Fifty years ago, President Lyndon Johnson traveled to Independence, Mo., to sign legislation creating Medicare and Medicaid in the presence of fellow Democrat and former President Harry Truman, who during his presidency led unsuccessful efforts to establish a national health insurance system.
The battle over the legislation was long and bruising, with conservatives including then-General Electric spokesman Ronald Reagan warning it would lead to socialized medicine.
So on this 50th anniversary of Medicare and Medicaid, as our nation struggles with its latest effort at health reform, it’s a good time to reflect on the programs’ successes and failures.
Medicare and Medicaid passed with broad bipartisan support. Medicare was a new federal program designed to provide health coverage to senior citizens over age 65. Medicaid, something of an afterthought, would be a joint federal-state program to assist the poor.
The legislation passed the Senate with 57 Democratic and 13 Republican votes and the House with 237 Democrats and 70 Republicans. So both parties had a stake in fixing the program problems that inevitably arose.
Proponents saw the programs as major steps forward in expanding access to health coverage — moving toward their ultimate goal of a single-payer national health care system. They certainly have made progress toward that goal.
In 1965, only about half of seniors and very few poor Americans had health coverage. Today, Medicare covers 46 million seniors and 9 million disabled Americans, and Medicaid covers nearly 70 million lower-income people.
Critics of the 1965 legislation warned that both programs would spend much more than supporters predicted, that price controls and rationing of care would follow and that the quality of care would eventually suffer. All of the warnings have proved correct.
Take Medicare. In 1965, the House Ways and Means Committee estimated that Medicare Part A, which covers hospital bills, would cost $9 billion a year by 1990. But the actual cost after the first 25 years was $67 billion, and that didn’t include Medicare Part B, which primarily covers outpatient costs.
As health economist Theodore Marmor pointed out: “Hospital price increases presented the most intractable political problem for the Johnson administration. In the first year of Medicare’s operation, the average daily service charge in America’s hospitals increased by an unprecedented 21.9%. Each month the Labor Department’s consumer price survey reported further increases . … In the State of the Union Address, Jan. 17, 1968, Johnson … promised to ‘stem the rising costs of medical care.’”
Washington has been trying, unsuccessfully, to do that ever since.
Congress imposed a type of price-control mechanism in 1983 called Diagnostic Related Groups, or DRGs. And in the early 1990s, Congress tried to cut spending on physicians by creating the Resource Based Relative Value Scale.
Then there was the infamous Medicare “Sustainable Growth Rate,” later dubbed the “doc fix,” which passed in 1996 to contain Medicare spending by cutting doctors’ fees. It was repealed only recently, after Congress had postponed the vote 17 times.
Today, both Medicare and Medicaid have exploding budgets. Medicare spent more than $600 billion last year. Federal Medicaid expenditures are estimated at $331 billion, with the federal portion averaging about 57% and states and some local governments paying the rest.
Once Congress creates such a mammoth entitlement, it can’t seem to leave the program alone. In 1973, Medicare began covering the disabled and patients with end-stage kidney disease. In 1980, Medicare expanded to cover the cost of home health care services and in 1982 included hospice care for the terminally ill.
In 1988, Congress tied Medicaid to the federal cash-assistance welfare program, known as Aid to Families with Dependent Children. States were required to cover AFDC-eligible, first-time pregnant women and children up to age five. That coverage now extends up to 185% of the federal poverty level. As a result, Medicaid pays for 40% of all U.S. births.
Budget pressures eventually will force cutbacks, though the politicians will usually claim the cuts are “improving” or making the program “more efficient.” Those cuts usually mean less access to care. Less than half of physicians accept Medicaid, and a growing number refuse to see Medicare patients because of low reimbursement rates and bureaucratic headaches.
No assessment of Medicare and Medicaid would be complete without mention of the rampant fraud and abuse plaguing both programs. Even the government pegs Medicare’s fee-for-service “improper payments” level at 12.7% — and that’s probably on the low side.
But now we face a new era where ObamaCare defenders are trying to expand health coverage and yet haven’t learned anything from 50 years of Medicare and Medicaid. Indeed, 6.5 million of ObamaCare’s newly insured were just dumped into an unreformed Medicaid system. As a result, we are already seeing many of the same problems emerge in ObamaCare.
States are struggling to balance their budgets as Medicaid spending soars, even for those that chose not to expand. States that created their own health insurance exchanges are facing financial challenges in operating these new bureaucracies. Health care costs are exploding as they did after the passage of Medicare and Medicaid, and the people who predicted the new program would force costs down are shocked.
Many lower-income, newly insured, who’ve been forced into policies with high deductibles (the average individual bronze plan deductible is $5,181, and $10,545 for a family), are returning to the few remaining free clinics for care. They may now have insurance, but not the money to cover the deductibles.
In short, it appears the Democrats who passed this massive and convoluted ObamaCare system learned nothing from 50 years of Medicare and Medicaid. Government involvement dramatically increases spending, followed by clampdowns on soaring prices, leading to restrictions on doctors and patients.
Perhaps next time, we might try market forces rather than another failed effort at centralized government programs.
Nah, not on The Agenda, plus it doesn’t benefit the government and the politicians to do that way.
Offensensitivitosis: Also Known As Whinybitchitis
Ladies and Gentlemen, children of all ages, creeds, and colors; I, E. Adam Thomas, being of sound mind and vaguely not-too-decrepit body, hereby serve notice upon all humanity that I am fucking sick to death of all of your whining and bullshit. I’m fed up with all of you. Gay or straight, black or white, theist or atheist… all of you can fuck right the hell off. Why, may you ask? Because about 98% of everybody who makes a big stink about being offended by one thing or another have no business being offended by it at all. You band-wagon hopping, trend-following, faux-vegan, hipster douchebags are finally hitting my last raw nerve.
