Preserving Medicare's Success, 43 Years Later

As popular as Medicare is now, it is hard to believe that it was once bitterly opposed. Medicare came into existence 43 years ago today, in the face of many who doubted that it could cover millions of people, provide them with excellent care, and keep costs low.

By now, though, Medicare has proven to be one of the most efficient ways of collecting and dispensing health care payments. It has meant peace of mind for generations of senior citizens and a boost to American industry, especially in the form of the wrap-around plans that have reduced health care costs for companies while actually increasing quality of care.

Today, Congress is debating the most significant reform to our health care system since Medicare. In fact, parts of Medicare itself may change -- which will give friends of the current broken status quo an array of scare tactics they can use to oppose health care reform as a whole.

The truth, though, is that doing nothing is no longer an option. Spiraling health care costs threaten to bankrupt our country and damage the well being of all Americans. Since 2000, family premiums have more than doubled, while wages have remained stagnant; just last year, employees' out-of-pocket health care costs were up more than 10%. Medicare shares the burden of those fast-rising costs; in fact, its current course is unsustainable, with its trust fund set to be exhausted in as little as eight years. For that reason alone, Medicare reform should go hand-in-hand with reform to bring affordable care to all Americans.

To save Medicare, we must make it more efficient -- but we also have to preserve what has made it so valuable for millions. Democrats are dedicated to protecting and improving Medicare, ensuring that all seniors have access to low-cost prescription drugs, improving low-income subsidy programs to make sure that Medicare is affordable to all, ending wasteful overpayments, and adding new consumer protections to private Medicare Advantage plans.

For years, physicians have treated aging patients as they've transitioned from private insurance to Medicare -- one of the services that make so many doctors pillars of their communities. But doctors also need new incentives to continue treating Medicare patients, which is why we're committed to improving payment rates for family doctors and other primary care physicians. We also want to eliminate the 21 percent cut in doctors' fees that is scheduled for 2011.

As we improve Medicare, we can also recognize that it has a lot to teach us about bringing quality care to millions of Americans. Those lessons will be vital to the health care reform debate. They include the importance of rewarding coordinated care, the harms of inaccurate payments and overpayments to private plans, and the need to make critical delivery system reforms to the way doctors are reimbursed. We have also learned that the fee-for-service system -- in which doctors are paid for procedures instead of health outcomes -- creates greater potential for fraud and abuse. Health care reform should tackle all of those challenges, while rewarding providers who give coordinated, quality care to patients at reasonable costs, with lower readmission rates.

This anniversary is a time to celebrate Medicare's many successes -- successes so many Americans have seen firsthand, in the lives of seniors who have received guaranteed, dignified health treatment. As far as we're concerned, that is something every American deserves. But preserving Medicare's success, and fixing our health care system as a whole, means that we need to face up to some urgent changes. With the largest generation of Americans set to retire, health care costs are set to skyrocket even further; without change, those costs are on pace to exceed the GDP of our entire country.

But now, while we can see that calamity coming, we have a chance to avert it. This summer, we have an opportunity to build a health care system worthy of all Americans. Doubters will tell us that it can't be done. But that's the same thing they said 44 years ago.

Comments

[JackNasty]

With all due respect, Rep. Hoyer, Democrats in Congress can ill afford to rest on the laurels of legislation passed 43 years ago. Cutting funding for Medicare, the program you just lauded, is a funny way to celebrate its success.

Democrats now have a majority in both houses of Congress, Yet they have refused to allow any discussion of single payer health care during the current debate. Dems haven't even pushed for a truly effective public option. It's extraordinary that with only 40 seats in the Senate, Republicans still have control of the health care debate and every other issue before Congress.

I strongly encourage each member of the Democratic caucus in both the the House and in the Senate to take time this July 4 weekend to grow a pair. Pass a public option that will serve the public not the for-profit health care insurance corporations. Otherwise, many Dems now in Congress will lose their publicly provided health care in the next election.

[Jer1957]

I support Medicare-For-All (HR 676.) I am a left-leaning Dem who thinks Obama-care is a cure even worse than the disease.

I oppose the $950 million Cut To Medicare, Medicaid and Aid to Hospitals, that Obama & his Wall Street sponsors are trying to pass off as "reform." Just as I opposed the slightly less massive cut proposed by the Bush-men. I am disgusted by the 'cost-effective' euthanasia of the elderly the Pres recently endorsed in Green Bay.

Obama is no progressive. Only his complexion makes gullible, guilty liberals think otherwise.

