50th Anniversary of Medicare/Medicaid, Republicans are still trying to kill it

There is something surreal about Biggs, et al v. Brewer, et al. (CV2013-011699 Maricopa County Superior Court), the Medicaid (AHCCCS) expansion case brought by almost every Tea-Publican legislator in the Arizona legislature, being heard today in court on the 50th Anniversary of the The Social Security Amendments of 1965 creating the Medicare and Medicaid programs. Medicaid (AHCCCS) expansion case set for hearing on July 30, 2015.

These Tea-Publican legislators are seeking to take away Medicaid (AHCCCS) health insurance coverage for an estimated 300,000 recipients (est. 463,000 Arizonans are eligible). Arizona Medicaid: eligibility, enrollment and benefits. I hope that one of the attorneys will point out the significance of today’s date to the Court.

On July 30, 1965, President Johnson signed the Social Security Amendments which established Medicare and Medicaid, promising that they would “improve a wide range of health and medical services for Americans of all ages.”

Former President Harry S. Truman was at his side in Independence, Missouri. Johnson credited Truman with “planting the seeds of compassion and duty which have today flowered into care for the sick and serenity for the fearful.”

LBJ_Medicare_Bill_Signing34896web
Medicare bill signing,Date: 7/30/65, Harry S. Truman Library, Independence, Missouri.

Excerpt from Indomitable Will: LBJ in the Presidency, by Mark K. Updegrove. 50th Anniversary of Medicare and Medicaid – LBJ Presidential Library:

At the top of President Lyndon Johnson’s legislative agenda in 1965 was Medicare, a federally funded insurance program to provide low-cost medical and hospital care for America’s elderly under Social Security. Half of the country’s population over age sixty-five had no medical insurance, and a third of the aged lived in poverty, unable to afford proper medical care; Johnson believed it was high time to do something about this.

Shortly after his November election win, he told Health, Education, and Welfare’s assistant secretary, Wilbur Cohen, to make Medicare the administration’s “number one priority.” On January 4, Johnson put the issue front and center in his State of the Union message (full text); three days later he pressed for passage of Medicare, issuing a statement to Congress demanding that America’s senior citizens “be spared the darkness of sickness without hope.”

Franklin Roosevelt was the first president to seriously consider a federal health insurance program. As Congress churned out New Deal legislation, Roosevelt advocated inclusion of a federal health insurance component in his Social Security Act of 1935, before dropping it to avoid jeopardizing the bill’s passage. Fourteen years later, Harry Truman sent the House a bill that would offer health insurance to those age sixty-five and older, but it was blocked by an intractable Ways and Means Committee. Kennedy tried, too, sending a comparable bill to Capitol Hill in 1962, where it missed passage in the Senate by a few votes.

Reagan-LPcoverIn each case, the American Medical Association (AMA) was the chief culprit in killing the legislation, spending millions to brand the concept as “socialized medicine,” an ambiguous characterization that nonetheless made it intrinsically un-American. Conservatives also cast a wary eye. Actor Ronald Reagan, a darling of the growing conservative movement and soon-to-be California gubernatorial candidate, warned that such a program would “invade every area of freedom in this country” and would, in years to come, have Americans waxing wistful to future generations about “what it was like in America when men were free.” [Ronald Reagan Speaks Out Against Socialized Medicine is a spoken word LP (1961)]

But sixteen years after Truman’s efforts were derailed by an unwilling Congress, Johnson believed “the times had caught up with the idea.” On July 30, 1965, Johnson traveled to the Harry S. Truman Library and Museum in Independence, Missouri, where the eighty-one-year-old Truman, lean and bent with age, his wife, Bess, in tow, watched Johnson sign Medicare into law.

Proclaiming the thirty-third president the “real daddy” of Medicare, Johnson awarded President and Mrs. Truman the first two Medicare cards, numbers one and two. “He had started it all, so many years before,” Johnson wrote of Truman later. “I wanted him to know that America remembered.”

Full text: President Johnson’s Remarks at the Medicare Bill Signing (July 30, 1965, The American Presidency Project).

