It's good to reflect on the past and how it brought us to the present.
This is an exercise that's foreign to most Americans. We are future-oriented and have little patience for the remembrance of things past. We want to roll up our sleeves and fix (or have somebody else fix) the problem and go back to what we were doing.
The drawback of this attitude is that the past offers clues to why things are the way they are and how they might be improved.
With this in mind, Modern Healthcare offers this week's cover story, which notes the 40th anniversary of Medicare and Medicaid. The legislation that created them was signed into law on July 30, 1965. Tony Fong of our Washington bureau reports on the history of the programs and where things stand today. In addition to charts, graphs and a chronology of key events in the history of the programs, we have commentaries from several distinguished authors, including the secretary of HHS, the presidents of the American Hospital Association and the American Medical Association, a former speaker of the House and a noted healthcare policy analyst.
It's impossible to recount a whole life on a birthday card, of course. We hope this editorial package will stimulate some thought, much as our national holidays prompt us to think about independence, wars, labor, gratitude, etc.
A lot has happened-and some might say not very quickly-since early 20th century reformers like Teddy Roosevelt proposed national health insurance. The nation witnessed bitter political disputes over the issue right up until Lyndon B. Johnson signed Medicare and Medicaid into law. The fighting didn't end there. There have been rolling battles over provider reimbursement and patient benefits. In the latter category, most of us probably remember protesters angry over the aborted catastrophic coverage plan riding on the hood of Ways and Means Chairman Dan Rostenkowski's car. A more recent memory is the Medicare drug bill and the flap over the program actuary's suppressed cost estimates.
But in reflecting on the battles, let's not forget what the war achieved. Through Medicare and Social Security, many senior citizens were spared a descent into a subsistence retirement. In the 1950s, hospital prices had doubled. Almost half of all seniors had no health insurance, and about a third lived in poverty.
Providers, too, have done quite well. While complaining about Medicare reimbursement is second only to cursing managed care among many physicians and hospital executives, providers should remember that the program created a huge new market for services. It subsidized capital spending and physician training. It made many providers personally affluent. The landscape of healthcare would be a lot bleaker without Medicare, and the U.S. would be far behind other industrialized nations in medical care.
Medicare's condition isn't perfect, of course. Its organizational structure may not be the most efficient arrangement. Physician payments may be too low. Geographic classifications and wage indexes are perennial problems. The new drug benefit may turn out to be a treasury-draining albatross and of little use to most seniors. (In fact, I'd bet on it. Again, remember Rostenkowski's car?) And Medicaid is a constant problem desperately seeking a solution.
And to top it off, while the troubles demand fixing, Congress seems more interested in publicity stunts and pandering to political constituencies. Medicare and Medicaid need adjustment more urgently than Social Security, but there appears to be little inclination to do anything comprehensive, let alone logical.
But then, we're Americans. Despite the hurdles, we can do what needs to be done. And we'll do a better job if we remember how the story began.
What do you think? Write us with your comments. Via e-mail, it's [email protected]; by fax, dial 312-280-3183.