Medicare, Medicaid mark 50 years of national impact

By Mark Liebow, M.D.
The Post-Bulletin (Rochester, Minn.), July 30, 2015

Fifty years ago today, President Lyndon B. Johnson flew to Independence, Mo., the retirement home of President Harry S. Truman, to sign the bill that created Medicare and Medicaid. He gave Truman and Truman's wife, Bess, Medicare cards No. 1 and No. 2.

When in office, Truman had advocated for a national health insurance program, but wasn't able to get it enacted into law.

Between Truman's time in the White House and Johnson's, many more workers and their families obtained health insurance, so there no longer seemed to be a need for a national health insurance program. However, seniors and poor people did not benefit from this employer-based expansion of health insurance. Most had no insurance and often were unable to afford health care. This was especially a problem for seniors who often had more medical problems than they had ever had before. President John F. Kennedy unsuccessfully tried to get a federal health insurance program for seniors passed.

When Johnson took office after Kennedy's assassination, he promised to get Kennedy's health insurance proposal passed. Republicans fought the proposal, saying it was "socialized medicine," but in 1964, the coattails from Johnson's landslide victory brought many liberal Democrats to Congress. A year later, those Democrats started working on legislation to create what had come to be known as Medicare.

The health insurance program for the poor, known as Medicaid, was added during congressional debate. Democrats in Congress voted overwhelmingly for the two programs while Republicans were split almost evenly.

The two programs started on Jan. 1, 1966. In the years since then, they have had a huge impact on the people they help.

The life expectancy for 65-year-old women has risen by 12.2 percent while that of 65-year-old men has climbed 33.3 percent. Seniors have gone from the poorest age group in the U.S. to being the richest because they no longer have to cope with large medical expenses on fixed incomes.

Medicaid covers a large share of pregnancies, which has saved lives. Maternal mortality has gone down by 41.5 percent, while infant mortality has gone down by 75 percent.

The programs came along at just the right time. From 1965 to 1980, we had huge improvements in what medical care could provide, including coronary bypass surgery, joint replacements and CT scans. Because of Medicare, many more seniors could take advantage of these medical advances. Medicaid made it possible for many poor children to have a healthier childhood. At the other end of life, Medicaid paid for nursing homes when people ran out of money, allowing seniors who could no longer live at home to live out their lives with more dignity than the traditional poorhouses offered.

Medicare and Medicaid were the first federal programs to pay private doctors and hospitals to care for patients. Before that, care was provided directly, as in the VA system, or through grants given to states.

The programs have grown to be the two biggest programs covering Americans today. Medicare covers 52.3 million Americans, and Medicaid, along with the later addition of Children's Health Insurance Program, covers 71.1 million, so they together cover 38 percent of Americans. Their experience has shown us a partial single-payer system can work.

Medicare and Medicaid haven't been problem-free. Medicare was set up so patients had to pay 20 percent of the costs of professional services, which quickly became a financial burden for seniors and led to Medigap policies to protect against those costs. At first, there was no coverage for oral medications, which made sense in 1965 when there were far fewer medications, but it took 38 years to create that coverage. Medicaid often has had such low fees for doctors that many refused to see Medicaid patients. However, many of the problems were eventually fixed.

These programs fundamentally transformed Rochester. We have 2.5 times as many people as we did in 1965, driven largely by the growth of medical practices. Mayo Clinic had fewer employees than IBM in 1965. It is about 10 times bigger now than it was in 1965. Olmsted Medical Group has grown dramatically, too. No other city in Southern Minnesota has grown like this. Austin and Albert Lea have fewer people now than in 1965, while Winona's population is only slightly larger.

Medicare and Medicaid have transformed America, as well. The vision of several Democratic presidents made our country a better place. Much of American health care and graduate medical education over the last 50 years has been paid for by the programs. Technology helping all of us became available faster because more people could afford health care. Generations of seniors have led longer and better lives due to Medicare.

Medicaid has made the difference between life and death for many poor people.

Perhaps before 2065, we can have Medicare for all.

Mark Liebow is a Rochester physician and the chairman of Senate District 26 DFL.