Medicare. An administrative viewpoint

Abstract

Medicare was the first significant legislation that provided a health insurance program for a segment of our nation's population, initially for the elderly population and then expanded to include other chronically ill patients that in a sense are high risk. It provided a recognition for the special services of doctors of podiatric medicine as equivalent to the services provided by other practitioners. What we fail to recognize many times is that Congress, as representatives of the people, projected a need for podiatric care in this particular entitlement program. It provides a scope of practice for podiatrists that is governed by state law, which also is a mandate of the people. The individual state practice acts are again the will of the people through their state legislatures, which established the need and recognition for podiatric care. The system designed by Medicare provides for fiscal intermediaries, who are the insurance carriers that administer the program. Each carrier then establishes its own guidelines to deal with the medical policies of the program. The local guidelines for each state or area are additional documents that need to be reviewed for local modifications of the Medicare regulations. There are four options for patient payment: assignment, direct payment by the patient, billing the patient followed by patient payment upon receipt of his or her Medicare payment, or the selection of a health maintenance organization or similar private insurance option. Under this fourth option, the patient gives up his or her right to direct podiatric care, which is clearly a violation of the intent of the legislation that added podiatric medicine to Medicare in 1967. Given the changes that take place in any system, the original intent of Medicare was to provide an availability and access for podiatric care as required by the patient. To modify the system to change that intent without a change in law is morally, ethically, and legally questionable.