Medicare and Medicaid: Successes and Drawbacks

The New York Times, Letters, July 11, 2015

PNHP note: The three letters below were among six published in the Sunday (July 12) print edition of The New York Times in response to its editorial noting the 50th anniversary of Medicare and Medicaid.

By Marcia Angell, M.D.

In "Medicare and Medicaid at 50" (editorial, July 3), you referred to polls between 1999 and 2009 that showed “consistent majorities in favor of expanding Medicare to people between the ages of 55 to 64 to cover more of the uninsured.” The next day, “Insurers Seek Steep Increases in Plans’ Rates,” a front-page news article, reported on likely double-digit rate increases — something the Affordable Care Act can discourage but not prevent.

Isn’t it time to accede to the wishes of the “consistent majorities” and begin dropping the qualifying age for Medicare one decade at a time? It would probably be less costly for consumers, since any increase in payroll taxes would be more than offset by lower premiums and out-of-pocket costs, it would provide truly universal care to those in the covered age groups and it would certainly be less inflationary.

Dr. Marcia Angell resides in Cambridge, Mass. She is a senior lecturer in social medicine at Harvard Medical School and a former editor in chief of The New England Journal of Medicine.

By Ann Troy, M.D.

Congress created Medicare 50 years ago to provide seniors with health care, giving them protection against financial ruin and peace of mind. Five years ago Congress could have and should have extended Medicare to cover all Americans, creating a single-payer system with the much freer choice of doctors and hospitals that seniors enjoy. Instead, it passed the hopelessly complex Affordable Care Act, which has kept the wasteful and bureaucratic insurance industry in health care and left millions uninsured and millions more with woefully inadequate coverage. It has also cost far more than simply extending Medicare.

It is well known that people without insurance or with high deductibles wait longer to seek medical care; thus their illnesses or problems become more difficult to treat. And sometimes they die because they have no insurance (an estimated 50,000 every year). Those with Medicare have more protection against the devastating effects of illness and injury, get more help overcoming or living with disabilities, and are protected against financial ruin.

“Equal protection” has been used, with some success, to improve access to education and, now, to allow same-sex couples to marry. It seems that an even stronger case can be made regarding access to health care — which is considered a right in every other developed nation.

Dr. Ann Troy resides in San Rafael, Calif. She is a pediatrician.

By Samuel Metz, M.D.

Medicare provides better care at lower cost than private health insurance can achieve. But it is woefully underfunded and may become insolvent. Many argue for privatization. However, every health care system in the world, especially our private insurance industry, faces increasing costs and a decreasing willingness of patients (and taxpayers) to pay for them.

Remarkably, Medicare costs are rising slower than those of private insurance — despite caring for older, sicker patients. Privately administered Medicare Advantage costs more than traditional Medicare; that’s not because patients receive care they don’t need, but because private insurance companies receive extra federal payments they don’t earn. Clearly Medicare needs less private interference, not more.

Medicare delivers high value. Its critical features — prepayment during high earning periods, reduced cost-sharing at time of need, inclusion of the broadest possible population, comprehensive benefits — should be reinforced. Then these features should extend to the rest of us. Medicare for some is good. Medicare for all is better.

Dr. Samuel Metz resides in Portland, Ore. He is an anesthesiologist and a member of Physicians for a National Health Program.