05/18/2012 09:26 am ET Updated Jul 17, 2012

The Democratization of Health Care: Medicare and Original Intent

When government launched the Medicare program, it made a pact with the American people that President Lyndon Johnson articulated (his statement) at the July 30, 1965 signing ceremony for the enabling legislation:

No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts. And no longer will this Nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this progressive country.

Fast forward to the August 7, 2009 correspondence from the Congressional Budget Office (CBO) Director Douglas W. Elmendorf (his letter) to Congressman Nathan Deal's inquiry regarding CBO's ability to recognize savings to Medicare that might occur from the provision of preventive services to seniors. His letter raises legitimate concerns about whether the original intent of the Medicare program has been distorted. The CBO director writes:

... some types of preventive care may increase longevity. Of course, that effect reinforces the desirability of such care, but it also could add to federal spending in the long run: Social Security outlays rise when people live longer, and Medicare outlays may rise because, even if a preventive service lowers a beneficiary's risk of one illness, a longer lifespan allows for more time to incur other health care expenses associated with age.

The contrast between these two statements is striking. It begs the question: Have federal accounting and budgetary practices subordinated the health and wellness of the American people -- the very people who trusted and invested in the Medicare program? Is our federal government -- both parties, both the legislative and executive branches -- using budgetary and accounting gimmicks to renege on the original intent by deliberately denying services to beneficiaries in a way that will foreshorten lives and limit government's financial exposure associated with a successful, outcomes-oriented health services system? If so, this is age discrimination -- and economic discrimination -- in the worst form. If not, then what are they doing? Is there no recognition that today's investment in improving the health of seniors will redound to the benefit of future generation's whose lives and productive capacity will be extended by the learnings and innovations that will necessarily occur as we care for our elderly parents?

Our social compact is predicated on government's commitment to protect each individual's right to life, liberty and the pursuit of happiness, and government's role as an insurer does not amend the compact. The great modifier to the aforementioned is, of course, due process of law. Yet, one would think that a principle so at odds with our core beliefs would be overtly stated in a legislative instrument for all to see and review. Indeed, as Mr. Elmendorf reminded Mr. Deal, Congress established the rules that prohibit the scoring of preventive services in Medicare.

In the tall grass, away from view, have both parties grown timid and negative about our future? Are they turning a necessity -- government-sponsored health insurance -- into an accounting practice that withholds medical care from seniors so as to achieve budget objectives? If the latter is untrue, at the very least we need a reaffirmation of President Lyndon Johnson's commitment.

We are surely in odd times when we have to ask our government to provide assurances for matters that it should embrace instinctively -- matters that should be so deeply rooted in administrative processes that any report to the contrary would strike the writer, the reader and the implementer as flawed policies that demand immediate redress.