Now, I think of myself as a generally sensitive guy. I don’t like to offend people (outside of my blog and my videos, anyway), and I try to be considerate of other people’s feelings, but lately, you dorks have made it almost impossible for me to avoid pissing someone off. I therefore hath decreed that I am officially out of fucks to give. They’re all gone, and the warehouse has notified me that there won’t be any more fucks in stock for the foreseeable future. Too many cooks, not enough fucks. The fuck train has been derailed, exploded, and burned up all the fucks it was supposed to deliver to needy fuck givers like myself. The fuck mines are depleted, and the manufacturer of fucks has shut down the plant indefinitely. The fuck fairy has died, and they can’t find a replacement. There is a massive fuck drought, impacting all of Fucklifornia. The fuck well has run dry. The National Fuck Service has declared that no more fucks will be made available in perpetuity, citing nonexistent supply sources. We’re all give-a-fucked out!
What has so egregiously exhausted my patience here? Well, let me tell you, Buddy Boy, I think the final straw was this bad boy here…
You see, this boring-ass piece of cloth has generated more furrowed brows and heightened heart rates than the time Jay Leno tossed Martha Stewart’s salad on the Tonight Show. It was sparked by some ignorant fucking hillbilly murdering several innocent people in a church because they weren’t white. Instead of getting mad at ignorant hillbillies, we get mad at an obsolete piece of cotton? Are you fucking stupid people? The problem isn’t the symbol, it’s the death-deprived jackfucks who think they have the right to murder people. That’s what it boils down to. They think they have a right to murder people. Doesn’t matter why, if they have some religious or ethnic prejudice… You can’t murder people! You just can’t, okay Opie? We understanding each other, Boah? Now you take that gun, clean ‘er up real purty like, and put ‘er away, then go git washed up fer supper. Aunt Bea’s made us a real fine pot roast!
What pisses me off about this whole situation is that, first of all, instead of demonizing the fuckheads that perpetrate these monstrous acts, we’re demonizing a fucking piece of fabric. That, my friends, is the textbook definition of STUPID! We overreact about the symbol, and under react about the crime. Nobody is even mentioning the event itself, because they’re all too wrapped up in trying to make it impossible to show the flag, or any representation of it therein. We’re always doing that kind of shit. Retconning the past to make it more politically correct. It’s absolutely idiotic. This kind of garbage is turning us into a society of over reactionary knee-jerkers, and I’m sick of it. Now, some folks like to blame 911 and the subsequent sociological fallout from that event, but that’s just bullshit. Political Correctness has been the scourge of our society since the 1990’s, and its impact is escalating to the extent that absolutely nothing is safe to talk about. Can’t talk about the weather, because someone in earshot may have lost an uncle in Hurricane Katrina. Can’t look at an old picture of the New York City skyline, lest we accidentally catch a glimpse of the World Trade Center. And Heaven forbid TV Land leave a show like the Dukes of Hazzard on the air, because a car has that fucking FLAG painted on it.
Now, I may catch some shit for this, but frankly, I can’t stand The Dukes of Hazzard. (ed: I obviously have a different view of the show, but not the issue) It’s a fucking stupid show. It’s not amusing, the stunts are lame, the characters are absolutely irritatingly unfunny and badly written… which makes it perfect for the demographic for which it was developed. Nonetheless, it is absolutely insane to stop airing the show on TV Land just because of an automotive paint job. It was not placed there to upset anyone.
Look, if someone punches you in the face, you have every right to get upset and even retaliate, but you can’t get mad at someone because they possess a hand, that could be made into a fist. You’re simply feeding into a monster of fear and intimidation created by your own weak, paranoid brain. It’s not entirely your fault, of course. The media has been force feeding tragedy and terror to you ever since the first newspaper guy noticed his circulation going up everytime the headline had something to do with one soggy bucket of blood and bones fucking over another soggy bucket of blood and bones out of no truly respectable reason whatsoever.
I’m not singling out the so-called “Liberal” media, either. All media outlets thrive on panic, terror and suffering. It’s infinitely more lucrative than headlines about a fireman saving a kitten from a tree, or a boy scout helping an old lady across the street. It ain’t news unless the kitten goes feral and attacks the fireman, or both the old lady and the boy scout are killed (the more horrible the gore the better) by a stolen semi full of nuclear bomb parts blasting through the intersection at 125 mph, spewing blood, viscera and merit badges in all directions. If both the kitten and the fireman are also impaled by pieces of the old lady’s walker, that’s extra money in the bank! This is why I cannot, in all good conscience, take any of your offensensitivity bullshit the least bit serious.
I have always loved Bloom County! Best comic strip other than Peanuts ever!
Also, you might want to take into consideration the fact that the more you whine and pout about being offended by something, the more it hurts the credibility of anyone else who might have a valid reason to take offense to something truly egregious. You’re basically making things worse for people who don’t need things to get any worse, and you’re only doing so to make your own visibility on social media more prominent. In your own way, you’re trying to make yourself a microcelebrity on the backs of other people’s legitimate misery. That, my friend, makes you a selfish fucking prick! Pure and simple! You suck as a human being, because you’re trying to make yourself feel more important than the people who are genuinely hurt by whatever it is.
Therefore, I decree that, as of this day, anyone who flies into a rage about a topic that frankly has nothing to do with their own personal experience, or anyone who takes a peripherally tangible issue and exaggerates it out of proportion, can go fuck themselves into a corner. You have just made yourself and your “cause” a subject of scorn and ridicule, and anyone truly affected by whatever it is that you are flopsweating about should have the right to come right up behind you and smack you hard on the back of your head!