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Quentin Young's Comments in The Chicago Tribune on Medicare's 45th Birthday

Health & Medicine Policy Research Group (HMPRG)
August 5, 2010

Quentin's recent article on the Anniversary of Medicare was printed in theChicago Tribune

Read the article at chicagotribune.com

Rx for Medicare's birthday: Expand it

PRO

By Quentin Young

6:37 PM CDT, August 4, 2010


Medicare, one of our nation's most cherished social programs, turned 45 lastweek.

I was in active medical practice on July 30, 1965, when Medicare was signedinto law by President Lyndon B. Johnson. Its impact on older Americans and theirfamilies was swift and spectacular. I saw the results with my own eyes.

Almost overnight, millions of Americans age 65 and older had the doors tohealth care opened to them that had hitherto been closed. They streamed into ourdoctors' offices seeking long-deferred and sometimes urgently needed medicalattention.

Simultaneously, the specter of crushing medical debt was lifted from theshoulders of tens of millions of America's seniors and their children. You couldalmost hear a collective sigh of relief.

That was only the beginning. Through the years, Medicare dramatically reducedpoverty among the elderly. It added new benefits like preventive care. Itreduced racial and income-based disparities. It extended its coverage to theseverely disabled. It laid the basis for nationwide, comparative health studiesthat have improved the quality of care for everyone.

In short, Medicare, a government-sponsored program that now covers over 45million Americans, has been a triumphant success.

However, instead of celebrating, Medicare is facing ominous rumblings fromPresident Obama's debt commission and not-so-veiled threats from otherquarters.

"Medicare's going broke," its market-obsessed critics say. "It's draggingdown the economy."

Such alarms have been sounded about every six or seven years since Medicarebegan, but in real life it continues to thrive. Either the economy prospers,yielding greater tax revenues, or Congress tweaks the payroll tax by a tinyfraction of a percentage point, and immediately the projected shortfalldisappears. (The last adjustment was in 1985, when the rate was increased to1.45 percent from 1.30 percent.)

While it's true aging baby boomers will make bigger demands on Medicare,again, modest adjustments today will assure its financial solvency tomorrow.

In fact, Medicare stands like a rock in a troubled sea of waste, inefficiencyand disarray in the rest of our health care system, dominated as it is by big,corporate insurers whose paramount goal is to maximize profits, often byenrolling the healthy, avoiding the sick, raising premiums and denyingclaims.

Medicare is not without its problems, of course. Its benefits package couldbe richer. It lacks authority to negotiate lower prices with drug companies. Thereimbursement rate to physicians could be enhanced and stabilized, instead ofdepending on an annual cat-and-mouse game with Congress (the "doc fix") over aflawed accounting formula that only erodes physician confidence in theprogram.

But the best way to remedy these problems — and to bring down skyrocketinghealth care costs at the same time — is to improve the program and, mostimportant, to expand it to cover every person in the United States.

That's right: Extend Medicare to everyone. By replacing our crazy-quilt,inefficient system of private health insurers with a streamlined, publiclyfinanced single-payer program, we would reap enormous savings.

First, we would save about $400 billion annually that is presently wasted onunnecessary paperwork and bureaucracy. That's enough money to cover everyone whois currently uninsured and to upgrade everyone else's coverage withoutincreasing overall U.S. health spending by a single penny.

Patients could go to the doctor and hospital of their choice. They'd becovered for all medically necessary services and medications, with no co-pays ordeductibles.

Second, we'd acquire powerful cost-control tools like the ability to purchasemedications in bulk, negotiate fees, develop global budgets for hospitals andcoordinate capital investments. Such tools would rein in costs and help assurethe program's sustainability over the long haul.

Conventional wisdom suggests we should wait and see how the new health lawplays out. But we've seen how comparable reforms have fared on the state level:They've invariably failed after only a few years, chiefly because they can'tcontrol costs. Meanwhile more millions suffer.

It's never too late to do the right thing. So when naysayers urge cuts toMedicare, don't buy it. Tell them to ask Congress to enhance Medicare and toextend it to all.