The more things change, the more they stay the same: Republicans are still trying to kill Medicare/Medicaid. Paul Krugman of the New York Times writes, Zombies Against Medicare:

Medicare turns 50 this week, and it has been a very good half-century. Before the program went into effect, Ronald Reagan warned that it would destroy American freedom; it didn’t, as far as anyone can tell. What it did do was provide a huge improvement in financial security for seniors and their families, and in many cases it has literally been a lifesaver as well.

But the right has never abandoned its dream of killing the program. So it’s really no surprise that Jeb Bush recently declared that while he wants to let those already on Medicare keep their benefits, “We need to figure out a way to phase out this program for others.”

What is somewhat surprising, however, is the argument he chose to use, which might have sounded plausible five years ago, but now looks completely out of touch. In this, as in other spheres, Mr. Bush often seems like a Rip Van Winkle who slept through everything that has happened since he left the governor’s office — after all, he’s still boasting about Florida’s housing-bubble boom. [See The Washington Post, Under Jeb Bush, housing prices fueled Florida’s boom. Then it all went bust.]

krugman.pngActually, before I get to Mr. Bush’s argument, I guess I need to acknowledge that a Bush spokesman claims that the candidate wasn’t actually calling for an end to Medicare, he was just talking about things like raising the age of eligibility. There are two things to say about this claim. First, it’s clearly false: in context, Mr. Bush was obviously talking about converting Medicare into a voucher system, along the lines proposed by Paul Ryan.

And second, while raising the Medicare age has long been a favorite idea of Washington’s Very Serious People, a couple of years ago the Congressional Budget Office did a careful study and discovered that it would hardly save any money. That is, at this point raising the Medicare age is a zombie idea, which should have been killed by analysis and evidence, but is still out there eating some people’s brains.

But then, Mr. Bush’s real argument, as opposed to his campaign’s lame attempt at a rewrite, is just a bigger zombie.

The real reason conservatives want to do away with Medicare has always been political: It’s the very idea of the government providing a universal safety net that they hate, and they hate it even more when such programs are successful. But when they make their case to the public they usually shy away from making their real case, and have even, incredibly, sometimes posed as the program’s defenders against liberals and their death panels.

What Medicare’s would-be killers usually argue, instead, is that the program as we know it is unaffordable — that we must destroy the system in order to save it, that, as Mr. Bush put it, we must “move to a new system that allows [seniors] to have something — because they’re not going to have anything.” And the new system they usually advocate is, as I said, vouchers that can be applied to the purchase of private insurance.

The underlying premise here is that Medicare as we know it is incapable of controlling costs, that only the only way to keep health care affordable going forward is to rely on the magic of privatization.

Now, this was always a dubious claim. It’s true that for most of Medicare’s history its spending has grown faster than the economy as a whole — but this is true of health spending in general. In fact, Medicare costs per beneficiary have consistently grown more slowly than private insurance premiums, suggesting that Medicare is, if anything, better than private insurers at cost control. Furthermore, other wealthy countries with government-provided health insurance spend much less than we do, again suggesting that Medicare-type programs can indeed control costs.

Still, conservatives scoffed at the cost-control measures included in the Affordable Care Act, insisting that nothing short of privatization would work.

And then a funny thing happened: the act’s passage was immediately followed by an unprecedented pause in Medicare cost growth. Indeed, Medicare spending keeps coming in ever further below expectations, to an extent that has revolutionized our views about the sustainability of the program and of government spending as a whole.

Right now is, in other words, a very odd time to be going on about the impossibility of preserving Medicare, a program whose finances will be strained by an aging population but no longer look disastrous. One can only guess that Mr. Bush is unaware of all this, that he’s living inside the conservative information bubble, whose impervious shield blocks all positive news about health reform.

Meanwhile, what the rest of us need to know is that Medicare at 50 still looks very good. It needs to keep working on costs, it will need some additional resources, but it looks eminently sustainable. The only real threat it faces is that of attack by right-wing zombies.

Right on, professor!

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