Medicare then and now

By Charles R. Mathews, M.D.
This pulmonologist was plying his profession in upstate New York some 44 years ago when his receptionist announced, “The White House is calling!” I assumed it was a hoax, since my only direct contact with that eminent residence had been limited to passing through as a tourist.
But my receptionist persisted and connected me to the caller, who inquired whether I’d be available for a “presidential meeting on Medicare’s implementation” to take place in Washington on June 15, 1966.
The invitation, which was shortly confirmed by telegram, was not to be declined. I was more than a bit surprised, since I’d been actively supporting the American Medical Association’s campaign to stave off the inroads of government into our medical domains, decrying and demonizing Medicare as “socialized medicine.”
But President Lyndon B. Johnson, the consummate politician, was able to draw me and many others into the orbit of his Great Society programs by dint of his overwhelming electoral triumph in 1964. His formidable political capital helped win passage of civil rights and anti-poverty legislation, aid to education, and, of most consequence to us physicians and our patients, Medicare and Medicaid.
About 200 of us from all 50 states attended the meeting. We were whisked into the East Room, where, because of its small size, we barely had room to breathe. (Take it from a lung doctor.) Minutes later, the president took the podium and delivered a moving half-hour address.
“For the first time in the history of America,” Johnson said, “every senior citizen will be able to receive hospital care – not as a ward of the state, not as a charity case, but as an insured patient.”
The changes had been breathtaking. Medicare had been enacted into law just one year before, on July 30, 1965, and here we were, assessing its progress. But certainly more remained to be done.
For example, the president noted that some 20 percent of the nation’s hospitals were not in compliance with the Civil Rights Act. Over 90 percent of hospitals in the South were still segregated.
“We believe the answer to that problem is a simple one,” LBJ said, noting that hospitals had been put on notice that their Medicare reimbursement payments would be contingent on their compliance with the Civil Rights Act’s ban on any discrimination based on race, color or national origin.
While the desegregation process was sometimes slow, “whites only” hospital wards were ultimately consigned to the dustbin of history, and Medicare had played an honorable part in their abolition.
Forty-five years have passed since Medicare became the law of the land. It’s hard to overstate the beneficial effect it’s had on the health and financial security of our nation’s seniors and their families. It remains absolutely essential for persons over 65 and for those with severe disabilities or end-stage renal disease.
But it faces new challenges. The basic Medicare program worked well for many years as an efficient, not-for-profit system with a standard benefit package for all enrollees. However, beginning with the passage of the Balanced Budget Act of 1997, the private, for-profit health insurance companies began to more aggressively bore their way into the program with the aim of siphoning off public and beneficiary dollars.
They’ve succeeded in doing so through their Medicare Advantage plans (which offer some additional benefits but which don’t improve overall quality, even as they rack up much higher overhead expenses than traditional Medicare) and through a prescription drug program that boosts insurance and drug company profits.
Partially as a consequence, health costs continue to skyrocket.
It is clear to me that President Johnson’s original vision of providing universal access to health care through an equitable, publicly financed plan is one that we must turn to again. It’s the only approach that is sustainable and just.
We need an improved Medicare for all. Research shows the $400 billion in savings we’d reap from eliminating all the excess paperwork and bureaucracy associated with the private insurance industry, plus the cost-control tools we’d acquire have like bulk purchasing of medications, would be enough to assure high quality, affordable and comprehensive care for everyone over the long haul.
It remains to be seen how long the health care oligarchs, particularly the private insurers and Big Pharma, can forestall this badly needed solution. They managed to do so this round of reform. But its day must come.
Charles R. Mathews is a Tallahassee, Fla., physician and a member of Physicians for a National Health Program (www.pnhp.org).