The subject of health insurance for all is not a new concept, in fact it goes back to the time of Theodore Roosevelt whose election platform in 1912 prominently featured (among other progressive planks) a plan for a National Health Insurance (“Progressive Party Platform of 1912,” 2019). Unfortunately for Roosevelt (and for the country-in my humble opinion) he was not elected, and the idea of a comprehensive National Health Plan had to wait until after World War II and into the presidency of Harry S. Truman.

On November 19, 1945, Truman sent a letter to Congress outlining the plan for the creation of a National Health Insurance Fund which was to be open to all Americans. It would have provided for total health care coverage for individuals, paying for doctor’s visits, hospital stays, laboratory services, dental care, and nursing services. Suffice it say that this measure was successfully blocked in congress by the strong lobbying efforts of multiple Medical Industry special interest groups, primarily among them the American Medical Association (ironically enough as that group now champions a single payer system). Taken in context however, this was the period of the “Red Scare” when anything that even remotely smacked of Communism or its cousin Socialism (gasp, that word!) was shied away from due to the relentless hounding and unfounded charges of anti-Americanism brought by Senator Joseph McCarthy (“Joseph McCarthy United States Senator,” 2019) and his ilk. These charges could (and did) ruin careers and destroyed people’s lives. So… the deadly combination of high-priced lobbyists and McCarthyism quashed the idea of “Nationalized Medicine” for many years (although Great Britain and Canada started it and maintain excellent National Health Services to this day). 

John F. Kennedy made his own push for a more limited National Health Plan that would cover seniors after a national survey showed that 56% of Americans over 65 had no health coverage. But the events of the early 1960’s conspired to hold that off until president Lyndon B. Johnson (the master congressional deal maker) was able to get Medicare over the line and signed in 1965 with coverage for those over 65 beginning in 1966. Harry Truman and his wife Bess were Medicare recipients numbers 1 and 2.

Timeline

1966 – Medicare Part A (Hospitalization Coverage) and Part B (Coverage for Doctor’s Visits) begins.

1972 – President Richard Nixon signed into law expanded coverage to those under 65 with a chronic long-term disability or end stage renal failure on dialysis (hemodialysis or peritoneal dialysis).

1980 – Home Care Services were added. “Medigap” insurance plans came under Federal Regulation.

1982 – Hospice Services were added

1988 – Caps placed on Medicare A and B outlay in case of catastrophic illness. States required to provide funding for Part B premiums for Qualified Medicare Beneficiaries who are at the poverty line.

1990’s – Medicare Part C enacted. This led to the creation of Medicare Advantage Plans otherwise known as Managed Medicare.

2000 – People under the age of 65 with ALS can get benefits without a waiting period if approved for Social Security Disability (SSDI), normally there is a 24 month wait.

2003 – President George W. Bush enacted Medicare Part D which is an optional prescription benefit which can be purchased alone, combined with Medicare part A and B or combined with a Medicare Part C plan (confused yet?).

2010 – Patient Protection and Affordable Care Act (ACA) was enacted which seeks to decrease costs to Medicare while improving quality of care.

2015 – Medicare and CHIP Reauthorization Act (MACRA) passed. Changes the way Medicare pays physicians to try and improve quality of care at a lower cost to Medicare. Essentially, Doctors must provide better quality of care or else they get paid less.

Closing thoughts

As of this writing, there were approximately 60.6 million people on Medicare costing 705.9 billion dollars in 2017 (Anderson, 2019). This is about 20% of total health spending in the US. 

Medicare now stands to account for 18% of the total federal spending by 2028 with the result that the Part A trust fund will be depleted and the difference needs to be made up by payroll taxes (not likely to cover the total Part A spending). As ACA has helped slow the growth in Medicare spending while improving quality, it is unlikely to “bankrupt Medicare”, but there must be something done that will provide better quality care, at less cost, with better coverage for all Americans, returning to the original vision of Teddy Roosevelt and Harry Truman.

References

Anderson, S. (2019, May 1). A brief history of Medicare in America Landmark social program now covers 58.5 million Americans. Medicare Resources.org. Retrieved from https://www.medicareresources.org/basic-medicare-information/brief-history-of-medicare/

Joseph McCarthy United States Senator. (2019). Retrieved June 23, 2019, from https://www.britannica.com/biography/Joseph-McCarthy

Progressive Party Platform of 1912. (2019). Retrieved from https://teachingamericanhistory.org/library/document/progressive-platform-of-1912/