In the mid-1960s, half of older Americans had no health insurance. Fewer had good insurance because older persons who were the highest risks for insurers were charged the highest rates. Health care might not have been as extensive or expensive, but those without insurance had to pay the bill. Getting sick and paying for care was a worry and you had to either have the money to pay for medical services or not get treated. Or, you had to depend on your children for financial support. That fear changed 50 years ago when President Lyndon Johnson signed the Medicare Act on July 30 in Independence, Missouri with former President Truman at his side.
The effort to get coverage for health care for all preoccupied most of the 20th century. Truman tried and failed as the American Medical Association and insurers attacked his plan as “socialized medicine.” It wasn’t until 1957 that a narrower health insurance bill for seniors was considered, thinking it would be more politically popular. Organized labor and senior organizations provided the public support but even the idea of Medicare was controversial. JFK tried to get a Medicare type bill passed but couldn’t get it out of Congressional committees. It too was called socialism by its opponents. It was only after Lyndon Johnson’s landslide election victory in 1964 that swept in many new liberals and he had such big majorities of his own party that he was able to get the bill through Congress. Different proposals called Eldercare, Bettercare and Medicare were combined into a hybrid system of doctor and hospital coverage. So, in that summer of dizzying major legislation in 1965 on voting rights and economic opportunity, making life better for older Americans also became a cornerstone of his Great Society. The Older Americans Act was signed in mid-July and then Medicare with Medicaid as companion legislation as amendments to the 1935 Social Security Act passed and were signed at the end of the month.
Today, 98% of older Americans are covered by Medicare. 55 million older and disabled Americans rely on it for health coverage. And, it is social insurance, not welfare. We have all contributed through a payroll tax which currently assesses 1.45% of payroll from employee and employer. Medicaid was designed as insurance for the poor of all ages, but it has been an especially important lifeline for many middle class elders after nursing home costs have depleted most of their finances.
Medicare was a great achievement and it is directly responsible for the fact that older and disabled persons live longer now and are in better health than ever. It is not a perfect program. There is no health insurance program that is. Medicare doesn’t cover dental care, eyeglasses or long term care. Some of its rules like “observation status” rather than admitting patients to hospitals make no sense. The program always needs to be modernized. A positive change is the new care coordination being developed in Medicare to make sure that a patient is not simply treated and sent home but that doctors and hospitals work together for wellness with prevention services and follow up care coordination.
As Medicare turns 50, the battle goes on because there remain many in Congress who still don’t want to pay more for it, even though there are more older Americans. They would like to turn Medicare into a private voucher program with a fixed amount of money that might not be enough for those who have serious illness and need to use many services. So, as we celebrate, those of us who believe in and support Medicare have to also be vigilant and always prepared to defend the right to social insurance that has improved the quality of life for older and disabled Americans.