Let's expand Medicare to everyone

By Meghan Geary, M.D.
The Providence (R.I.) Journal, Aug. 6, 2015

William Butler Years wrote: “From our birthday until we die, is but the winking of an eye.”

As in Yeats’s rhyme, I barely blinked and a year has gone by. In the time between the last two Julys, I completed my first year of residency training as an internal medicine physician at Brown University.

When I think back over the past year, one impression that stands out is this: What a difference the Medicare Program and Rhode Island’s expansion of Medicaid has made for my patients!

Medicare is observing its 50th birthday. In July 1965, President Lyndon B. Johnson signed legislation to implement Medicare. From its inception, Medicare experienced a rapid enrollment and the program gained widespread popularity.

Today, Medicare insures 55 million Americans, nearly everyone over age 65. We might take a moment to contrast Medicare’s rapid, relatively untroubled rollout -- accomplished before the existence of the Internet -- with the hassle and glitches of purchasing health insurance through the Affordable Care Act.

Since birthdays are a time for shared celebration, it is worthwhile to acknowledge that all of us have benefited from Medicare.

Medicare has added five additional years of life expectancy to those who reach 65. Many of them were my patients this past year. They were the retired baseball coaches, former businessmen, lifelong homemakers and loving grandparents.

I met them on the wards, in the Intensive Care Unit and in the Medical Clinic at Rhode Island Hospital.

However, those under age 65 continue to face serious financial barriers to care. In spite of expanded coverage through the Affordable Care Act, out-of-pocket costs remain high and many people continue to have insufficient coverage or, worse yet, remain uninsured.

Individuals without health insurance were also my patients. They included the father who suffered a stroke and the mother who had trouble obtaining the blood pressure medications she needed to prevent damage to her kidneys, brain, eyes and heart.

For these parents, timely access to health care depended upon their having insurance. Convincing, peer-reviewed research has shown that over 42,000 deaths would have been prevented in 2014 if everyone in America had health insurance.

Tragically, this means there are 42,000 individual stories of Americans who did not celebrate their birthdays this year in large part because they lacked coverage.

We could change this picture in the blink of an eye by expanding Medicare to cover all Americans. As we celebrate Medicare’s 50th birthday, we should resolve to establish a system that provides access to all medically necessary health care for everyone, from birth to death.

The Expanded and Improved Medicare for All Act, H.R. 676, a bill in Congress sponsored by U.S. Rep. John Conyers, D-Mich., and co-sponsored by 49 others lawmakers, would do just that. Under this legislation, all Americans would be covered for all medically necessary services, including doctor’s visits, hospital care, prevention programs, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.

Skeptics may believe the cost of such a program would be prohibitive, but the administrative cost savings that we would obtain from having a streamlined, nonprofit, single payer of all medical bills -- savings reliably estimated to be more than $375 billion annually -- would not only allow us to cover everyone, but to eliminate all co-pays and deductibles.

In addition, the new system’s bargaining clout would let us reduce and control the cost of medications and other supplies. We would also be better positioned to prevent or provide early treatment for chronic conditions that, left untreated, require more costly and complex medical care.

An improved Medicare for all is not socialism. As with Medicare presently, the government would not own hospitals or clinics. Patients would go to the doctor of their choice. Only the means of payment would change.

Enacting an improved version of Medicare for all would enable each and every one of us to have access to the medical care we need, and by extension to celebrate as many birthdays as our lives allow. That would truly be a cause for a celebration.

Meghan Geary, M.D., of Providence, is a second-year resident in internal medicine.