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The Marvel That is Medicare

The Marvel That is Medicare

By Marie Cocco - July 30, 2009

WASHINGTON -- Happy Birthday, Medicare.

It's a fine time -- perfect, in fact -- to celebrate the government-run, taxpayer-supported colossus in the American health care system that turns 44 this week. Medicare has done all it was supposed to do, and more.

It thrives despite apocalyptic warnings from its original opponents that "socialized medicine" would hamper doctors, hospitals, patients -- perhaps even doom the entire American health care system. Medicare is exceedingly popular and remarkably well-functioning despite its current critics' claims that it is singularly wasteful, out of control in some never-specified way, or at the very least, holds the potential to bankrupt us all in the next generation.

Medicare is where political posturing runs headlong into historical truth: It is, along with Social Security, the most successful government program -- other than its unrivaled military -- that the United States has ever created.

And it has delivered for elderly people what President Barack Obama and at least some Democrats say they want to deliver for the rest of us: universal coverage ensuring that people with medical problems will not become impoverished by their illness, with patients offered a guaranteed set of services and a choice of private doctors, hospitals and other practitioners when they need treatment.

"Medicare was a comprehensive -- and comprehensible -- program, available throughout the country and with a core set of benefits," says Judith Stein, director of the Center for Medicare Advocacy.

In other words, it delivers the opposite of what the private insurance industry has been providing. And it is doing so with a better track record of controlling costs. Beginning in 1997, the growth in Medicare's cost per beneficiary has been slower than the cost escalation in coverage delivered by private insurers. Between 2002 and 2006, for example, Medicare's cost per beneficiary rose 5.4 percent, while per-capita costs in private insurance rose 7.7 percent, according to MedPAC, an independent agency charged with advising Congress on Medicare issues.

So why would Congress create a new health insurance system that doesn't have a Medicare-like public plan for consumers to purchase?

Because conservatives, Democrats among them, never let the facts get in the way of their ideology. The Senate, in particular, seems intent on creating a new private health insurance "cooperative" that has never been tested, has no track record of delivering quality coverage at an affordable price, and which consumers would have to learn to navigate.

Forty-four years ago, on July 30, 1965, President Lyndon Johnson signed the law creating Medicare. In its way, Medicare was a testament to our failure to create a national health insurance system that would cover everyone. With former President Harry Truman looking on, Johnson said the need was great, and urgent. "There are more than 18 million Americans over the age of 65. Most of them have low incomes. Most of them are threatened by illness and medical expenses that they cannot afford."

At the time, about half of the elderly had no health insurance -- they were too old and likely to get sick, so the private market simply wouldn't insure them. The elderly were the demographic group most likely to live in poverty, and about one in three older Americans were poor. Blacks and other minorities could not receive treatment in whites-only medical facilities, discrimination that was barred by Medicare.

Now the elderly are among the best-insured Americans, with upward of 95 percent covered by Medicare. The rate of poverty among those 65 and older is under 10 percent. The decline in elderly poverty began with the creation of Social Security -- but it accelerated, according to Census Bureau data, only after Medicare coverage began.

"The need for this action is plain," Johnson said in signing the law in Truman's hometown of Independence, Mo. "And it is so clear indeed that we marvel not simply at the passage of this bill, but what we marvel at is that it took so many years to pass it."

Now we marvel again at the long and contentious legislative path that health-care revision is taking. We hear the same arguments against a national health insurance plan that were made nearly half a century ago.

But now we have Medicare, and its demonstrated history of delivering exactly what Johnson said it would. And the marvel of our own time is that we ignore this success, while promoting untried alternatives that may well fail.

mariecocco@washpost.com

Copyright 2009, Washington Post Writers Group

Marie Cocco

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