availability of primary health care, elevated infant mortality rates and a fixed growth of the uninsured in the United States. Rising demand for care, for effective treatment of chronic conditions and the tremendous increase of people over the age of 65 persist to challenge system resources to find out for needed solutions and for remarkable change (Jennings, 2002).


Medicare, Vision for the Reform in Health Care Delivery System

As Medicare is predicted to run out of funds until 2030 or beyond, it has diffused the necessity of structural modification. Based on Welch’s (2001) observation, in the present time, Medicare does not meet the needs of the elderly. The impact of the aging baby boomers’ health demands is starting to be felt. Nevertheless, the most significant message to the current administration is that the people do not support piecemeal change. Medicare needs wide-ranging improvement to provide the elderly the same kind of health care package enjoyed by all national staff, elected constituents of Congress, through the Federal Employees Health Benefits Plan including choice, quality, access to advancement, the flexibility of benefits, and a system of modern cost management. This turn out to be more vital when one considers that the population is expected to multiply to 76 million beneficiaries by 2030; that citizens will live longer; that medical technology improvement will most likely keep increasing the cost of health care; and that the quantity of personnel supporting retirees will fall from 3.3 to 2.3 workers by 2030. The extra fund must be invested into Medicare, but during the Bush administration, the government is without comprehensive Medicare modernization. The former administration patronized Medicare modernization in the form of balancing budget amendment cuts, layering drug coverage onto the Medicare program, and placing cost controls on prescription drugs. It is serious that structural reforms in Medicare left the market to take action in altering beneficiary needs and advancing technology with a stable stream of pioneering products, many of which are presently indefinite. In this manner, improvements in the course of the health care delivery system will turn out to be foreseeable in relation to the current trends of affordable health services (Welch, 2001).

Future Trends in Health Care and its Impact in the Nursing Profession

The health care system is developing into a better and united direction as more cost and quality-responsible, more consumer-focused, and as more communication as well as information technology-driven. Those are the four trends in the health care delivery system that will exert an enormous impact on health experts, practitioners and the constituency. The present nursing and other personnel predicament and deficiency will drive changes within the whole health care delivery system. As health care grows to be more directed, more united and more cost and quality responsible, practitioners will need to become competent to fully integrate systems in which competition for contracts will be immense. Increasing a value perspective and judging specialized contributions accordingly will aid practitioners in upholding a competitive edge. Value is attained at the junction of cost, quality, choice, and access. Evidence-based practice protocols must be built up through investigation and practice and serve as the center for clinical learning in health care programs. Health care in the new millennium persists to change the focus of care from a single patient to the population of consumers. Medical professionals including doctors, nurses, and their counterparts with the help of education, practice and research, will be able to operate wellness, prevention, and primary care efficiently. These are necessary services in fully integrated systems. Health professionals function close to patients and they could serve as the glue that holds up-and-coming health systems together. As patient advocates, health care professionals are ideally suitable for assuming accountability for lifetime care across settings and for organizing services across disciplines that sooner or later contribute to the future higher advancement of the health care delivery system (Jennings, 2001).

The Next-Generation Atmosphere of Health Delivery System

The economic, political, and societal trends in the health care delivery system are implemented play a vital function and have a tremendous impact on healthcare in the present most especially, in the succeeding generation. There are amplified chances for collective action and knowledge development through which stakeholders seek for. In turn, inadequate resources are already inspiring organizations across the state to invest and become partners in the delivery of services specifically, health care services. Consequently, it was predicted that two specific trends will considerably influence healthcare in the next generation: healthcare delivery will be according on strong public and private-sector partnerships; and cost and quality pressures joint together with universal information portability will generate global markets for healthcare providers and consumers as well (RCHE, Publications, 2006).

Continuing the Path of Medicare Through Future Success

Based on the study of Vladeck (2005), it is really significant to be familiar with the programs that would have been profoundly ambivalent about their current success and popularity. Government officials earlier believed that Medicare can stand alone as a unique instance of national health insurance but the elderly and disabled are two of the groups in the U.S. without certain access to health care. Instead, Medicare was vested as of the first and incremental walk towards universal health care. Compared to the Social Security system on which Medicare was modeled, the SS had been enhanced and expanded upon several times in its first 30 years. Medicare was theoretically to be the foundation of future expansion in both vertical which is incorporating more of the populace and horizontal which is broadening the advantages. At first, Medicare stayed on the expected track that the 1972 Social Security Amendments extended. Medicare coverage was provided to the disabled and patients with end-stage renal illness and provided some humble benefits. Since then, though, it has been stalled, if not reverted. The 2003 prescription drug legislation invested a lot of additional capital into the program, but there is no consistency with Medicare’s founding principles of universality and defined benefits.

