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A Program for Fighting Poverty: No Cuts to Social Security or Medicare, and Medicare for All

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AP Photo/J. Scott Applewhite
AP Photo/J. Scott Applewhite

With poverty rates spinning perilously out of control in the U.S., it's time to send an unmistakable message to Congress and the White House as they prepare to resume the ongoing obsession with the deficit: End the silence on poverty, don't make poverty worse by making cuts to Social Security or Medicare, and address a principle cause of poverty with a permanent fix to our dysfunctional health care system. Given a shocking new report on U.S. life expectancy, which is disproportionately low among the poor, and a high-profile forum on poverty just behind us, this is a good time to highlight the inseparable links between income, health care, Social Security and Medicare, which are probably the two most effective anti-poverty programs ever enacted in the U.S.

Census Bureau data puts the official poverty rate at 15 percent, or 46 million people, and at 22 percent for children under 18. Some have speculated that the real number is two to three times that amount. Not that you would notice listening to the debates inside the beltway, where too many politicians are focused on spending cuts, not on addressing the daily shortages of food, shelter, health care and jobs faced by a large swath of our nation. It's one reason why nationally syndicated broadcaster Tavis Smiley hosted a major forum, "Vision for a New America: A Future Without Poverty," which was broadcast on CSPAN last week, in D.C.

Every day, in the hospitals and clinics across the U.S. where they work, nurses see the correlation between low income and deteriorating health status. The consequences are evident in a report issued this month by the National Research Council and the Institute of Medicine. That report found that the U.S. ranked last in life expectancy among 17 affluent countries. All the other countries have some form of a national health care system. No gold medals for us in this international competition, except in how much we spend and waste on health care as a result of our profit-focused private system.

Sadly, the Affordable Care Act has not eradicated the problem, especially when it comes to rising cost of health care, which alone contributes to two thirds of personal bankruptcies and a myriad of the health woes that nurses witness regularly. Nurses see the effects in premature and low-weight babies and other widespread nutrition problems resulting from hunger and malnutrition that can lead to disease and even organ failure. They see children with high levels of stress and anxiety, heart attacks in younger and younger men, rampant unaddressed mental health problems and emotional disorders, and scores of patients who routinely skip needed medical care because of the cost, until they end up in emergency rooms with major untreated diseases, by which point it may be too late to heal them. They see patients like the widowed woman in a midwestern state whose diabetes led to foot and leg wounds that became severe because she could not afford constant treatment. Finally admitted to a hospital, she faced a "Sophie's choice" between amputation or lengthy, more expensive longterm care. She chose amputation because it was cheaper. No, that's not a story from the Middle Ages or a Civil War battlefield; it's modern-day America.

Permanent disability would not have been her fate had this woman been just a little older, so that she could have qualified for Medicare. Indeed, the NRC/Institute of Medicine study found the U.S. catching up to other countries only among older cohorts of patients -- because of Medicare. Upon signing the Medicare law in 1965, President Lyndon B. Johnson cited the long history in the U.S. of "bill after bill [being] introduced to help older citizens meet the often crushing and always rising cost of disease and crippling illness." Before Medicare, barely half of seniors had medical coverage. Within five years 97 percent had it.

A similar story can be told about Social Security. Before that law was enacted in 1935, only 15 percent of workers had private pension plans, and many American seniors were mired in poverty, totally dependent on their sons and daughters. Now Social Security provides two thirds of the income for recipients over 65, and more than 90 percent of the income for one third of seniors, reports the Center on Budget and Policy Priorities. Only 10 percent of seniors are below the official poverty level, but without Social Security more than half would be.

That's the context in which the "deficit scolds," as economist Paul Krugman calls them, are targeting Social Security and Medicare. It is the working poor who must work longer, and it those who would be thrown back into poverty (especially women, who have historically earned less than men and built less of an income base that determines amounts of benefits) who would be most harmed by cuts to these programs, raising the eligibility age or slashing benefits. By itself, the proposal to shift Social Security benefits to a "chained" consumer price index, a proposal floated by President Obama and others, could cut monthly benefits for a typical single, 80-year-old woman by $56, says the National Women's Law Center.

A comprehensive program to combat poverty in America is long overdue. It should start by insisting on no cuts to Social Security or Medicare. Then it should move on to a permanent fix of our health care system by upgrading Medicare with full funding and an end to its creeping privatization, and expanding it to cover everyone.