Happy Birthday to Medicare

By Dr. Margaret A. Nosek for the Houston Chronicle

With all the commotion surrounding the Supreme Court and the Affordable Care Act (ACA), it would be easy to overlook an important birthday: Today is the 47th anniversary of Medicare, the public health insurance program that covers our nation’s seniors and people with severe disabilities.

It’s a birthday that deserves to be celebrated, including here in the Lone Star State. Medicare provides 48 million Americans – about 3 million of them in Texas – with reasonably good access to health care, thereby easing their suffering, prolonging their lives, and reducing financial pressures on them and their families. Before Medicare was enacted in 1965, most retired older people were at risk of financial ruin when they got sick. Medicare changed that picture, and our state and nation are much better for it.

The Medicare program is not perfect, of course. It has burdensome co-pays and deductibles, and its benefits could be better. But it remains immensely popular, and it’s not hard to figure out why. A new study in the journal Health Affairs found that “Medicare beneficiaries age 65 and older are more satisfied with their health insurance, have better access to care, and are less likely to have problems paying medical bills than working-age adults who get insurance through employers or purchase coverage on their own.”

Keep that in mind the next time you hear a politician or pundit argue that the Medicare program should be converted to a private voucher program, where seniors would get a flat amount to buy a health policy from a commercial insurance company. Such schemes are lucrative for the big private insurers but would be bad for most seniors, leaving them with inferior and progressively deteriorating coverage.

The pretext for privatizing Medicare is the claim that it is financially unsustainable. While it’s true the program faces big financial challenges, it’s more of a victim than a cause of skyrocketing health costs. Privatizing the program would only make matters worse as the insurers, notorious for their inability to control costs, would skim more premium dollars off the top.

Yes, there are some partial, short-term solutions. For example, Congress could tweak the payroll tax by a fraction of a percentage point to make Medicare’s reserves flush again. Or lawmakers could give Medicare the power to negotiate lower drug prices, something the ACA currently prohibits.

Ironically, the best way to save Medicare is to improve and expand it to cover everybody. By establishing an improved Medicare for all, a single-payer health-care financing system, we could recoup about $400 billion that is wasted each year on unnecessary, private-insurance-related profits, paperwork and bureaucracy. That’s enough money to provide health care to everyone in the U.S. with no co-pays or deductibles and without spending a penny more than we do now.

We would also acquire other cost-control tools like the market clout needed to negotiate lower prices for medical supplies, and the ability to set global budgets for hospitals.

This type of system would bring back free choice of doctor and hospital – the one thing everyone agrees is among the top goals of health-care reform.

Polls show an improved-Medicare-for-all approach enjoys the support of about two-thirds of the public and more than half of all physicians. Yet up to now, this commonsense solution has been blocked by private insurers, pharmaceutical companies and their allies in Congress.

On Medicare’s anniversary, what do you say we give them a run for their money? Tell your elected officials the ACA doesn’t go far enough. Cut the private insurers out of the picture. We need an improved and expanded Medicare for all.

Nosek is a professor in the Department of Physical Medicine and Rehabilitation at Baylor College of Medicine and president of Health Care for All Texas.