Medicare is a Success: Preserving a Sound Program for Future Generations

The Medicare program is a success story. It was designed and enacted in 1965 as a social insurance program because private companies failed to insure older people. It was intended to provide basic coverage through one health insurance system, with a defined set of benefits. Reforms to Medicare should honor and maintain its core values to ensure its continued success for future generations.

As stated by Nancy-Ann DeParle, a former Administrator of the Health Care Financing Administration (HCFA, now CMS):

Few programs in the history of the United States have brought as much benefit to society as Medicare. Since its enactment in 1965, Medicare has provided access to quality health care for those Americans least likely to be attractive to private insurers – those over age 65, disabled, or with end stage renal disease. Medicare has also prevented many Americans from slipping into poverty. The elderly’s poverty rate has declined dramatically since Medicare was enacted – from 29 percent in 1966 to 10.5 percent in 1995. Medicare also provides security across generations: it has given American families assurance that they will not have to bear the full burden of health care costs of their elderly or disabled parents or relatives at the expense of their young families. (Preface, A Profile of Medicare, May 1998.)

Core Values That Should be Addressed in Any Medicare Reform Plan

• Medicare should continue to be a national health insurance program, not a set of independent private plans and payment options.
• Medicare should include a mandatory, secure set of defined benefits.
• Medicare should continue to provide one community of interests among the healthy and frail, rich and poor. It should not separate beneficiaries into separate groups with distinct and varying interests by creating multiple cost-sharing levels, benefit options, and delivery systems that differ depending upon the ability to pay or an individual’s health.
• Medicare should provide equal access to appropriate and high quality health services for all beneficiaries, including those with chronic, long-term, and mental health conditions.
• Private Medicare plans should be carefully monitored by CMS to ensure they provide full Medicare coverage and rights to their enrollees.
• Medicare should provide an accessible, meaningful appeals process that guarantees due process to all beneficiaries.  Medicare coverage decision-makers, at all levels, should be independent from CMS and should be required to make coverage decisions based on the law and regulations.

Conclusion

The public should listen carefully to the many proposals being considered that would dramatically change Medicare under the guise of reform, modernization, and deficit reduction.  Many of these proposals would abandon Medicare’s core values and increase expensive privatization. Medicare can be strengthened and preserved for future generations if an informed public demands it.