It may be hard for many to realize that as recently as 1964 there was no such thing as Medicare.
It was the product of Lyndon Johnson’s Great Society social welfare programs. Its purpose was always very limited.
Yet, as limited as it was, prior to 1965 there was nothing addressing the costs and availability of medical care for those over 65.
Under Johnson’s proposal Social Security expanded to provide more than 16 million people over the age of 65 with hospital coverage.
“Over the past several years, a large and growing proportion of those applying for public aid has been forced to do so only because they cannot meet their health costs,” said Anthony Celebrezze, LBJ’s Secretary of what was then the called the Department of Health, Education and Welfare.
Of course, the Republicans, some conservative Democrats and the American Medical Association opposed even this limited reform.
They warned that it was a foot in the door to national health and what they called “socialized medicine.”
They were very short-sighted, as the relatively small government program would grow into a massive profit center for insurance companies and Big Pharma.
Rep. A. S. Herlong Jr. Democrat from Florida, wondered at the time if the Administration wanted the legislative proposal expanded to cover doctors’ bills.
“Is it ever anticipated by you or anyone else that you know of in your department that we are going to increase the hospital benefits for the people here to include medical care as well as hospital care?”
No responded HEW Deputy Secretary Wilbur Cohen, the point man for the White House in negotiating with Congress on this legislation. “As far as I know, speaking for myself, Secretary Celebrezze, and Mr. Ball, the Administration has no intent to expand the scope of this to cover such things as physician services.”
I have been thinking about Medicare and medical cost and care lately because following major surgery for kidney cancer I have what might be considered a new relationship with Medicare and Medicare Advantage.
I have discovered what some may have known but has been hidden in plain sight: The privatization of a large portion of Medicare.
Pushed to the public debate by those like Bernie Sanders and Alexandria Ocasio Cortez, the presidential election included discussion of Medicare For All as the next step in national healthcare.
I thank them.
But what hasn’t been discussed is the current trend under way in privatizing existing Medicare. What began in 1965 as a woefully insufficient government add-on to Social Security, has now expanded into billion dollar for-profit sector of the economy.
A 65-year-old couple using original Medicare this year will spend around $10,300 on premiums for prescription drugs and Medigap, and various out-of-pocket costs.
In 20 years, their costs are projected to be around $33,000 annually in future dollars.
The for-profit sector of medical coverage for the elderly saw a massive expansion under President George W. Bush with the addition of privatized drug coverage and the growth of private programs like Medicare Advantage.
The New York Times’ Mark Miller writes that the privatization of Medicare has escaped scrutiny among policymakers, including those who are discussing using Medicare as a vehicle or model to expand health coverage:
The growth has occurred without much public policy debate about the effects of large-scale privatization on patient health, and on the costs to both the government and enrollees. As “Medicare for all” is debated in the 2020 presidential race, most voters perceive that these proposals are calling for a government alternative to commercial health insurance — yet the current Medicare program is shifting toward greater privatization, not less.
“When we talk about Medicare for all or public options,” said Tricia Neuman, director of the Medicare policy program at the Kaiser Family Foundation, “people may not realize that we already have a Medicare program that is coming to be dominated by some very large private insurance companies.”
I’ll be looking at this issue more in future posts.