Happy Birthday, Medicare

By Oliver Fein, M.D.
PNHP N.Y. Metro, July 30, 2015

The following are the prepared remarks of the speech that Dr. Oliver Fein delivered at the New York City celebration of the 50th anniversary of Medicare and Medicaid at the Professional Staff Congress CUNY in Manhattan on July 30.

We are gathered here today to celebrate the 50th Birthday of Medicare and Medicaid. At birth, Medicare was a fantastic program. The baby was really beautiful. Why?

  • Because every citizen who had a job contributed;
  • Because everyone who contributed had access to the same benefits;
  • Because access to benefits did not depend on how much you contributed or how much you earned;
  • Because enrollment occurred once in a lifetime, when you turned 65;
  • Because every hospital and more than 90 percent of doctors participated – it had as broad network of providers;
  • Because it was efficient: 97-98 percent of all dollars contributed to Medicare went to pay providers of health care – nurses, doctors, physician assistants, social workers, hospitals.

But the baby had some blemishes:

  • Health care was not free at the point of delivery: there were deductibles and co-payments;
  • Some benefits were not covered: preventive care, dental care, eye glasses and hearing aids, long-term care and prescription drugs;
  • Contributions were not progressive – they were the same percentage on all incomes;
  • People under 65 years of age were not covered.

Many of us assumed that when the baby grew up, all of these weaknesses would be overcome.

  • There would be no co-pays and no deductibles – health care would be free at the point of delivery.
  • When benefits were expanded to include medications, Medicare would be able to negotiate directly with pharmaceutical companies to lower prices on prescription drugs;
  • When the Medicare tax was increased, it would become more progressive like the income tax;
  • Medicare would be expanded to cover all residents of the United States.

But as Medicare has grown from 16 million enrollees in its first year to 55 million today, in its 50th year, it has become infected by potential deadly parasite, namely private, for-profit health insurance companies, which extracted over $34 billion in overpayments in 2012 alone. The private insurance companies accomplish this by attracting Medicare enrollees who are less sick and therefore less expensive, leaving those who are sicker and more expensive in the original program. If this continues, the original program will become the repository of the sickest, most expensive patients – resulting in an insurance death spiral, killing the original Medicare as we know it. We must work to phase out Medicare Advantage plans and work for an improved, Medicare-for-All – with no co-pays and deductibles, automatic enrollment of all residents of the United States, in a single-payer national health insurance program.

So what is to be done?

First, each of us should call our representatives in Congress in the House and the Senate with three demands to protect the Medicare program:

  • Do NOT raise the age of Medicare eligibility above 65 years, if anything lower it;
  • Allow Medicare to negotiate directly with the pharmaceutical industry for drug prices;
  • If any money is to be saved from Medicare, it must come from the overpayments to Medicare Advantage plans.

Second, each of us should write our member of Congress proposing they sign-on to an improved, expanded Medicare-for-All bill such as H.R. 676 (the Conyers bill) or S.B. 1782 (the Sanders bill). Thank them if they have signed on.

Third, each of us should try to meet with our New York State senator and assemblyperson and ask them to sign on to the New York Health Act (A5062 or S3525), a statewide single-payer bill for New York State.

Fourth, invite a friend or neighbor to join you for some apple pie and tell them what an improved, expanded Medicare-for-All would look like and invite them to join a single-payer advocacy group, such as Healthcare-NOW, the Campaign for the New York Health Act, union action committees, the New York State Nurses Association and Physicians for a National Health Program.

Happy Birthday Medicare! We pledge to protect, improve and expand you to everyone who lives in America.

Dr. Oliver Fein is the chair of the New York Metro chapter of Physicians for a National Health Program.