The implication of Medicare Cost

The high health care costs in the U.S. among the elderly population are mainly due to Medicare expenses for acute and post-acute care at 65 to 84 years old and to long-term care. Medicaid spending above age 85 and the cost inferences of the latest technological improvements in health care in the United States may be explicable. The latest health care technology is most likely to affect acute and post-acute care provided at age 65 to 84 for healing or even regenerative reasons. This gives the possibility of delivering data that will eventually contribute to the development of the health care delivery system (Manton, 2007).

Finance and System Reform

Although the U.S. health care system has made remarkable improvements, it is expensive and extravagant, and it leaves many citizens without suitable care. The challenge for public strategy is to allow consumers and taxpayers to attain good value for their health care currency. Attaining this point stands the greatest chance of success if health care markets function well. To make markets work, changes in five areas of public policy are needed. These include tax reform, insurance reform, enhanced provision of data, improved rivalry, and malpractice change. Policy reforms will advance the output of the health care system, make insurance more inexpensive, reduce rates of uninsured, and increase tax equality and progressivity (Habbard, 2005). In spite of spending the most on health care, the United States lags behind other developed nations on many extents of health system performance. Formulated in July 2005, the Commonwealth Fund’s Commission on a High-Performance Health System looks for a course to chart for a U.S. health care system that offers significantly expanded access, advanced quality, and greater capability for all Americans, especially those who are most susceptible. In this consensus declaration, the Commission identifies high performance and outlines its visualization of a distinctively American, high-performance health system. It then defines the most critical bases of the existing system’s failures and offers a tactical framework for addressing them through detailed measures (Commonwealth Fund, 2006).


The recent concern shown by the US President about health care signals a time in the history of the U.S. for a major change in the health care delivery system. It is a time of vast opportunity not only for doctors, specialists, nurses and other health care professionals but also for private institutions and policy-makers to adopt to fitting changes that correspond with the demands of the time. In the wake of the scarcity of health service provision in most patient care settings, health care professionals have tremendous influence to chart the path for the redesign of work settings, educational curricula, and investigative agendas. It is also a time to genuinely collaborate with other related agencies for the good of patients and to pool resources with other industries. Each health profession has its unique view of the patient’s needs, its own language, and an intensely territorial view of its participation in the care process, and with that of the Medicare itself. To hold consumer respect and confidence, all health professionals must actively exert effort to ensure that sufficient supply of highly educated, diverse, and geographically distributed health professionals is onboard. Likewise, the future of the health care delivery system requires the necessary solutions to the medical field and resource shortage should be addressed from a long-range perspective.

Past analyses of the said dilemma have assumed that models of practice stay steady while assessments of the oversupply or undersupply of the health workforce are measured only within the reality of existing model contexts. Today, health care needs to suggest new models and estimate the impact of deficiency in light of new health care workforce supply and required scenarios. Health service organizations will go after this kind of thinking. There are no quick solutions with the issues regarding health care delivery system; a longer time for analysis is a worthy one. The future is uncertain without this sort of effort; the time for kind action is now.


  1. Hubbard, R. (2005). Making markets work: Five steps to a better health care system. Health Affairs 24(6): 1447-1457.
  2. Jennings, C. (2001).The Evolution of U.S. Health Policy and the Impact of Future Trends on Nursing Practice, Research, and Education Policy Polit Nurs Pract; 2; 218. doi: 10.1177/152715440100200310
  3. Jennings, C. (2002). Medicare, Past, Present, and Future: A Policy Perspective. Policy Polit Nurs Pract; 3; 57. doi: 10.1177/152715440200300108
  4. Manton, K. (2007). Medicare Cost Effects of Recent U.S. Disability Trends in the Elderly: Future Implications. Aging Health; 19; 359. doi: 10.1177/0898264307300186
  5. RCHE Publications. (2006). Healthcare-Delivery System for the Next Generation
  6. The Commonwealth Fund Commission on a High Performance Health System, (2006). Framework for a High Performance Health System for the United States, The Commonwealth Fund. 
  7. Vladeck, B. (2005). Medicare’s Future: Finishing What We Started. The Commonwealth Fund. 
  8. Welch, C. (2001). Medicare: Visions for Reform. Policy Polit Nurs Pract; 2; 95. doi: 10.1177/152715440100200202
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