Medicare at 50 — Origins and Evolution (New Eng Jour Med)

[pinto]

Medicare at 50 — Origins and Evolution

David Blumenthal, M.D., M.P.P., Karen Davis, Ph.D., and Stuart Guterman, M.A.
N Engl J Med 2015; January 29, 2015

Many Americans have never known a world without Medicare. For 50 years, it has been a reliable guarantor of the health and welfare of older and disabled Americans by paying their medical bills, ensuring their access to needed health care services, and protecting them from potentially crushing health expenses. However, as popular as Medicare has become, Congress created the program only after a long and deeply ideological struggle that still reverberates in continuing debates about its future. Nor was the Medicare program that was signed into law by President Lyndon B. Johnson on July 30, 1965, identical to the program we know today. As we mark the beginning of Medicare's 50th anniversary year, this first report in a two-part series recounts the history of this remarkable health care initiative and explains how it came to be, what it has accomplished, and how it has evolved over the past five decades. In the second report in the series, we will describe the ongoing challenges of the program and discuss proposals to address them.

Origins of Medicare

Medicare was born out of frustration, desperate need, and political opportunity. The intellectual and political architects of the program did not set out to create a health care system for the elderly (defined here as persons 65 years of age or older). Starting in the early 1930s, during President Franklin D. Roosevelt's New Deal, they sought a much grander prize: the enactment of universal national health insurance for all Americans. However, opposition from Republicans, conservative Democrats, and organized medicine frustrated those ambitions. Even after Harry Truman became the first president to unreservedly advocate national health insurance in 1948, his proposal stalled on Capitol Hill. Supporters reluctantly concluded they would have to pursue more modest goals, so they targeted health insurance for elderly Americans.

The logic for this new focus was compelling. 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. Politically, the elderly were also an attractive constituency. They showed up at the polls, and even in the mid-20th century, demographic trends showed that their numbers would surge.

(more at) http://www.nejm.org/doi/full/10.1056/NEJMhpr1411701

[area51]

1. And then we have the crazies, like

"wean people off medicare".