“Medicare would not have been enacted in 1965 if Lyndon Johnson had not been President.”
“The Medicare Program as a Capstone to the Great Society-Recent Revelations in the LBJ White House Tapes” by Larry DeWitt May 2003
http://www.larrydewitt.net/Essays/MedicareDaddy.htm\
The above document describes how the first Medicare legislation was passed in 1965. It was not easy. Truman advocated a national health insurance program for everyone, but the idea was shot down by Republicans opposed to “red” policies and by the AMA, which objected to government regulation of medicine. Decades later, LBJ worked like a dog in order to win passage of the nation’s first major public health insurance program, one limited to seniors and folks on disability. He shuffled the staff at HEW so that he could get an ardent Medicare supporter, Wilbur Cohen in charge. He applied pressure directly on Congressmen of both parties. He exploited his political capital from the landslide 1965 election
and sentimentality about JFK.
The result was the
Social Security Act of 1965 which created Medicare Parts A and B (physician and hospital health insurance coverage for the elderly and disabled ) and Medicaid, which covered the nation’s poor. This was intended to be just the first step towards universal health care. Insurance for the nation’s elderly was supposed to be an easy sell (it was not). Once people got used to Medicare, there would be popular calls to expand it to cover everyone.
Forty years later, we still do not have universal coverage. Instead, we have a system that seems designed to discourage disease prevention in the young and encourage health care over utilization in the elderly. The nation’s 50 million uninsured are denied basic care that would keep them healthy. As a result, they are more likely to reach retirement age with severe, debilitating and costly diseases like congestive heart failure and renal insufficiency. Even those with insurance often find that well care is not covered. Since younger people do not have a dedicated health insurance provider, there is little economic incentive to spend money to prevent disease. Private insurance companies stand to make more profit by “cherry picking” healthy people and denying care to anyone who happens to get sick. This means that younger people who develop illness are often unable to get the treatment they need when they need it. Instead, they have to cross their fingers and hope they survive until 65. Or become so ill that they qualify for Medicare disability.
Medical costs associated with end of life care have risen, since universal Medicare coverage for these procedures has encouraged the development of new, expensive (sometimes futile) technology. And after a few decades of medical neglect, our nation’s seniors are ready for lots of overpriced, futile care from their “forget disease prevention, we’ll just pay to fix you up once you break” Medicare system. When you treat your organs and joints as disposable, your health care bills stack up pretty fast. Sort of like buying a new car every year, when proper maintenance on the old one would have kept it running---except that when it comes to the human body, the "new car" is never as good as the one you trashed. The U.S. spends twice as much per person per year to achieve results that would embarrass an Eastern European country. Americans die earlier, they are more likely to die in infancy, they suffer more chronic preventable diseases than their counterparts in other industrialized countries like Japan and France. And their Medicare costs keep rising.
By any parameter---cost, outcome, accessibility---“the best health care system in the world” is broken. Congress’s proposed solution---make everyone buy private insurance—is pretty broken, too. There is only one way to fix what ails us. We must take the next step, the one that Medicare's creators envisioned, the one that Harry Truman worked for almost 60 years ago. We must make Medicare a
universal, cradle to grave health insurance program.
If one insurer knows that it will be responsible for Michael’s health care expenses for the rest of his life, that insurer will spend a few hundred dollars to keep his cholesterol down and his blood pressure controlled, so that it does not have to pay hundreds of thousands of dollars later to treat his congestive heart failure. The insurer will have a financial interest in helping Wanda keep her blood sugar under control, since that will save on dialysis costs twenty years from now. There will be an incentive to fund research into disease prevention. Broad public health initiatives aimed at keeping people from getting sick will become more cost effective.
The single insurer does not have to be called “Medicare”, but it must be the same insurer that cover folks of Medicare age. If we allow privates to collect the premiums of young Americans but do not make them responsible for the diseases of later life, the privates will continue to scrimp on preventive services.
I am delighted that Obama has decided to follow in the footsteps of LBJ and seize control of the health care debate. As a nation, we will continue to suffer from chronic diseases at an unacceptably high rate, unless we change our basic health insurance model. If we become healthier, then our health care costs will go down, too, making the single payer option a win-win proposition for almost everyone.
This is going to be a long, nasty fight---as it was back in 1964-5. There is a lot of money at stake, which means that the public is going to be bombarded with misinformation and Congress will be bribed with campaign donations. Even if the executive branch fights for health care reform, it is not guaranteed to pass this year. However, now that the administration has gotten serious about it, I think that there is a much better chance that we will see some progress. And I think (hope) that years from now, someone will write
"National Health Care would not have been enacted in 2009 if Obama had not been president."
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