LBJ signing Medicare legislation, July 30, 1965. Truman – in black – looks on. Mrs. Johnson – in blue – and Mrs Truman – in yellow – stand behind their husbands while VP Humphrey grins. (wikipedia)
It’s As American As Apple Pie
By Doug Porter
On July 30, 1965 President Lyndon Johnson signed legislation creating the Medicare program. After more than five decades of failed attempts dating back to President Theodore Roosevelt, at least some Americans were eligible for coverage under a federal health insurance program.
Today more than 54 million people are covered by Medicare. It’s far from perfect, but it’s a damn sight better than the alternatives being proposed by the GOP. In fact, many of the problems facing medicare can be addressed by e x p a n d i n g the program, an idea gaining currency nationally.
Registered nurses are leading the way, with actions in over 25 U.S. cities July 30th to honor Medicare and Medicaid’s 50th anniversary with a National Day of Action celebrating the theme, “Medicare is as American as Apple Pie.” (The nearest local action is in LA) They’re calling on policy makers to protect, improve, and expand Medicare to cover all Americans with a single standard of quality care not based on ability to pay.
50 Years of Health Care
Medicare was created in lieu of national health insurance programs covering every person in the United States, like the one proposed by President Harry S. Truman in 1945.
From the Harry S. Truman Library:
President Truman’s health proposals finally came to Congress in the form of a Social Security expansion bill, co-sponsored in Congress by Senators Robert Wagner (D-NY) and James Murray (D-MT), along with Representative John Dingell (D-MI). For this reason, the bill was known popularly as the W-M-D bill. The American Medical Association (AMA) launched a spirited attack against the bill, capitalizing on fears of Communism in the public mind. The AMA characterized the bill as “socialized medicine”, and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers “followers of the Moscow party line”.
As John Wilkens pointed out in a Union-Tribune article looking back (and forward) on Medicare:
In truth, the idea predated Truman. It was raised in the early 1900s, after similar “social insurance” programs were adopted in Europe. Then World War I happened, and the Russian Revolution of 1917, and anything seen as potentially socialist was viewed with suspicion. A vote in California on public health insurance lost by a 2-1 margin. A bill in New York passed the Senate but not the Assembly. The movement collapsed.
The Great Depression revived it. President Franklin Roosevelt appointed a committee to study ways to provide “economic security” for the nation’s most vulnerable citizens, and out of that Social Security was born in 1935.
It’s also important to remember Medicare led to the racial integration of medicine by making payments to health care providers conditional on desegregation. In 1964, about 50 percent of seniors were uninsured, according to the Center for American Progress. Today only 2 percent are uninsured, thanks to Medicare..
The GOP Plan, or Lack Thereof
Republican orthodoxy these days holds that the program needs to go away, to be replaced by block grants or vouchers. We’re told by their pet prognosticators the system is headed for bankruptcy, that it will swallow up the federal budget. And we’re supposed to not remember the past, when these ideologues opposed the program and spewed innumerable falsehoods in their quest to block it.
Despite the blusterings of GOP candidates like Jeb Bush, the GOP strategy towards Medicare has been to chip away at the program whenever possible. Back in June the party leadership tried to trim $950 million from Medicare as part of the horse trading over a deal giving President Obama fast-track authority to approve trade agreements.
This pattern of chipping away and undermining fits the general pattern of conservative attacks on government programs: find a way, either through budget cuts, mis-management, or poison pills inserted into legislation, to denigrate public trust and then propose privatization as the “common sense” cure.
None of these replacement programs would actually benefit people over time, except those folks lucky enough to own stock in the companies profiting off them.
Grow the Program
Now is the time to follow through by expanding Medicare to everyone, and to improve the program.
Here’s economist and former treasury secretary Robert Reich:
The fact is, Medicare isn’t the problem. In fact, it’s the solution.
Its costs are being pushed upward by the rising costs of health care overall – which have slowed somewhat since the Affordable Care Act was introduced but are still rising faster than inflation.
Medicare costs are also rising because of the growing ranks of boomers becoming eligible for Medicare.
Medicare offers a way to reduce these underlying costs – if Washington would let it.
Spend More, Get Less
The US spends more than two and a half times the average of other advanced nations on private and public health care (and we get less for our money). In terms of per capita spending, we’re number one.
From Wikipedia (sources cited):
Bloomberg finds “the U.S. spends the most on health care on a relative cost basis with the worst outcome”[4] and notes Cubans live longer than Americans, but Americans pay more than fourteen times as much for less effective health care. The Commonwealth Fund ranked seven developed countries on health care, the US ranked lowest[5](AU, CA, DE, NL, NZ, UK , US[6]).
Why? As Reich tells it, our system is based on revenue as opposed to health care outcomes:
…administrative costs account for 15 to 30 percent of all health care spending in the United States, twice the rate of most other advanced nations.
