When Lyndon Johnson signed the Social Security Act of 1965, the law that created Medicare and Medicaid, he credited Harry Truman for “planting the seeds of compassion and duty which have today flowered into care for the sick and serenity for the fearful.” With his tribute to the former president, Johnson acknowledged that it took leadership and a moral imperative to pave the way for the sweeping legislation that would serve America’s most vulnerable populations.
Medicare was created from this national conscience because senior citizens who had worked their whole lives, from the Great Depression through World War II and beyond, to ensure that their children would be better off than they were faced disproportionate rates of poverty and disability from poor health. As the inevitability of illness that plagued older age crippled family incomes, the provision of health insurance to this great generation was both the rational and the right thing to do. Despite the opposition that it faced in 1965 amid accusations of “socialism” by prominent politicians like Ronald Reagan, as well as from the American Medical Association, Medicare has by all accounts been successful in its mission. Since its passing, Medicare has ensured a longer life expectancy for seniors, lower rates of disability among seniors, and lower rates of poverty, all through affordable access to health care. Even in the current day, Medicare serves its seniors so well that they report more satisfaction than customers of employer-sponsored private insurance plans.
However, Medicare has for decades been under threat of being underfinanced. Due to its large share of all federal government spending (12% in 2010), it has been a political target for spending cuts by fiscal conservatives. Even staunch supporters and budget analysts admit that its rapid growth in cost (nearly 6% per year) threatens its own survival. Estimates in 2009 (before the Affordable Care Act was passed), reported that the Part A Trust Fund, which is financed by payroll taxes, would be exhausted by 2017 and would not be able to support full benefits unless the financing was dramatically reformed.
For this reason, the Affordable Care Act (ACA), passed one year ago, makes such dramatic reforms, protecting this vital necessity for senior citizens and disabled Americans. According the Kaiser Family Foundation, the law is projected to reduce annual growth in Medicare spending over the next decade, saving about $322 billion from 2010 to 2019 and continuing beyond that. It would do so by reducing the growth in payments to health care providers (other than physicians) and Medicare Advantage plans, experimenting with payment systems alternative to Fee-for-service (such as bundled payments) that encourage value not volume of services, and establishing a new Independent Payment Advisory Board to recommend Medicare spending reductions if projected spending exceeds target growth rates. Additional revenues also come from raising the Part A payroll tax rate and Part B and D premiums for higher‐income people.
In addition, the long-term threat to Medicare is the very health care crisis that plagues the whole nation: the problem of the uninsured, spiraling health care costs, and disparate levels of quality. The nation’s nearly 50 million uninsured and many more underinsured go without prevention and care for their chronic diseases, suffering acute illnesses and preventable complications. When they turn 65 years old, their complex medical problems become Medicare’s (and the American taxpayer’s). By expanding access to affordable health insurance to over 30 million more Americans through the individual mandate, tax credits for small businesses, subsidies for individuals to buy insurance in the exchanges, the ACA will likely unburden Medicare in the future.
Ironically—or expectedly—opponents of the ACA hurl accusations against it for threatening Medicare and cutting senior citizens’ benefits. Opponents also argue that the cutting of Medicare Advantage (MA) plans would decrease the availability of doctors and specialized benefits that are not available in traditional Medicare. However, as policy experts have repeatedly explained, MA plans are overpaid for similar care, and numerous provisions are in place to protect seniors from cuts in benefits and regional deficiencies and to reward highly rated MA plans.
By now the vitriol of “death panels,” “rationing” grandma’s care, and even the paradoxical specter of “government intrusion” in Medicare are well-known.
The ridiculousness of these latter claims should speak for themselves. Unfortunately, the lies have worked. According to the Kaiser Family Foundation’s Health Tracking Poll (March 2011), over 50% senior citizens consistently each month seem to be skeptical of the ACA’s reforms, fearing that Medicare will be worse off than now, not better. This is despite the fact that the AARP supports the ACA and has launched education campaigns to dispel these myths among its members.
But here are the facts about how the ACA affects Medicare Recipients
- It does NOT reduce benefits…. In fact it increases them: 1) Nationally recommended Prevention Services will now be completely free of co-payments and a personal wellness plan will be constructed for recipients. 2) It eventually closes the Medicare Part D Doughnut hole, decreasing the out-of-pocket costs for prescription drugs to 25% by 2020.
- It would NOT force doctors to ration care … None of the advice provided by the Independent Payment Advisory Board would be binding, and only positive incentives would exist for doctors to provide coordinated, value-based care in the demonstration projects. Also doctors would be positively incentivized to report data on quality measures, not necessarily meet them. 3) It would crack down on waste, fraud, and abuse, which accounts for at least $60 billion per year and probably more.
- It would NOT be more expensive… It would actually help to shore up the Medicare Part A Hospital Insurance “trust fund” so that this remains solvent until 2029
- There are NO Death Panels…. There never were. But even what was once a bi-partisan idea to support doctors’ discussions for patients’ advanced directives preferences was nixed amidst the falsehoods run amok.
These are the facts. And this is how the ACA protects, not harms, Medicare. But in the same way that our seniors remain a vulnerable population because of physical illness, they are also the most vulnerable to misinformation, myth, and scare tactics.
The more that we use Medicare as a political football, by jockeying for points among seniors without telling them the truth about its finances and reform efforts, the more we ignore the stark consequences for Medicare and do disservice to seniors and the disabled. We as physicians and health reform advocates must fight for the truth and fight to protect the vulnerable among us. Let us re-establish the atmosphere of 1965, reclaim the moral imperative, and elevate the needs of patients over politics.