On July 30, 1965, President Lyndon Johnson signed Medicare into law, making 19 million Americans aged 65 and over eligible for health care coverage.
Given what you know about the federal government, how long do you think it took to implement?
Keep in mind that implementation involved identifying everyone over 65 for automatic enrollment in Medicare Part A (hospitalization) and identifying who would opt to enroll in (and pay for) Medicare Part B (office visits); enrolling the providers for Part A and the doctors and insurance companies for Part B; coordinating various government agencies; and developing policy.
Since there was no Internet, enrollment was accomplished by a quaint process using punch cards sent through the U.S. mail, supplemented by door-knocking.
Medicare was fully implemented on July 1, 1966 – 11 months after enactment – with 95 percent of eligible individuals signed up.
As we watch the cumbersome, protracted enactment of the Affordable Care Act, we should be aware that much of the problem is not the government, but the complications of dealing with insurance companies with their varying coverage, premiums, co-pays and networks, as well as their concerns about losing profits by paying for medical expenses.
While we laud the ACA for insuring the previously uninsured (and sometimes desperate), we should keep in mind those left behind: those still uninsured and often still desperate. As a doctor who sees low-income patients, I know many.
I recently saw a woman in her 40s who had had a stroke three months earlier. Her diabetes and blood pressure were seriously out of control. Because she had no insurance, she had not kept the primary care and neurology appointments made for her at her discharge from the hospital. She easily could have died waiting to seek medical care.
Another patient had suffered for years with a serious, yet treatable, skin condition. Why? After he lost his job, he lost his health insurance, and thus his dermatologist.
The public must look beyond the ACA to a system that will not leave so many locked out and suffering.
And when we do, we should start with Medicare as a framework, recognizing that:
• Medicare operates more efficiently than private insurance, spending less than 2 percent on administration and overhead, whereas private insurance companies typically spend more than 12 percent, sometimes considerably more.
• Participants in Medicare report greater health-care satisfaction than the privately insured.
• Medicare costs have a slower rate of growth than costs under private insurance.
• Medicare pays providers more quickly than private insurance.
• Medicare has decreased poverty among the elderly.
And it achieves these successes while covering the aged and disabled – the sickest among us.
Is Medicare perfect? Hardly. But it is the best model the U.S. has, and it can be improved. Expanding Medicare to cover everyone – thus dispensing with the wasteful middleman, i.e. the insurance companies – would provide many benefits. It would save hundreds of billions of dollars a year in reduced administrative costs. It would have negotiating clout to rein in medical supply prices. It would give us the choice we want – not the choice of convoluted insurance plans, but the choice of doctors and hospitals.
And the issues agonizingly debated in Burwell v. Hobby Lobby of whether employers should have a say in the contraceptive decisions of their employees? Poof! The discussion would disappear because employers would no longer be involved in health insurance. That alone would save the nation from lawsuits and endless public debate.
Furthermore, letting employers out of the health care business would free them to spend their time on their own businesses and spare them worrying about whether their workforce can get needed health care. And it will make their businesses more competitive in the international marketplace.
We should celebrate the anniversary of Medicare’s enactment this year by moving toward improved and expanded Medicare for all, which will give us the access, quality, cost-control and choice that we deserve – and that our wealthy country can easily provide. Wouldn’t achieving that be cause to celebrate in its golden anniversary year of 2015?
Jessica Schorr Saxe is a family physician in Charlotte.
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