Thursday, July 30, 2015

Half Century – Half Measure?

Last November I turned fifty. In a burst of youthful energy I jetted to the West Coast for a party and back to the East Coast for a celebration all in a 24-hour period. Sure it’s just a number, but milestones are opportunities to look back and to look forward. Today, July 30, marks another half century milestone – the anniversary of Medicare and Medicaid. Like me, it’s showing its age and needs some fine tuning.

President Johnson said at the bill signing: “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."

Despite the noble goal, according to CNBC medical bills are the number one cause of bankruptcy in the U.S. “Even outside of bankruptcy, about 56 million adults—more than 20 percent of the population between the ages of 19 and 64—will still struggle with health-care-related bills.”

The report continues: “15 million people will deplete their savings to cover medical bills. Another 10 million will be unable to pay for necessities such as rent, food and utilities because of those bills.”

Today one in three Americans are covered by the program. It pays for nearly half of U.S. births and a little over half of the nation's nursing home bill. 3 out of 4 poor children are enrolled.

Over the past 50 years Medicare / Medicaid has cost hundreds of billions of dollars. It went from a small percentage of the federal budget to 23% today according to The Kaiser Family Foundation. It is funded by payroll taxes and fees charged for services. There is a gap between revenue and costs – with solvency at risk in 2030 (right around the time I’d be eligible for the program.)

There are plenty of examples of waste, fraud and abuse that are infuriating – and only 5% of the claims are ever audited. It’s also a program that many studies show is less efficient than private insurance, though its administrative costs are lower. (Private insurance can mitigate their costs by refusing claims, while the government program has a different mandate.) It grows at a pace that far exceeds inflation. It has an unfunded mandate of nearly $40 trillion.

Thanks to Roosevelt’s New Deal from the 30’s and a half century of Johnson’s Great Society programs, American’s historic support of allowing the private sector to sort out services has given way to having government be the answer. Medicare/Medicaid are now Entitlement programs because the citizens have been trained that the government will provide these services. The battle has been lost.

My family has directly benefited from these programs. I’ve experienced the extraordinary relief of having medical care provided a loved one who otherwise would be in pain and discomfort thanks to the Government. I’ve also been frustrated and outraged at working in a bureaucratic morass where paperwork is more important than people.

My 50th birthday wasn’t one of those moments where I looked and saw what I hadn’t done. Instead it was a time to celebrate what I have been blessed to have and recommit myself to what more I want in my remaining years. It’s time to fine-tune - make sure all is working in sync. Since Medicare/Medicaid is now the essential government provider of health care – perhaps it’s time to move from being a half-measure to providing Medicare for all. 

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