This blog post is an expanded version of an op-ed published in Common Dreams.
Like Sarah Jessica Parker, Chris Rock, and Brooke Shields, Medicare has turned 60 years old. President Lyndon B. Johnson signed the program into law on July 30, 1965, giving seniors a guarantee of health coverage that never existed before. Prior to Medicare’s enactment, it was nearly impossible for older people to obtain health insurance, as they were considered a ‘bad risk.’
Medicare provides universal coverage to Americans over 65 years of age. (Ironically, Medicare would not yet be old enough to qualify for itself.) The law created Medicare Part A as a national hospital insurance program. Part B is a voluntary program for doctor visits and other medical services. Medicare Part C is another name for the privatized, for-profit version of the program called “Medicare Advantage.” And Part D is the prescription drug program enacted in 2003.
The Hospital Insurance portion is funded through workers’ payroll contributions. At the signing ceremony in Independence, MO, LBJ said: “Through this new law, every citizen will be able, in their productive years when they are earning, to insure themselves against the ravages of illness in old age.”
Lyndon Johnson paid tribute to former President Harry S. Truman, presenting him with the very first Medicare card. It was Truman who, 20 years earlier, had proposed a form of universal medical coverage for the American people.
LBJ quoted Truman’s remarks from the 1940s:
“Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection.” – President Harry S. Truman
It turned out that the time had not yet arrived. Truman’s proposal failed to gain traction during a time of retrenchment from the expansions of the New Deal, and opposition from the Republican majority on Capitol Hill which he famously labeled the “do-nothing Congress.”
President Johnson’s determination to enact his Great Society agenda and sheer political muscle – not to mention solid Democratic control of Congress – pushed Medicare (and its sister program, Medicaid) into being. LBJ was known for his intense style of political arm-twisting, known as “the Johnson Treatment.” Once he latched onto a goal, he was unlikely to let it go.
Naturally, Medicare faced fierce opposition from conservatives. None other than Ronald Reagan made the ludicrous prediction that if Medicare were enacted, “You and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” Sixty years later, we are no less “free” because of Medicare. In fact, having guaranteed health care makes seniors and people with disabilities (and their families) much more free – from disease, from worry, and financial ruin.
Today, 68 million people rely on Medicare for health coverage, including 12 million who are dually eligible for Medicare and Medicaid. Medicare isn’t perfect: The for-profit Medicare Advantage (Part C) program is extremely problematic (see below). The Medicare Part A trust fund will become depleted in 2033 if Congress fails to take action to strengthen it. Traditional Medicare still doesn’t cover basic hearing, vision, and dental care — which we have been pushing for many years. But most concerning of all — President Trump and his party have spent this 60th anniversary year actively undermining both Medicare and Medicaid.
Some 68 million seniors and people with disabilities rely on Medicare for health coverage
The “Unfair, Ugly” bill that Trump signed earlier this month slashed nearly $1 trillion from Medicaid, which will strip health coverage from an estimated 10 to 16 million lower-income Americans. The new law — projected to add more than $3 trillion to the national debt — could trigger cuts to Medicare down the road.
Meanwhile, the Trump administration is recklessly taking steps to privatize the entire Medicare program. It has announced a pilot project to involve private companies in conducting prior authorizations for care (now an infamous aspect of the for-profit Medicare Advantage program) in traditional Medicare. The administration, under HHS Secretary Robert F. Kennedy, Jr. and CMS Director Mehmet Oz, also has announced a plan to automatically enroll new Medicare beneficiaries in the for-profit Medicare Advantage (MA) program — a huge gift to the multi-billion dollar insurance industry at the expense of patients.
The problems with Medicare Advantage are now legendary. Enrollees are basically put into HMO’s run by insurance giants like Aetna, Humana, and United HealthCare, with limited networks of providers. Unreasonable denials of care are rampant. Patients who become disenchanted with MA plans often find it impossible to switch to traditional Medicare. Meanwhile, MA Insurers have been overcharging the government for their services and ripping off taxpayers. (Several of these insurance companies are currently under investigation.)
Joe Namath pitches for-profit Medicare Advantage plans in tv ads by insurance industry
We are watching to see if the Trump administration, which talks a good game about lowering prescription medication costs while simultaneously doing favors for Big Pharma, will honor the provisions of President Biden’s Inflation Reduction Act, which made myriad patient-friendly reforms to the Part D drug program — including out of pocket caps for beneficiaries and the ability of the government to negotiate prices with the industry.
The bottom line is: Let’s please not allow President Trump and congressional Republicans to shred one of the greatest legacies of LBJ’s Great Society. We and our fellow advocacy groups are pushing back — and so is the general public. But we don’t want to be fighting this same battle every time Medicare (and Medicaid) mark an anniversary — when we should be purely celebrating.
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