On July 30, Medicare turned 50 — a milestone that every American can celebrate. Though started as a basic health coverage program, it has evolved to become an integral component of American life, providing access to affordable, quality healthcare and setting a pioneering example of a universal, single payer system for the nation.
The launch of Medicare was the culmination of a decades-long effort to establish comprehensive national healthcare in the U.S. The political battle that ultimately led to its adoption was heated. The White House, the labor movement and other supporters pushed to enact a national, single payer program of universal care — a concept that polls indicated had broad public support. There was fierce opposition from industry forces and within Congress.
In the end, Medicare, and its contemporary, Medicaid, were born of compromise, settling on a solution that carved out the elderly and extreme poor, respectively. Medicare limited coverage to those 65 years of age and older (about 20 million in 1965), and states were given leeway in determining Medicaid eligibility and program implementation.
Today, on its golden anniversary, 55 million Americans directly benefit from Medicare (46 million over 65 and 9 million younger people with permanent disabilities) — almost one-sixth of the country’s total population. Medicaid, in any given month, covers an additional 70 million children, pregnant women, low-income adults and people living with disabilities. Together, these programs touch the lives of all of us through the well-being, financial security, and quality of life provided for our family members, patients, friends and communities. Year after year, in poll after poll, Medicare has enjoyed overwhelming public support.
Healthcare has seen many changes since 1965. Through it all, Medicare has evolved to consistently deliver an array of benefits. One of the most significant changes came in 1972 when Congress extended eligibility to those under age 65 who qualified for Social Security disability or had end-stage renal disease — two groups that had experienced exceptional difficulty in securing or affording private insurance.
Medicare had an immediate positive impact on healthcare outcomes. Between 1963 and 1970, access to care increased, as annual hospital admissions per 100 elderly Americans rose from 18 to 21, and the proportion of elderly persons who had contact with a physician each year increased from 68% to 76%. These contributed to a five-year increase in life expectancy for those over age 65 recorded between 1970 and 2010.
Medicare created a sea change in the economics of aging in America. In the 1950s and 1960s, almost half of American seniors had no health insurance — often not by choice, but because insurance companies would not sell affordable coverage to an aging population. Elderly Americans lived in constant fear that the high cost of healthcare would drive them into poverty, which it did. In 1966, one-third of women and one-quarter of men over 65 lived in poverty.
Medicare is bedrock
Today, five decades after Medicare’s enactment, the poverty rate among seniors has plummeted. Medicare avoids the high costs of utilizing insurance companies in the healthcare process and is a good steward of public spending. Total Medicare spending consistently grows at a slower rate than that of private insurance — despite caring for older, sicker patients. Medicare per capita spending has remained remarkably flat since 2010. In fact, Medicare is widely acknowledged as among the most efficient and well-managed health insurance programs in the entire world.
In 1965, there was no infrastructure for measuring or assessing quality. Medicare has facilitated the collection of data on processes, outcomes and costs that have led to innovations in treatment and payments, identified best practices, enabled patients to become better healthcare consumers, and improved accountability among physicians and other providers.
For 50 years, Medicare has been a bedrock of economic and health security for older Americans, providing access to hospital care, doctors’ services and more recently prescription drugs. It has proved its superiority over any private, market-based alternative. It is time to build on the success of its first fifty years and expand its benefits to all Americans. It’s time to enact Medicare for All!