HEALTH MATTERS: Medicare vs. Medicaid

• Dr. Joshua Wynne

Dr. Joshua Wynne

Talk about it

Q. What’s the difference between Medicare and Medicaid?

A. Both Medicare and Medicaid are federal health insurance programs. Medicare is a fully federal program that relies on a combination of general taxes, payroll taxes and individual contributions from beneficiaries for funding.

It mainly covers people 65 and older, and some other groups, including disabled Americans and those with end-stage chronic kidney disease. There are four parts to Medicare: Part A, covers hospital care; Part B, covers outpatient care; Part C, a program providing coverage through private insurance companies; and Part D, provides prescription drug coverage.

Medicaid, on the other hand, is a federal and state partnership, with states providing anywhere from about one-quarter to one-half of the total cost depending on the wealth of the state, and the federal government paying the rest. In North Dakota, the state share is about 30 percent.

Unlike Medicare, Medicaid is means-tested, and is for people with low incomes. A major fraction of its expenditures are for the disabled and mainly older adults who are in long-term care.

Q. I see ads for screenings performed for various forms of hardening of the arteries, such as the blood vessels in the neck. Since these tests often require out-of-pocket expenditures, are they a good idea?

A. Atherosclerosis, or plaque buildup that occurs in the arteries, often is a diffuse process and can simultaneously involve the arteries that go to the legs, brain and heart.

Since narrowing of these vessels can lead to a variety of problems, it makes some sense to look at the arteries before problems develop to see if severe complications can be avoided. Looking at the plaque buildup is safe, easy and typically uses an ultrasound machine.

There are three major problems with this type of screening for subjects who have no symptoms suggesting a blockage. It costs money, a lot of people have to be screened to prevent one heart attack or stroke and the findings often don’t change how the patient is managed.

The last issue is most important. If I found out my patient has a significant blockage and no symptoms, I’d recommend quitting smoking, a low cholesterol diet or medication, control of high blood pressure, sensible exercise, and perhaps a baby aspirin a day.

But I’d recommend all of these even in patients without blockages. So, in most patients, I wouldn’t necessarily do anything different from a management standpoint. The one major exception (and there are a few others) is someone with no symptoms but who has a severe blockage in a neck vessel.

In this case, there is reason to consider surgery rather than just medical therapy. But in most patients who are at low risk for atherosclerosis, I don’t think routine screening is such a good idea.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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