Voices / Column

Medicare isn't perfect, but it’s a good model for a single-payer health care system

By Deborah Lee Luskin/The Commons

Williamsville

When my grandmother was born, in 1900, her life expectancy was 48 years. Unlike her twin brother, she survived childhood, and at the age of 9, left the Austrian-Hungarian Empire for the United States.

She discontinued school after eighth grade and went to work as a milliner. In time, she became quite skilled; for a while, she worked for an exclusive Fifth Avenue hat maker.

But after she married my grandfather, she helped him run a delicatessen. When the enterprise failed, my grandfather returned to driving as a teamster, and my grandmother kept house in a 500-square-foot apartment, where she raised two children and sewed piecework for extra income.

Despite my grandparents’ very modest income and lifestyle, both their children — my mother and my uncle — were able to earn college degrees at a publicly funded college.

And when my grandmother turned 65, the first Medicare bill was signed into law.

Harry Truman was famously the first person to sign up for it. Even though Lyndon B. Johnson was the president who signed the bill, it was Harry Truman who started the process 20 years earlier, in 1945, by sending a message to Congress seeking legislation that would establish a national health insurance plan.

The idea of universal health coverage was met with an outcry against socialized medicine, so the plan was modified to offer health benefits only to recipients of Social Security.

In 1965, when my grandmother started collecting Social Security, her life expectancy was estimated at 73.8 years. She was in the first cohort to receive Medicare benefits, beginning in 1966. Starting about 1970, she had a series of strokes that robbed her first of her sewing hand, then the ability to walk, and finally, the ability to care for herself.

My grandfather cared for my grandmother until he died. He was about 76 years old at the time of his death — outliving by a few years the statistical life expectancy for a white man born in the last decade of the 19th century. He was hospitalized for the last three weeks of his life.

A year and a half later, my grandmother died, aged 73 years and 8 months.

As designed, Medicare paid for my grandparents’ health care, which they would not otherwise have been able to afford.

According the National Academy of Social Science, “the Medicare program was modeled on the private insurance system in place in the 1960s,” insurance that was aimed at covering hospitalization for catastrophic illness, not outpatient medical treatment, which is more typical of current medical practice. But in 1965, no insurance company would sell a policy to someone over the age of 65.

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My parents are both 87 and have been Medicare beneficiaries for over 20 years. According to the Social Security Administration’s Life Expectancy Calculator, I can expect to live another 28.6 years. But unless some big changes are made to Medicare, I’m not sure I’ll have the same health insurance coverage that Medicare was designed to provide.

Big changes are exactly what Medicare has been lacking. My family’s story illustrates just two areas: adjusting for longer life expectancy and adjusting for changes in medical care.

Generally, Americans are living longer. According to the Social Security Administration, a man who turned 65 in 1940 was expected to live another 12.7 years on average, to 77.7; a woman who turned 65 that year could expect to live to nearly 80.

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