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48 Years of Medicare (and Counting)

July 26, 2013

By Shawn Kennedy, AJN editor-in-chief, and Jacob Molyneux, senior editor

Next week marks Medicare’s 48th anniversary. President Lyndon Johnson signed the legislation creating Medicare on July 30, 1965, guaranteeing health coverage for the elderly. With the gradual implementation of the Affordable Care Act (ACA; 2010), Medicare, along with other government and private forms of health insurance, is undergoing changes, with efforts being made to rein in rising costs, combat fraud, tie quality of care to reimbursement, and so on.

PPresident Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

President Lyndon B. Johnson signing the Medicare Bill. Former President Harry S. Truman is seated at the table with President Johnson. Photo: National Archives and Records Administration.

With the ACA’s date for mandated purchase of health insurance fast approaching, some states are setting up state-run health insurance exchanges to provide consumers with a standardized menu of health insurance plans in order to make it easier to purchase a plan that fits both budget and health care needs. Other states have refused to participate (see “Policy and Politics: Update on the Affordable Care Act” in the April 2013 issue of AJN); by default, citizens of those states will instead participate in federally run exchanges.

The debate over government-sponsored health insurance is not new. According to a timeline at SocialSecurity.gov, Congressional hearings on the topic occurred as early as 1916, with the American Medical Association (AMA) first voicing support for a proposed state health insurance program and then, in 1920, reversing its position. A government health insurance program was a key initiative of President Harry Truman, but, as with the Clinton health initiative several decades later, it didn’t go anywhere because of strong opposition from the AMA and others.

AJN covered the topic in an article (AJN articles cited in this post will be free until August 26) in the May 1958 issue after a health insurance bill was introduced in 1957 by representative Aime J. Forand of Rhode Island  (HR 9467). Yet again, one of the staunchest opponents was the AMA. In the September 1958 issue, “at the request of the American Medical Association,” AJN published an article by its general manager, explaining the AMA’s opposition.

Many commentators have pointed out that the ACA, frequently attacked and undermined by its opponents during these years of its gradual implementation, may one day be seen much as we now see Medicare, which was also widely attacked when it began—that is, the ACA may be simply taken for granted as a necessary, if complex and flawed, program that many people depend upon.

Yet even as the ACA faces continued opposition in its early years, Medicare itself is in flux as costs continue to spiral higher and the population continues to age.  It’s no secret that elected officials have long been leery of risking the wrath of seniors by suggesting cuts to Medicare or Medicaid programs. At most demonstrations involving health care, there’s usually at least one sign being held aloft by a gray haired individual, proclaiming “Hands-off my Medicare.” And the Wall Street Journal reported on a recent national poll that found that 93% of seniors want Congress to avoid cuts to Medicare and instead focus on combating fraud to save costs.

However, the climate has changed, and Congress is arguing over potentially deep budget cuts that may ultimately affect these programs; while some proposed cuts may be necessary to ensure the program’s continued solvency and viability as it goes forward, others seem short-sighted and dangerous. (And of course, there’s a subset of legislators who still believe we’d be better off without Medicare and who are using the need for streamlining and reform as a cover to push for its replacement with a voucher program.)

What Medicare might look like on its 50th anniversary is anyone’s guess right now. And as to how the ACA will look in 50 years, well, let’s leave that to the prophets among us.

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