I am writing this on the 52nd anniversary of the official signing by President Lyndon Johnson of the legislation enacting Medicare, generally regarded as the most successful and popular U.S. government program ever. Just as many of us take inventory on our birthdays, this seems like a good time to consider what Medicare is and isn’t, what it accomplished and what it didn’t.
First of all, Medicare is not socialized medicine. It is, however, a way to pay for medical care provided by non-government hospitals, physicians and others. It is not the same as insurance but has some similarities. We all pay for Medicare, either through payroll taxes or premiums but Medicare coverage is reserved for those of us over age 65 or with a few specified diseases.
It is hard to prove, but Medicare has probably decreased bankruptcies among older adults, one of its original goals, although medical expenses account for 60 percent of bankruptcies.
While Medicare has a number of ways to control costs, one thing it cannot do is negotiate drug prices; it is prohibited from doing so by federal law. Costs have also increased because of Medicare Advantage programs that were seen as a means to begin privatization of Medicare. Many politicians are unhappy with the idea of “government healthcare,” but speaking out publicly against Medicare would, undoubtedly, interfere with any chance of reelection.
Medicare is designed to pay for a percentage of all necessary healthcare, making supplemental insurance necessary. Although it does need to stay solvent, it doesn’t need to make a profit, and has an overhead of around 2 percent, compared to insurance company overhead of 15 to 25 percent. Think: no marketing, no excessive salaries or stockholders, no “Department of Denials.”
To be sure, Medicare is not perfect; it suffers from being a big bureaucracy trying to keep up with our ever-changing medical environment, but most Americans think it is an important part of American life, worth preserving.
Because healthcare has been in the news so much lately, it is not surprising that Medicare is mentioned more and more frequently as a model for solving some problems with our present system (or lack thereof). I always laugh when someone says they don’t want to pay for someone else’s healthcare because that is exactly what someone else will do for them if they ever develop a serious illness.
And we all pay for the bankruptcies. And when someone can’t pay for care and gets it anyway (would you turn anyone away from lifesaving treatment because they couldn’t pay?), we all end up paying for it.
Tax revenue already pays for 60 percent of all U.S. healthcare. Since we cannot predict what diseases we will develop, insurance cannot be tailored to our needs, so Medicare provides universal coverage. We all pay for Medicare; the crafters recognized that everyone needed to pay into the system. Unfortunately, they didn’t recognize that everyone needed to be covered.
So, Medicare, I hope you have a good day. I didn’t get you a card but if I had it might have said something like this: Thanks for the past 52 years. You make a good example for those wrestling now with providing healthcare for all Americans.
Dr. Kluzak, an Idyllwild resident, is board certified in Anatomic Pathology, Obstetrics and Gynecology. He also is a freelance photographer for the Town Crier.