Fifty years ago today, in Independence, Missouri, President Lyndon B. Johnson signed into law the legislation creating Medicare. Former President Harry S. Truman sat by Johnson’s side at a table in Truman Library for the signing, and LBJ paid him tribute. Truman, he said, had “planted the seeds of compassion and duty” that had made Medicare possible.
Truman had in fact advocated a national health care system covering everyone, not just seniors. Medicare, which John F. Kennedy had championed as a Senator, represented a sort of compromise. Conservative opposition made Truman’s dream unrealizable, but LBJ used his formidable legislative skills to persuade Congress that at least the elderly should be spared from devastating health bills. As Mary Beth Hamel wrote in the New England Journal of Medicine,
“The health care situation of retirees was desperate. Bills for health care in this population were roughly triple those of younger Americans, but retirees did not have access to employer-sponsored coverage and they were unattractive to private insurers in the individual health insurance market. In the early 1960s, only about half of Americans who were 65 years of age or older had any health insurance, and many of their policies did not offer meaningful health care coverage.”
Those were dark days for Americans over 65, and today, seniors with common sense pray they will never come again. But we can’t rest easy. Nor should anyone, since Medicare is under constant assault from the right.
On July 22, Jeb Bush, regarded by many as the real Republican front-runner for the presidency whatever Donald Trump’s poll numbers, said that the time had come to bring Medicare to an end. Speaking at a meeting in New Hampshire organized by the Koch brothers’ Americans for Prosperity, Bush said he would preserve the program for those who now have it, “but we need to figure out a way to phase out this program for others….” He evidently thinks this approach will win him the votes of seniors, even though he intends to pull the rug out from under anyone younger. Bush is the supposed moderate among the Republican candidates.
Bush and others who would end Medicare claim that it is unaffordable, but as Paul Krugman pointed out on Monday, in “Zombies Against Medicare,” there has been an unprecedented pause in the rise of Medicare expenditures, thanks largely to cost savings in the Affordable Care Act. (Bush has called the ACA a “monstrosity.”) Medicare trustees now predict that the hospital care trust fund will be fully solvent until 2030. After that, some easily affordable increase in resources will likely be needed. Over the long term, as the baby boom generation fades away, Medicare costs are expected to level off as a percentage of GDP.
Medicare has its shortcomings. It doesn’t pay for nursing home care beyond 100 days following hospitalization. The “fee for service” approach to paying physicians, means that our monthly premiums for Part B insurance to cover doctor visits, rise year by year. Our coverage costs more and offers less than health care systems in other advanced countries, even though life expectancy in those countries is higher.
But the shortcomings just point to ways in which Medicare could be improved. To phase out Medicare, as Jeb Bush advocates, would be a major setback for all of us, old and young.