Medicare, one of our nation's most cherished social programs, turned 45 last
week.
I was in active medical practice on July 30, 1965, when Medicare was signed
into law by President Lyndon B. Johnson. Its impact on older Americans and their
families was swift and spectacular. I saw the results with my own eyes.
Almost overnight, millions of Americans age 65 and older had the doors to
health care opened to them that had hitherto been closed. They streamed into our
doctors' offices seeking long-deferred and sometimes urgently needed medical
attention.
Simultaneously, the specter of crushing medical debt was lifted from the
shoulders of tens of millions of America's seniors and their children. You could
almost hear a collective sigh of relief.
That was only the beginning. Through the years, Medicare dramatically reduced
poverty among the elderly. It added new benefits like preventive care. It
reduced racial and income-based disparities. It extended its coverage to the
severely disabled. It laid the basis for nationwide, comparative health studies
that have improved the quality of care for everyone.
In short, Medicare, a government-sponsored program that now covers over 45
million Americans, has been a triumphant success.
However, instead of celebrating, Medicare is facing ominous rumblings from
President Obama's debt commission and not-so-veiled threats from other
quarters.
"Medicare's going broke," its market-obsessed critics say. "It's dragging
down the economy."
Such alarms have been sounded about every six or seven years since Medicare
began, but in real life it continues to thrive. Either the economy prospers,
yielding greater tax revenues, or Congress tweaks the payroll tax by a tiny
fraction of a percentage point, and immediately the projected shortfall
disappears. (The last adjustment was in 1985, when the rate was increased to
1.45 percent from 1.30 percent.)
While it's true aging baby boomers will make bigger demands on Medicare,
again, modest adjustments today will assure its financial solvency tomorrow.
In fact, Medicare stands like a rock in a troubled sea of waste, inefficiency
and disarray in the rest of our health care system, dominated as it is by big,
corporate insurers whose paramount goal is to maximize profits, often by
enrolling the healthy, avoiding the sick, raising premiums and denying
claims.
Medicare is not without its problems, of course. Its benefits package could
be richer. It lacks authority to negotiate lower prices with drug companies. The
reimbursement rate to physicians could be enhanced and stabilized, instead of
depending on an annual cat-and-mouse game with Congress (the "doc fix") over a
flawed accounting formula that only erodes physician confidence in the
program.
But the best way to remedy these problems — and to bring down skyrocketing
health care costs at the same time — is to improve the program and, most
important, to expand it to cover every person in the United States.
That's right: Extend Medicare to everyone. By replacing our crazy-quilt,
inefficient system of private health insurers with a streamlined, publicly
financed single-payer program, we would reap enormous savings.
First, we would save about $400 billion annually that is presently wasted on
unnecessary paperwork and bureaucracy. That's enough money to cover everyone who
is currently uninsured and to upgrade everyone else's coverage without
increasing overall U.S. health spending by a single penny.
Patients could go to the doctor and hospital of their choice. They'd be
covered for all medically necessary services and medications, with no co-pays or
deductibles.
Second, we'd acquire powerful cost-control tools like the ability to purchase
medications in bulk, negotiate fees, develop global budgets for hospitals and
coordinate capital investments. Such tools would rein in costs and help assure
the program's sustainability over the long haul.
Conventional wisdom suggests we should wait and see how the new health law
plays out. But we've seen how comparable reforms have fared on the state level:
They've invariably failed after only a few years, chiefly because they can't
control costs. Meanwhile more millions suffer.
It's never too late to do the right thing. So when naysayers urge cuts to
Medicare, don't buy it. Tell them to ask Congress to enhance Medicare and to
extend it to all.