Most of this is to collect money: Doctors collecting from hospitals and insurers, hospitals collecting from insurers, insurers collecting from companies or policy holders. A third of nursing hours are devoted to documenting what’s done so that insurers have proof.
Cutting back Medicare won’t affect any of this. It will just funnel more money into the hands of for-profit insurers while limiting the amount of care seniors receive.
The answer isn’t to shrink Medicare. It’s to grow it – allowing anyone at any age to join.
Medicare’s administrative costs are in the range of 3 percent.
How the System’s Rigged
When you hear right wing politicians complaining about the cost of Medicare, it’s important to remember that many of those costs are dictated by the “industry” and have no relation to costs.
Take, for instance, drugs, as explained here by Daniel Hoffman at Philly.com:
Today the pharmaceutical industry has replaced the AMA as the chief proponent of the view that in health care, it should be every man for himself, the game should stay rigged and the pursuit of profit should trump everything else (no pun intended).
So it came as no surprise last week when Public Citizen, the consumer advocacy group, and Carleton University of Canada published a report that concluded the U.S. federal government could save almost $16 billion a year if Congress allowed Medicare to negotiate drug prices.
Their 16-page report is worth reading, if only because it compares U.S. drug spending to that of 31 other advanced countries in the Organization for Economic Cooperation and Development. The report also compares Medicare prices to what Medicaid and the Veterans Administration pay.
It turns out that 27 of the 31 advanced countries in the OECD pay less than half of what the U.S. pays for the same drugs. Our per capita costs for buying drugs are more than twice the average paid by OECD countries.
John Lawrence’s three part series from two years ago here the San Diego Free Press explains some of the other tricks of the health care business. It should only be read with a (non-hospital supplied) barf bag near by.
A Single Payer Program
What people are really talking about when they say ‘expand Medicare’ is ultimately a single payer program.
There is legislation in Congress, H.R. 676, the Expanded and Medicare for All Act, which would establish a national single-payer health care program, to:
- Provide universal, comprehensive coverage, with no co-pays or deductibles.
Allow patients freedom to choose their doctors and hospitals. - Eliminate private insurance and save $400 billion/year in administrative costs.
- Negotiate drug prices.
- Reap savings by creating global budgets for health facilities.
- Free doctors from their onerous administrative burdens.
- Eliminate medical bankruptcy.
- Fund long-term care for the elderly.
- Stimulate the economy, as patients would have extra income to spend.
- Improve the health and productivity of the work force.
There are other plans out there, and I’m not wedded to this one. My point is that we need to move forward, not backward.
Show Me the Money
If I said the plan for financing expanded Medicare was in the same folder as Mayor Kevin Faulconer’s financing plan for a new stadium, would you believe me? I didn’t think so.
There is good news about Medicare. It just depends on who reports it. The Heritage Foundation would like us to believe hospitals will be throwing grandma off the balcony in 2030.
Here’s a fact based report from Vox.com
Slow health cost growth has improved Medicare’s financial outlook, extending the program’s trust fund to last until 2030.
The 2014 Medicare Trustees Report projects that, if absolutely nothing changes, the trust fund that pays for most of seniors’ hospital visits will now last an additional four years beyond the 2013 forecast. A four-year slowdown in health care costs means that the exact same amount of Medicare funding can now stretch those few years longer.
The health spending slowdown has had a noted impact on Medicare spending. Per person spending in the program, for example, has grown at an average of 0.8 percent over the past four years — much slower than the overall economy, which grew at an average annual pace of 3.1 percent.
This does not mean that Medicare is set to bankrupt in 2030, as this report’s projected date of insolvency is often read — more on that point here. You can also read the full Trustees’ report here.
The fact is that there are paths towards improving the long-term stability of Medicare:
- like recouping the $16 billion annually lost because Congress prohibits them from negotiating on drug prices, or
- addressing the $19 billion annual cost of correcting medical errors, or
- a tiny fraction of a percent increase in the payroll tax, which hasn’t been increased since the mid-1980’s
If there was an actual will to expand Medicare, there would be a way to do. The problem is that most if not all of the people (and they would never say this in public) crying about the cost of Medicare simply want to the program abolished.
So let’s celebrate the 50th Anniversary of Medicare by talking about what we can do. It’s as American as Apple Pie.
The Sanders Factor
Sen. Bernie Sanders will highlight a large Washington, D.C. rally Thursday, July 30 in Upper Senate Park celebrating the 50th anniversary of Medicare, joining with other legislators, registered nurses and community members.
Sanders alone among Presidential candidates favors a single payer program. The event will be live streamed at http://www.ustream.tv/channel/national-nurses-united. Sanders’ speech is scheduled for 6:45am Pacific Daylight Savings time.
FYI- After 28 of the 29 events kicking off the Sanders campaign on July 29th (tonite!) in San Diego filled up, the campaign coalesced all the sites into the North Park Observatory Theater. Over 600 people have signed up as of when I’m writing this.
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This is an excerpt – hell! – it’s most of it – from Doug Porter’s column at SD Free Press.
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