Friday, July 31, 2015

Medicare & Medicaid Turn 50

It was a happy moment, 50 years ago yesterday, when President Lyndon B. Johnson signed Medicare and Medicaid into law (photo). That he chose to do so at the Truman Library in Independence, Missouri, in the presence of former President Harry S Truman, was both a tribute to Truman's earlier leadership in the cause of providing Americans with access to health care - and also a testimony to how long it had taken and what a struggle it had been!

Obviously, access to health insurance should have been available long before 1965 - and it should have been universal. Even then, however, something about American political culture made it difficult to accomplish what other advanced industrial countries accomplished with such greater ease. Everyone knows, of course, how the post-war Labour Party Government introduced universal health care in the United Kingdom.  But Britain was by no means the first to cross that Rubicon. The developed world's oldest national health insurance system is found in Germany - dating back to Chancellor Otto von Bismarck's 1883 Health Insurance Bill.

Undoubtedly FDR would have included health insurance in Social Security if he had thought it could pass. Truman tried in 1949. Instead, it took another generation at the climax of the period of post-war economic prosperity to pass a downsized version of national health care - Medicare for seniors and Medicaid for the poor.  In the end it took the quixotic 1964 candidacy of Barry Goldwater to guarantee a Democratic landslide and with it a Congress so lopsidedly liberal enough to make LBJ's Great Society (of which Medicare and Medicaid were critical components) a long-awaited reality.

It is alleged that LBJ envisioned a gradual decrease in the Medicare age, eventually evolving into universal access to health care regardless of age. Something like that could have happened in 1973, when President Nixon was willing to consider extending Medicare for all. But that didn't happen either. The first was a casualty of Vietnam; the second of Watergate. 

So it wasn't until President Obama that this country finally got something close to what we should have had all those decades ago, although in a much more complicated - and compromised - form than if we had just extended Medicare to all.

Medicare remains one of the crown jewels of American social policy. Medicaid, because it serves the poor (who don't vote that much) rather than senior citizens (who vote a lot) has always been the demeaned stepchild of American health-care policy. Even now, after Obamacare made a widespread extension of Medicaid easy for states to implement, many states have refused to participate. What is one to make of such a dysfunctional political ideology, one of the primary pillars of which is denying people access to adequate healthcare? 

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