Happy Birthday, Medicare -- the Most Popular Kid on the Block!

Forty-four years ago today, LBJ signed Medicare into law.  At the time, 40% of the elderly did not have health insurance.  A third of them also lived in poverty.  Today, everyone in the country over 65 has a basic level of health security that those of us under 65 still do not enjoy.  How to evaluate Medicare on its birthday?  Let’s start with this – it’s worked.

The Commonwealth Fund published a study in Health Affairs which can be summed up in a single sentence, “Compared with the employer-coverage group, people in the Medicare group report fewer problems obtaining medical care, less financial hardship due to medical bills, and higher overall satisfaction with their coverage.”  Make no mistake, Medicare doesn’t score perfectly.  I'm positive you can find bad stories (although a colorful anecdote is never as relevant as years of hard data).  In fact, 8% of beneficiaries rated their coverage “fair or poor,” but that’s a pretty good number – way better than the 18% private insurance got.  The same study showed that reported problems of access to care increased from 12% in 2001 to 18% in 2007 – but private insurance in 2007 was at a shocking 45%.  And, in keeping with the moral reasons for which Medicare was first founded, only 14% reported a problem paying bills – better than the 35% for private insurance, and the presumably 80-100% of the uninsured.  Note that this holds true even though the Medicare patient base is, by definition, older, sicker and usually poorer than those in private insurance.

National Journal, hardly a bastion of liberal thought, comes to the same analysis in regards to Medicare’s popularity.  In their analysis of data from the Consumer Assessment of Healthcare Providers and Services, they found that 56% of Medicare beneficiaries rate their coverage a 9 or 10 on a scale of 10 (only 40% for private insurance.)

More importantly, the higher scores for Medicare are based on perceptions of better access to care. More than two thirds (70 percent) of traditional Medicare enrollees say they "always" get access to needed care (appointments with specialists or other necessary tests and treatment), compared with 63 percent in Medicare managed care plans and only 51 percent of those with private insurance.

There are, of course, problems – as there are with any health care system.  I’ve gone on at length in other posts about the problems with the fee-for-service reimbursement system, long-term care, and problems associated with the prescription drug plan and Medicare Advantage private HMOs.  As the cost of all U.S. health care outpaces inflation, so does Medicare.  Since 1970, Medicare costs have risen 8.8% per year.  That’s bad, no question, and unsustainable.  But over that same time frame, private insurance went up 9.9% per year.  Not bad for a government-run program!

In a political climate where once again we’re being told government can’t run anything, people are responding in the most peculiar way.  President Obama said at a town hall this week, “I've received letters that say, I don't want a government-run program, I don't want socialized medicine, and by the way don't touch my Medicare.”  Old reliable government-run Medicare has a golden name.  If you want to build on what works, you start with Medicare.  Hence, single-payer health care is Medicare for All.  When John Edwards and Hillary Clinton pitched their versions of the public health insurance option, they called it, “a public plan, similar to Medicare.”  We’re witnessing a revolt by progressives in the House right now against the deal struck with the Blue Dog Democrats about how close the public option will get to Medicare, with a letter of protest proclaiming, “Any bill that does not provide, at a minimum, for a public option with reimbursement rates based on Medicare rates – not negotiated rates – is unacceptable.”

Of course, what’s old is new again for the opposition, as well.  Ronald Reagan was the most famous opponent of Medicare’s passage, claiming, “[I]f you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”  Classic.  Today’s fear-mongering pales in comparison.  It’s somewhat surprising to see Republicans so desperate to stop health care reform that they’re willing to demonize and fear-monger one of the country’s most popular programs.  But this week, we’re hearing from Rep. Roy Blunt (“Medicare has never done anything to make people more healthy”) and Rep. Tom Price (“nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare”), all in the same week that conservative after conservative takes to the floor with the most recent big lie about health care reform:  Rep. Foxx’s mendacious declaration that reform would “put seniors in a position of being put to death by their government.”

They ought to be ashamed of themselves – really and truly ashamed of themselves – that they’re so willing to say and do anything that they’ll bring back memories of the bad old days, when if you were old and poor there was no care for you and too many seniors had little choice other than death.  The bad old days, when the number of those over 65 was half what it is now, and life expectancy over 65 was nearly 4 years shorter.  The bad old days, when too many saw “illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.”

As Foxx and Blunt and Price should know all too well, we finally found a way to end the nightmare conditions they warn about.  We instituted a government-run program named Medicare.  And that has made all the difference.