Jemkort 1

Stefan Jemkort

Fowler

PS1010 504

30 March 2017

Policy Paper: Forging Healthcare

Today, the United States is seeing health care costs growing exponentially. Forbes

magazine shows that in ten years the average cost of annual healthcare premiums has gone up

over seven thousand dollars, or roughly fifty one percent, for family coverage and is continuing

on this trend (Munro, 2014). Soon this sky rocketing price will be out of reach for many,

especially for the elderly population; the people that need medical care more than most. CNN

Money states that a healthy couple over the age of sixty five can expect to spend over $266,000

on Medicare premiums alone, and that number does not include additional money that will have

to be spent on what is not covered (Lobosco, 2015). This cost is outrageous compared to the

average retiree income of $31,742 per year (Bowman, 2017). This high cost is causing the

elderly population to make a critical decision; either pay up or suffer.

Those who choose to pay, but cannot afford it, more often than not dig themselves a hole

they will never be able to climb out of, even after they pass on. An article written by the

Washington Post brings light to the disgusting fact that (the) State can seize your assets to pay

for care after youre forced into Medicaid by Obamacare (Somashekhar, 2014). All hopes of

passing down hard earned assets to another family member are suddenly crushed. On the other

hand, the article discusses that someone who earns just slightly more can have the opportunity to
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be granted a subsidy for their insurance. These facts detail the struggle of the elderly population

in the battle for health care. This demographic needs the care more than most, but yet are

hindered by growing costs and consequences beyond their control.

There has been one piece of policy passed in history that has helped the elderly

population receive health care more than any other. On July 30th, 1965, President Lyndon

Johnson signed into law a policy that would revolutionize health care for senior citizens.

Medicare was created over fifty years ago and the central idea still stands today, providing tens

of millions of older Americans with a crucial measure of financial security and access to medical

care (Oberlander, 2015).

In the beginning, the push for national health insurance was not always a favored idea. In

fact, there were policies submitted to congress well before this one that failed to gain any traction

at all (Marmor, 1973). The push for universal health care started in 1915 and did not see a single

move forward until 1962 when the idea of focusing on one population group, the elderly, was

proposed (Ball 1995). This group would benefit tremendously being that most of their incomes

were below the poverty line (Moon, 2006) and before enactment, only about half had any

health insurance coverage and those that did had very limited benefits (Marmor, 1973). This

was the least concern of Medicare advocates, however. The real purpose was to push their

political agenda for national health care (Oberlander, 2015).

Targeting older Americans worked well for the advocates. However, they would not have

to deal with just congress, but also the American Medical Association. The AMA was not a fan of

this newly proposed policy. David Allman, AMA president, was outraged stating "is at least

nine parts evil to one part sincerity" and "the beginning of the end of the private practice of
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medicine" (Journal of the American Medical Association, 1957). The AMA saw this as a threat to

the medical industry. They feared a threat to the justice of physicians and the destruction of a

private medical industry. This was a major barrier for advocates because past opposition from the

AMA caused previous policies to be scrapped. There was also opposition from the Ronald

Reagan, who was president at the time. The president stated, if Medicare passed, then behind it

will come other federal programs that will invade every area of freedom as we have known it in

this country" (Morone, 1990). Getting a policy passed is next to impossible without the approval

from the president.

President Lyndon Johnson signed Medicare into law in 1965. The act came in two parts.

Medicare Part A contained the original plan of hospital costs funded by a payroll tax, a vision of

social insurance. However there was another part included. Medicare Part B covered physician

and outpatient services. This was secretly added and approved by the president. They feared that

the elderly would not bother even being hospitalized knowing they would be stuck with a

massive medical bill from the doctor.

In order to finally be passed, Medicare had to go through fifty years of barriers. Initially,

in 1915, the general idea of national health care was not popular with congress and was of no

concern to them. Moving to 1935, the New Deal included one line in regards to researching the

possibility of health insurance but it was immediately shot down by the American Medical

Association due to interest in keeping the Medical industry a private one. President Truman

endorsed universal insurance, but was again stopped by congress and the AMA so he did not

bother to fight for it. Once the plan was narrowed to elderly, there was hope for advocates, but

again the AMA and even president Reagan strongly opposed the idea. Opposition was based on

keeping the medical industry private. The AMA wanted to keep it a business and a well-paying
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one; they wanted as little government intervention as possible. Reagan told the public this would

be the first step in freedoms being invaded to convince the public to not back the idea.

