Definitions/Background
Medicare is a health insurance plan created and paid for by the federal government for people who are aged 65 or older, have certain disabilities or have End-Stage Renal disease. Medicare is a single-payer medical insurance program that is funded by payroll taxes, premiums, surtaxes on beneficiaries and general federal revenues (Medicare.gov, What’s Medicare?). In 2015, 55 million Americans used Medicare, and on average, the program covered about half of the costs of healthcare for its recipients. There are three different components of Medicare: Part A, Part B and Part C. Part A, titled Hospital Insurance, covers inpatient hospital stays, care in skilled nursing facilities, hospice care and some aspects of health care. Part B, titled Medical Insurance, covers doctors’ services, outpatient care, medical supplies and preventive services. Typically, Parts A and B are presented as a package deal, and most citizens have both (Medicare.gov, What is Medicare?). Part C, titled Medicare Advantage Plan, is a plan offered by a private company in partnership with Medicare in which people privately receive the services of Part A and Part B in addition to prescription drug coverage (Medicare.gov, What is Medicare?). Finally, Part D includes prescription drug coverage in the original Medicare plan (Parts A and B) by utilizing insurance companies approved by Medicare.
In 1965, President Lyndon B. Johnson enacted the Medicare program under Title XVIII of the Social Security Act (Folliard). Since then, the program has undergone several changes. In 1972, the program was expanded to cover the costs of speech and physical therapy, and the program started partnering with private companies in the 1980s (Folliard). In 1982, the program was expanded to include hospice care, and over time, young people with disabilities and those with ESRD were given coverage. In 1997, President Clinton formalized those partnerships into Medicare Part C, and in 2003, President Bush created Medicare Part D (Folliard).
Historical Context
The implementation of Medicare across the United States proved to create many unintended consequences that shaped the future of medical services. Most importantly, the implementation of Medicare as an aspect of Social Security in the middle of the 1960’s placed the program in the middle of the Civil Rights Movement (Smith, 24). Upon its creation, the legislation was subject to the stipulations of the Civil Rights Act of 1964, which required any institution receiving funds from the federal government to be fully integrated (Smith, 25). As a result, thousands of previously segregated hospitals across the country were forced to desegregate hospital floors, waiting rooms and physicians practices. After its implementation, all but five specifically black hospitals were closed or repurposed (Smith, 35). This historical context is incredibly important in understanding the political and social climate in which Medicare was created and implemented. Not only was it a major milestone in the Civil Rights Movement, it contributed to the acknowledgement that health services and practices did not need to be different along racial lines. Racialization of medicine and diseases, as a result, became much less institutionalized through the mechanisms of healthcare treatment in the United States. Now, physicians and healthcare providers were forced to treat people of different race at least in the same areas within the same hospitals (Smith, 36). Medicare implementation in this regard is an interesting example of a way the federal government can directly and indirectly affect the social and political structure of the country.
Controversy/Perspectives
The implementation and continued growth of the Medicare program over the last fifty years has been riddled with controversy, and its position as a vital yet expensive government program has created several different perspectives. Perhaps most debated is the most efficient and fair ways to decrease incredible costs surrounding the program. In a specific instance, House Budget Committee Chairman Paul Ryan proposed a system of Medicare premium support rather than federal funded Medicare (Van de Water). Under this system, beneficiaries would pay a flat fee, dependent on their income and inflation that could then be used to purchase health insurance publicly or privately (Van de Water). The proposal was a direct response to the increasing costs of Medicare due to an aging population and attempted to offset some of those costs. However, the plan failed to recognize that the growing costs of healthcare outpaced the rate of inflation, meaning more costs would increasingly go towards the beneficiaries of the program (Van de Water). As such, the program did not receive enough political support to be passed, and the next major changes to Medicare costs would come with the ACA, which slightly increased rates on wealthy senior citizens (Van de Water).
This specific example of controversy over the funding of Medicare represents the overall major perspectives on the question of how to decrease costs without cutting support. Most politicians agree upon the necessity of Medicare and support the program in some capacity or another due to its effect on a large number of their constituents. Cutting the program is incredibly politically unviable, so most conversation has centered around cutting costs, whether that be through Senator Ryan’s budget proposal, President Clinton’s failed healthcare program or the Affordable Care Act under President Obama.
Relation to Politics of Health
Finally, aside from its inherent involvement in the Civil Rights Movement upon its implementation, the Medicare program relates to the politics of health in many important ways. Most obviously, the inclusion of prescription drugs under Medicare coverage was hugely political and resulted from an increase in pharmaceuticalization in the medical industry. Pharmaceuticalization refers to the increasing human dependency on pharmaceutical drugs to solve health issues, resulting from increased consumerism and medicalization (Williams, Martin, Gabe 20). As a result of this movement, more and more healthcare coverage was dependent on prescription drugs. Many Americans felt Medicare should include the costs for these drugs, and consequently, President George W. Bush signed the Medicare Prescription Drug, Improvement and Modernization Act in 2003 (Oliver, Lee, Lipton). The law cost taxpayers about $400 billion, and it was used to offer credit and subsidies from prescription drug coverage to those on Medicare (Oliver, Lee, Lipton). The bill followed 35 years of missed opportunities and intense lobbying for drug coverage; however, about 56% of people closely following the healthcare debate disapproved of its conclusion (Oliver, Lee, Lipton). Ultimately, the expansion proved to be too much spending for conservatives and didn’t provide enough drug coverage for many liberals. However, it was only a matter of time before Medicare had to be expanded to include prescription drug coverage; the vast majority of senior healthcare takes the form of these drugs as a result of the booming pharmaceutical industry and modern medicine’s tendency to treat all issues with drugs as a “silver bullet.” The passage of this controversial bill shows just how important the inclusion of prescription drug coverage was to many senior Americans as a result of the pharmaceuticalization of the healthcare industry.
Citations
Medicare.gov. “What’s Medicare?” Accessed on February 13, 2017. https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html
Edward Folliard, “Medicare Bill Signed by Johnson,” The Washington Post, July 31, 1965.
David B. Smith, “Civil Rights and Medicare,” in Medicare and Medicaid at 50, edited by Alan B. Cohen, David C. Colby, Keith A. Wailoo and Julian E. Zelizer, 21-38. Oxford University Press.
Paul N. Van de Water, “Ryan-Wyden Premium Support Proposal Not What It May Seem,” Center on Budget and Policy Priorities, Revised December 21, 2011.
Simon J. Williams, Paul Martin and Jonathan Gabe, “The Pharmaceuticalisation of Society? A Framework for Analysis,” Sociology of Health and Wellness 5 (2011): 20-47.
Thomas R. Oliver, Philip R. Lee, Helene L. Lipton, “A Political History of Medicare and Prescription Drug Coverage,” The Milbank Quarterly 82 (2004): 283-354.
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