Health-Care rationing was defined as a Crime Against Humanity at the post -WWII Nuremberg Tribunal.

It is for God to decide when any individual dies--not Obama or Goldman Sachs HMO statisticians.

Some other Democrats might want to remind Obama that he is not God.

The arrogant but inept Obama's ego seems to have trouble with that concept.
(See Bush, GW)

[saltpeter]

Rep. Hoyer, the argument you need to be making for the "public option" is not to ballyhoo the merits of Medicaid because, although it is one of the most important federal domestic policies ever made it is also one that the GOP has seized upon as being "problematic" because many Americans are familiar with it's "short-comings". The GOP's greatest achievement is, through some twisted logic known as talking points, turning what are essentially successes into liabilities. They rewrite history and redefine vocabulary so often and so cunningly that they have people believing the up is down and the sky is green.

If you want to be the GOP at their own game, use their own rhetoric against them. Last decade as the GOP advocated for charter schools, they used the argument that since the public schools "monopolized" education in our country and our education results weren't stellar, that in order to "improve" the schools there needed to be "competition" from the private sector through "charter schools". Now the Democrats are making the same argument in reverse about healthcare. Since the private sector insurance companies have monopolized healthcare in this country and the results are lackluster, there needs to be healthy "competition" in the guise of a public option to improve the state of our healthcare. This is the argument you need to make, this is feeding the GOP their own logic and watching them twitch in response. Loaded code words like "socialized", "Medicare" aren't going to work.

[bobtr900]

saltpeter,

Many thanks for an excellent post. Kudos and blessings to you. You are correct in everything you said.

[lady49]

Again, Medicare is medical care for the seniors over 65- it is not the same as medicaid which is designed to provide care for those in poverty.

[lady49]

uuh...Medicare is medical care for seniors 65 years and older. It has NOTHING to do with medicaid which is medical coverage for those in poverty........

Having said that, I agree that Dems should pump up the volume and get the job done!

[unionave]

The only real fix is a return to the pre - Reagan health care programs . They were not insurance programs . They were low cost clinic and hospital affordable health care that some compassionate law makers put in place to compete with the health care providers . Medicare problems are caused by exploding billing amounts by the health care providers and can only be fixed by bringing these billing amounts down , which brings into play another group of lobbyist .

[loudspeaker]

It is not the health care costs that are spiraling out control but the unconstitutional bailout of the Wall Street casinos.

[myarmsaregreen]

A proposed rule on the 2010 Medicare Physician Fee Schedule calls for a 21.5% reduction in physician payments, the Centers for Medicare and Medicaid Services announced.

The 21.5% cut stems from the sustainable growth rate (SGR), a factor in the Medicare payment formula, and intervention by Congress to stall earlier payment cuts, the CMS said in a news release.

"As you know, there can be no meaningful health care reform without long-term reforms to the Medicare physician payment system, which is based on the flawed SGR formula, and the physician community does not support another short-term 'fix' that only temporarily prevents Medicare payment cuts," according to an American Society of Cataract and Refractive Surgery news release.

However, based on data from the Physician Practice Information Survey, conducted by the American Medical Association, the CMS plans to increase ophthalmology's practice expense per hour from $103.28 to $170.08, yielding an overall 11% increase in ophthalmic services, the ASCRS release said.

The proposed fee schedule also adds two ophthalmic measures to the Physicians Quality Reporting Initiative: 20/40 or better visual acuity within 90 days after cataract surgery and postop complications within 30 days after cataract surgery that require additional surgery, the ASCRS said.

In addition, the CMS has proposed removing physician-­administer­ed drugs from the definition of "physician services."

The CMS will accept comment on the proposed rule until Aug. 31 and is scheduled to issue a final rule by Nov. 1, the agency said.

[fredly2]

Saving Medicare and Social Securiy have become TAX PROBLEMS fostered by polititions who divrt our attetion from the job market. Our social services are hurting because far too many American Jobs are sent over seas to the benefit of mega American Corportions invesing in forign countries.

SOP the over seas job market incentive and there will be plenty taxible income right here in America to afford a robust Social Security and Universal health care system for all.

Ain' that right, Steny. Go ahead on and tell 'um aout it.

[johnnydajogger]

Medicare would have been fine and dandy if the politicians had left the Medicare fund alone, as it was originally intended. After Reagan slashed the taxes of his rich friends, it suddenly dawned on him that he couldnt pay for it so he asked Paul Volker for some advice. Volker advised raiding the Medicare fund which up to that point had been separate and apart from the federal budget. Every President since then has raided the Fund for various purposes. So, dont blame Medicare "inefficiencies". Blame the pols.