Despite opposition from nearly every power that was crucial for Medicare to be passed, it

managed to prevail. However, it did so in a covert manner. Advocates chose the elderly

population to gain sympathy from the public. Rational from their income and lack of coverage

was not the real reason they were chosen, it was a ploy to push for universal care in the future.

They just needed a stepping stone. Once on the table, Wilbur Mills engineered an unexpected

compromise, with the hidden approval of Lyndon Johnson (Blumenthal and Morone, 2009).

This was another tactic to forge the policy they wanted. Additions were made secretively. This

included coverage for physician and outpatient services, what the AMA strongly opposed.

Medicare single handedly birthed a national healthcare program. It was the first step to

creating the complex system America has today. While it was changed significantly throughout

the last fifty years, its core function still stands. It is still the reason the elderly population has a

chance at healthcare. Battling fifty years of barriers has proved to be worth the success. Without

this policy, the medical industry may be entirely private and costs could be worse than they are.

Connecting to today, there is one aspect to this policy that was overlooked, the future.

Although at the time is may have been impossible to predict the advances the United States has

today, the policy seemed to be left broad and open ended. Kraft and Furlong identify this as

forecasting (Kraft 2010). Anticipating the future is highly important to consider with a policy.

Medicare failed to account for the ageing of the baby boomer generation. This massive amount

of people all in needed of Medicare at one time contributed to rising costs America sees today.
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The policys broad terms also left room for additional amendments like seizing assets to recover

unpaid costs.

The success of Medicare provides an opportunity for my group and I to better prepare

and present a policy to reform the current health care system. One example is how Medicare was

passed, Advocates for the plan had a main goal of universal health care, but knew everyone was

against that idea. Instead, they changed how they presented the idea. This tactic can be useful for

our group. Republicans and Democrats think differently and respond differently. It would be

foolish to approach them both in the same manner. Like the advocates for Medicare, it may be

beneficial for our group to not openly state our main goal. That may be met with direct

opposition without consideration from one party or the other. We will have to conduct research

on the local representatives to see if they are pursuing a particular reform or if healthcare is even

one of their concerns at all. Another aspect than can be applied to our group is forecasting.

Medicare, while it paved the way in healthcare, has recently seen destruction from Obamacare.

When researching policies to employ as a fix we must keep in mind the future and question how

it may be manipulated by others and turn into a downfall. If a flaw is discovered in a slid plan it

will be crucial that we fill in those gaps and work to identify those who drafted the idea.

Medicare forged the healthcare system the United States has today. It was the first step in

creating plans for national healthcare. Despite facing barriers from crucial parties in passing the

law, it prevailed. Without it, the medical industry would be an entirely private business.
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Works Cited

Ball, R. 1995. "What Medicare's Architects Had in Mind." Health Affairs 14(4): 62-72.

Blumenthal, D., and Morone, J. A. 2009. The Heart of Power: Health and Politics in the Oval

Office. Berkeley: University of California Press.

Bowman, Jeremy. "The Average American Has This Much Retirement Income. How Do You

Compare?" The Motley Fool. The Motley Fool, 11 Jan. 2017. Web.

Journal of the American Medical Association (JAMA). 1957. "Organization Section: Highlights

of A.M.A. Clinical Session." JAMA 165(16): 290-2.

Kraft, Michael E., & Furlong, Scott R. 2010. Public policy: Politics, analysis, and alternatives

(3rd ed.). Washington, DC: CQ Press, Chapter 5

Lobosco, Katie. "How much money you'll need for health care costs in retirement." CNNMoney.

Cable News Network, 30 Dec. 2015. Web.

Oberlander, Jonathan. "The Political History of Medicare." Generations 39.2 (2015): 119-25.

ProQuest.

Marmor, T. R. 1973. The Politics of Medicare. Hawthorne, NY: Aldine Publishing Company.

Moon, M. 2006. Medicare: A Policy Primer. Washington, DC: Urban Institute Press.

Morone, J. A. 1990. The Democratic Wish: Popular Participation and the Limits of American

Government. New York: Basic Books.

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Munro, Dan. "2012 - The Year In Healthcare Charts." Forbes. Forbes Magazine, 25 Apr. 2014.

Web.

Somashekhar, Sandhya. "Little-known aspect of Medicaid now causing people to avoid

coverage." The Washington Post. WP Company, 23 Jan. 2014. Web.