Regarding coverage of the 50th anniversary of Medicare and Medicaid (Modern Healthcare, May 25, p. 13), in 1979 as an American Hospital Association/Blue Cross and Blue Shield Association fellow, I had the privilege of meeting Wilbur Cohen, the architect of Medicare and Medicaid, and the first secretary of the Department of Health, Education and Welfare under President Lyndon Johnson (predecessor agency to HHS). I was so impressed by his passion about expanding coverage to senior citizens and poor and disabled citizens of the U.S., who like all of us need healthcare and benefit from the security of health insurance.
Mr. Cohen's vision has been realized in many respects. Medicare and Medicaid have provided essential services to millions of Americans, have fueled the expansion of medical technology, expanded the capabilities of healthcare providers, and have resulted in greater life expectancy and extended quality of life for men and women in our country.
I am sure that Mr. Cohen did not fully anticipate the current size and complexity of Medicare and Medicaid, which now include an enormous CMS infrastructure, or how the healthcare industry would drive costs to 17% of GDP. Medicare and Medicaid have often been criticized for the lack of realistic financial planning and the impact on federal and state budgets, the unfunded costs of providing care in hospitals and physician offices—which has shifted those costs to employers and individuals in the commercial insurance market—and the regulatory burden that has significantly increased the administrative costs of healthcare.
However, the individual patient who now has access to high-quality healthcare never wants Medicare or Medicaid to go away.