[Vieweraudience]

Medicare hasn't paid it's own freight for the past 20 years, since hospital payment rules were overhauled. Private insurance holders and the uninsured have been picking up the tab ever since.

As far as "generous" government delivered healthcare is concerned, who should America be more generous to than our veterans? There aren't any lines forming or people clamoring for admission into our nation's VA hospitals. They are a last resort!

The federal government owns a long and troubled history of delivering substandard healthcare to our most deserving citizens. They own a long and troubled history as the nation's largest insurer, refusing to pay for the resources their patients need. On what basis should we expect better from government in the future?

[Jason Cisco]

Rep. Hoyer:

It's funny how you can pour all of this time into making sure you prop up broken ideas for health care reform. However, when I write to you in good faith as a voter in the State of Maryland, you can't be bothered to answer my letter. I wrote to you asking you to pull your ads from an insidious local paper that is ran by a known racist who writes articles such as these

http://www.stmarystoday.com/News/WillBlacksEverSlowonFastTracktoPrison.html

It's nice to know that my concerns went unheard and you continue to put your face in this publication as well as advertisement for your "open to the public" Bull Roast Birthday Party. I'm sorry but I'm not going to listen to a guy that throws his hat in the ring with publications such as these.....not on social issues, not on fiscal issues, not on anything..­.......goo­d day sir.

[lbrty 2112]

Medicare is beyond broke. No matter how much lipstick Steny wants to put on it, it's still a pig. This is the nature of governments. 'National' healthcare will be no different

[Nooneyouknow]

It works well enough, and if government transitioned to completely public health insurance, it would be fine. All the money anyone could need is being sucked up by the health insurance companies as profit. It's inhumane to profit by denying health care to people.

[sbonventure2]

As much as I agree that government should run healthcare, entirely, I continue to find it odd that politicians and authors rave about the success of medicare.

While it is absolutely true that overhead costs for running medicare are far below those of private insurers, which would seem to indicate better efficiency, I have yet to talk to ANYONE on medicare that raves about it as much as these politicians and authors (Krugman) do. It's expensive for seniors, because it doesn't cover that much. In rural areas, it can be difficult to find docs that take medicare.

I think healthcare should be a cost of living for everyone, and everyone should have coverage. But I also think it's at least slightly dishonest to rave about the success of medicare.

[lvogt]

Every dollar that goes to an insurance company is a dollar not going to heal a patient.
Every dollar used to heal a patient is a loss to the insurance company.
Insurance companies provide NOTHING to healthcare. Their interests are in direct opposition to patients.
Single-payer is the best option but, at the very least, there must be the public option so people can vote with their wallets for the kind of healthcare they want.

[jmpurser]

Which is why single payer does away with insurance companies for all basic health care.

[noneIn2008]

Yep, it works. When some one in Washington tells you your Dr. gave you a non approved drug, you no longer get it. When the DEA leans on Dr.'s to cut pain meds to the elderly, it is done. You know those old folks really don't understand pain and don't need all those pain meds. Did we mention it is broke and running up several trillion in unfunded liabilities. Yet, it works. I just don't know for whom.

[lvogt]

Medicare has denied my parents and my in-laws nothing. Insurance companies deny people every day. What kind of system tells people they can't even buy in? Just NO. You can't have it because you need it. That is not free enterprise. That's immoral.

[scooperss]

Have health insurance do you?

[bayside]

I agree medicare works..Next time those blue dogs and republicans tell you why we can not do this, tell them we care about the health of of their familes, why dont they care about ours..

[Nooneyouknow]

Yup; I'd like to see Congress's extremely generous taxpayer-funded healthcare suspended if they deny at least a public option. Why should they give themselves what they refuse to give to their constituents? Do you have an answer for that, Mr. Hoyer?

[YewNeekId]

Hint to Obama and acolytes - Medicare is a public health care option with a 40+ year track record. Not perfect, but it works

[ponderman]

Is it true that the insurance industry "invented" Medicare so they wouldn't have to pay out claims to people when they experience the health problems that come with old age?

[jmpurser]

No. In fact the AMA hired Ronald Reagan to preach that this was the onset of socialism and the end of America.

[sbonventure2]

. . .furthermore, private insurance companies vehemently opposed medicare, and even briefly tried to compete with it and failed. Part of the reason that private insurance companies are so afraid of a public healthcare option, such as medicare, is that they can't compete . . .at all.