Medicare turns 50: A time for celebration and action

By Ahmed Kutty, M.D.
Monadnock Ledger-Transcript (Peterborough, N.H.), July 30, 2015

Fifty years ago today, on July 30, 1965, President Lyndon Johnson signed the Medicare Act into law, a historic and transformative moment when our polity gave expression to America’s highest ideals of inclusion and compassion by providing for a publicly-funded healthcare program for the elderly and the disabled in our society. Today over 50 million seniors are guaranteed a basic minimum of healthcare services, regardless of their ability to pay or their health status. Like the momentous Social Security Act signed 20 years earlier by President Franklin Roosevelt, both programs became enormously popular and have evolved into the third rail of our politics.

Twenty-five years ago, in July 1990, President George H.W. Bush enacted the Americans With Disabilities Act (ADA), another great piece of legislation giving voice and restoring dignity to the disabled, a fifth of our population. Five years ago in April 2010, President Obama gave us the Affordable Care Act (ACA, also known as Obamacare), a significant step toward assuring access to healthcare services for about 17 million of our fellow Americans hitherto uninsured, mostly from the lower middle-class and the near-poor segments of our society.

With 35 million people who will remain uninsured after full implementation of the ACA in 2018, according to the Congressional Budget Office, and another 35 million who will be grossly underinsured upon accessing our current system of healthcare financing, we cannot be complacent and rest on the laurels of gains made thus far. Our total health care spending consumes 18 percent of the gross domestic product, as opposed to an average of 9 percent in all the nations that belong to the Organization for Economic Cooperation and Development. Yet we rank in the lower middle of the pack when measured with metrics for population health such as life expectancy, infant mortality, maternal health, vaccination rate and others. This is not sustainable long-term.

The ADA of 1990 soon became a model that inspired a global movement for social and legislative programs that empowered and enriched the lives of the disabled everywhere. Now it is our turn to look outward, with an open mind, at the systems of healthcare financing and delivery prevalent among the major industrialized nations and, without emulating, to incorporate their core features into a uniquely American model that is universal (covers everybody from cradle to grave),is affordable to individuals and families (financed by payroll and progressive taxation), sustainable (with cost controls built in via global budgeting, negotiated pricing for services, drugs, devices and medical supplies), equitable (all 320 million of us in a single risk pool, and a one-tier only program), comprehensive (covering all medically necessary care) and without economic barriers to care (no premiums, deductibles, copay, coinsurance and arbitrary exclusions of coverage).

First-dollar coverage and full choice of doctors and hospitals are available under the Conyers Bill in the House (HR 676), known as the U.S. National Health Care Act or the Improved Medicare for All Act. This bill, when passed, would replace the deeply flawed Obamacare and, by preserving, enhancing and expanding Medicare of 1965, would give us a world-class, yet equitable, self-sustaining system of financing health care, still delivered privately as now and controlled locally, transparently and with public accountability. An estimated $590 billion in savings nationwide could be had in the first year of operation of the national plan.

Health care spending costs us about $4 trillion a year, nearly a fourth of our $17 trillion gross domestic product. Any attempt to change the course of such a behemoth is akin to steering the Titanic. Yet steer we must, lest the ship of our economy hits the iceberg. Entrenched, well-heeled and formidable interest groups in our country are happy with status quo, while the other 99 percent are to confront hardships and avoidable financial ruin to varying degrees now and in the near-term under the highly priced, unequal and insanely inefficient system we now have. Of course there is more to attaining health than merely having a national health plan in place. Each one of us carries personal responsibility for a healthy lifestyle and also shares the burden of providing for a system of social insurance, not for profit, based on a service rather than a business model, resulting in a dynamic, ongoing engagement between the individual and the society. The system design will have baked into its DNA, like all living systems, the capacity to evolve over time and for adaptation to the changing milieu of contemporaneous political economy.

We Americans, who put a man on the moon in July 1969, and this July had our spacecraft get 8,000 miles close to Pluto, the outermost heavenly body in our solar system, have it in us to meet one of mankind’s oldest challenges: how to care for the ill among us with dignity, compassion, competence, affordability and efficiency of cost and quality, if only we harness our collective will to build upon and out from Medicare, the foundation laid for us by President Johnson 50 years ago.

David did prevail over Goliath. Support HR 676 and a similar bill in the New Hampshire legislature (HB 686). Therein lies our last best hope for bringing forth a national health care system with everybody in and nobody out.

As the late South African leader, Mr. Nelson Mandela, said about the struggle for a good cause to prevail, “It always seems impossible until it is done.”

Dr. Ahmed Kutty lives in Peterborough.