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

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.

But men who turned 65 in 1990 could expect to live past 80, and women of the same age, to almost 85.

In 1970, when Medicare was five years old, there were 20.9 million Americans aged 65 or older. In 2000, that number had grown to 34.9 million senior citizens.

Not only has the over-65 population grown older and larger since 1965, but medical practice has also changed. Most notably, there have been tremendous changes in screening and treatment of chronic diseases.

In the mid-20th century, health insurance covered hospitalization, because that's where someone with heart disease would go after a heart attack. Now, heart disease is more commonly discovered during a wellness screening and treated with therapeutic medication coupled with changes in lifestyle.

Medicare has slowly added coverage for medical office visits and for prescription drugs, but not adequately. Medicare routinely underpays the health-care providers and institutions that deliver care to its beneficiaries, and it continues to pay per procedure rather than for care. Now, there are proposals to privatize it completely, shifting the entire burden of finding coverage to the seniors who qualify.

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These are just a few facets of a highly complex issue, but ones that those of us who vote must understand as the political discourse heats up.

Taxes support many things, from moon shots to cancer research, but not everyone goes into space or gets cancer. Every one uses health care. Currently, only Americans over 65, the disabled, and the impoverished have national health insurance; those of us who work and pay for it don't.

Medicare is not perfect, but it's a good model for single-payer health insurance.

It needs some fixes: it needs to account for more Americans living longer; it needs to emphasize health and wellness, not just pay for procedures; and it needs to cover all Americans, as it was initially intended.

Before the politicians of the last century lost their will.

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