Medicare’s 49th birthday: What is to be done?

By Danny Ash, M4, July 30, 2014

At a crowded townhall meeting in 1959, an elderly woman stepped up to the microphone and spoke to a panel of senators. “I am not worried for my son’s time,” she began. “He is 35, and I am sure he will face a better future when his time comes to retire. But what is to be done for those of us who need help right now?”

This was one of a series of grassroots hearings held by a Senate subcommittee between 1959 and 1961. The senators visited 38 American cities in all, inviting the elderly to come and speak of the troubles they faced in their everyday lives. And come they did, tens of thousands of them, packing halls from San Francisco to Miami.

As the transcripts show, these men and women had much on their minds, with concerns ranging from housing, to unemployment, to pensions. But there was one topic that dominated the hearings: health care.

“Here are the doctor and hospital bills for my wife’s latest illness,” said one man brandishing a sheaf of papers. “They come to more than $2,000. I’ve paid them and my savings are all gone now. What shall we do the next time one of us gets sick?”

These stories and others like them galvanized the nation into action, and on this day in 1965, Lyndon B. Johnson signed Medicare into law. In 1965 only 46% of seniors had hospital insurance; in 1970, that number was 97%. In those five years, the death rate for seniors over 85 dropped by 20%. Subsequent modifications expanded eligibility to include Americans with certain chronic diseases, as well as those too disabled to work. With the benefit of hindsight, most Americans now agree that Medicare has been a massive success, and the program has withstood repeated attempts to abolish or curtail its benefits.

Yet Medicare, and its sister program Medicaid, did not completely solve the problem of health care finance, especially for those under 65. As costs have continued to rise, it has become more and more difficult for Americans to get the care they need. Before the Affordable Care Act (ACA), there were more than 47 million of us without any health insurance, including me.

I couldn’t afford private insurance, and as a healthy young man, I hoped I wouldn’t need it. When I injured my right hand, the pain was excruciating. For days I could barely move my fingers, and my forearm looked like a banana well past its expiration date. But worst of all was the uncertainty. Had I broken a bone, torn a tendon? In any case, I knew I couldn’t afford to see a doctor. Federal law requires emergency departments to treat all patients regardless of their ability to pay, but uninsured patients still get stuck with the bill. I bought a $10 splint at a drug store and hoped for the best.

Thankfully, my injury eventually healed. But now, as a fourth year medical student, I have already seen many patients who faced the same dilemma and were not so lucky. One, who had gashed his leg in a fall, came to the hospital only after he had developed a rampant wound infection that required surgical treatment and could easily have left him wheelchair-bound. A woman who came in to a clinic with near-critical high blood pressure told me she hadn’t been able to afford her medications, so she had been taking a pill a week to make them last.

Should I pay my rent, or should I buy my water pill? Do I fix my car, or do I see someone about my shortness of breath? These are decisions nobody should have to make — and yet, these are the decisions many face every day. Medicare, Medicaid, and now the ACA have all been steps in the right direction, but affordable and high-quality health care is still out of reach for millions of Americans.

It is time to finish the job. It is time to acknowledge that health care is a human right, that no man, woman, or child can engage in the pursuit of happiness while under the threat of illness or death. The time for half-measures and quick fixes has passed. We need universal health care, Medicare for all.

On this day, the 49th birthday of Medicare, let us reflect on how much we have accomplished, and what still remains to be done. In 1959 an old woman asked, “What is to be done for those of us who need help right now?” It is my fervent hope that we will soon have an answer to her question.

Danny Ash is a medical student in Ohio.