On July 30, 1965, President Lyndon Johnson signed the Social Security Act Amendments into law creating Medicare and Medicaid. The signing ceremony featured former President Harry Truman being enrolled as Medicare’s first beneficiary, proudly receiving the first Medicare Card. This symbolic gesture honored Truman for proposing national health insurance in 1945, ten years after the Social Security Act was first passed. The idea of public health insurance was not the brainchild of Truman, it had been proposed by Franklin D. Roosevelt as part of the Social Security Act of 1935. The innovation never made it into the final bill because it was thought to impact the ability to pass the legislation. Going back to its origins, this idea of national health insurance is not political. The idea was originally championed by American labor organizers in the early 1900s. An idea born of the needs of everyday working Americans saying, “Not being able to access or afford healthcare is a problem for me and my family.” The idea was to cover everyone from cradle to grave. The reality was to argue for half a century while people needlessly died. 50 years of political debate culminated in covering only the most vulnerable in 1965; the elderly with Medicare and low income with Medicaid. Today, 57 years later, Medicare finds itself in mortal danger, not from insolvency, but from privatization. Ironically this was also its main opposition in 1935, 1945 and 1965. Today is not about doom and gloom. It’s a birthday, we celebrate first.
What’s great about Medicare?
- It works. Implemented in 1966, this efficient, public good program, enrolled 19 million people in Medicare in just 8 months. That was all Americans 65 years old or older at the time, across the entire nation, without the use of a single computer.
- Medicare ended racial segregation of healthcare and modernized hospitals.
- It’s a literal lifesaver for Americans with disabilities of all ages.
- Traditional Medicare’s historic low overhead of about 2% is a model for necessary cost savings for national healthcare financing.
- Traditional Medicare allows patients to choose virtually any doctor. Almost all doctors and hospitals in the United States accept Medicare.
What needs to be fixed?
- The donut hole, or Medicare D prescription drug coverage gap, needs to be eliminated and replaced with first dollar prescription drug coverage.
- Allow Medicare to negotiate prescription drug prices nationally. This can greatly reduce prescription drug prices for consumers.
- Vision, dental, and long-term care coverage should be included for all beneficiaries.
- Premiums, co-insurance, copays, and deductibles should be eliminated and replaced with first dollar coverage.
- Stop the diverting of public funds to unnecessary private insurers and middlemen. A common example is Medicare Advantage Plans which have much higher overhead costs, around 14% as compared to Traditional Medicare of around 2%.
- Eliminate narrow networks. Medicare Advantage Plans or other managed care schemes use narrow networks to reduce a patient’s choice of medical providers and create obstacles to care coordination.
- Value based payment schemes, like the deceptively named, Accountable Care Organizations and profit driven Medicare Advantage, Direct Contracting Entities and REACH, cannot be allowed to continue weakening Medicare by profiting from consumer misinformation and manipulation. Direct Contracting or REACH alone has the potential to effect 30 million of today’s 36 million Traditional Medicare beneficiaries, moving them into a contracted entity without their consent or notification and this is happening NOW in its pilot phase. These Direct Contracting Entities can spend as little as 60% on patient care and keep as much as 40% in profit and overhead.
Next steps
- Protect Traditional Medicare now.
- Implement an Improved Medicare For All that covers everyone.
Healthcare is not a product, it is an essential service. Healthcare financing should focus on patient outcomes over corporate outcomes. It should be sustainable, achieve clear cost savings, and be funded in a progressive manner. Ultimately, I want my doctor to be paid fairly. I want my neighbors to utilize more preventative care than sick care. Hospitals are important, every community should have access to one. We all want to live in a safe healthy community. Let’s protect Medicare now and improve this essential public good for all.
#StopREACH #SinglePayer #MedicareForAll
