Aug 082013

The traffic around Capitol Hill has ebbed with Congress on a five-week summer recess. But, before leaving town,  the House slammed the Affordable Care Act yet again with the fortieth vote for repeal.

In a ironic twist of history, 48 years ago President Johnson went to Independence, MO, the home of former president Harry Truman to sign Medicare legislation into law. Truman  first advocated for government-sponsored health insurance in 1945.

Now Medicare enables older adults and individuals with disabilities access to healthcare. No one can say that Medicare is without problems, but most healthcare analysts agree that the program does a good job for millions of people.

The back story about Medicare reverts to the 1930s. In 1935 President Franklin D. Roosevelt signed Social Security legislation. Even in  the Great Depression, when workers sold apples for five cents,  and the prairie dust blew farmer’s crops away, there was opposition to the program that would provide funds for older adults with no retirement cushion.

Jump ahead thirty years. Was Medicare a popular program at its inception?  As the Affordable Care Act nears fuller implementation, what can we, as citizens and consumers, learn from our history?

One of the greatest opponents of Medicare was the American Medical Association.  A December 3, 1964 article from the New York Times reported on the activities of the AMA’s annual meeting. The House of Delegates rejected any compromise on medicare and started active opposition to the Johnson Administration’s proposed new medicare programs. According to the Times, the AMA also repeated support for the 1960 Kerr-Mills Act, which allowed the states to determine which citizens needed medical assistance at what age.

A Wall Street Journal article from January 12, 1965 reminds–minus the jazz hands – everything old is new again. The lead in Arlen Large’s lengthy article notes, “The probability that Congress will approve President Johnson’s plan of health care for the aged is generating an array of glossy counter-proposals from the traditional foes of “medicare.”  These proposals,  or as Large called them “schemes, included:”

A proposal from Rep. Byrnes of Wisconsin, ranking Republican on the House Ways and Means committee, would make the program optional. Those persons wanting to participate would surrender some  of their Social Security pension after retirement.

Another proposal would do away with the 60 days of hospitalization coverage included in the original bill, forcing participants to pay “as much as $300″ for hospitalization (an amount that today seems minuscule.)  Hospitalization  would then have unlimited days, as long as participants paid a certain portion of it.  The Journal reported that this was similar to a catastrophic health care system for seniors proposed by President Eisenhower.

A third plan backed by House Republicans offers tax credits (for health expenses) to elderly couples with incomes less than $8,000 a year. These couples could subtract from their final tax up to $150 for the cost of private health insurance.

The American Medical Association long opposed any movement toward what they perceived as socialized medicine.  According to the Journal article, the week prior to this article, the AMA promised a system of pre-paid comprehensive medical insurance through the 1960 Kerr-Mills program.  By 1965, 38 states participated in the Kerr-Mills program which provided assistance to elderly individuals for  low income individuals.  The program was not comprehensive as the future Medicare program would be.

In late July 1965, the Senate finally gave approval to the Johnson Administration’s addition to the Social Security Act, what would forever be called Medicare with a capital M. The House passed a version of the significant legislation months before on April 8, according to a New York Times article.  After the Senate vote, the House then ratified the compromised version.

As  in today’s partisan Congressional votes, the Senate bill was supported by 57 Democrats and 13 Republicans.  In the ratification vote in the House, 237 Democrats and 65 Republicans opposed it.

The Times reviewed what the 1965 bill covered, including hospital care, nursing home care, home nursing services and out-patient diagnostic services for all Americans over 65.  In addition, the article noted that an additional program was set up for seniors on a voluntary basis at the cost of $3 per month in premiums.  Premiums today are slightly — enormously — higher than $3 a month for supplemental and Part D (coverage provided by the Bush the  Younger-era unfunded legislation for prescription drugs).

The furor and debate over continued funds available for Medicare as well as the need for Part D continues  in the public square.

Still, Medicare has been life changing for millions of Americans like my paternal grandmother, whose husband died in 1935 and left her with three young children on a rural farm in the middle of a Depression. Her eventual Social Security and Medicare benefits kept her out of poverty.  She did not complete elementary school, and only one of her children received a college education.  My father–born with a clubfoot that required multiple surgeries before he was five–attended college through Indiana Vocational Rehabilitation.  Dad says the state’s investment in him resulted in his successful nearly-four decade contribution to public life as a public school teacher.

The Affordable Care Act as well as Medicare and Vocational Rehabilitation programs is part of a social safety net profoundly needed by Americans.  As we look forward to the ACA, let’s figure out how to fully pay for and support these needed programs.

Published August 7, 2013 at The Broad Side. Please comment there.

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