What is So Special About People Over 65?

One of the great ironies attached to our national health care debate is the avid support that individuals over the age of 65 (seniors) have for the status quo. I don’t mean to suggest that all seniors think alike, even on national issues, but as a group they fall pretty solidly with the Conservative message on health care - that things are better left unchanged instead of embarking onto something as demonic as Government supported health care. Anecdotally, it has been my experience in talking with many seniors that the vast majority do abhor the idea of change, even as many criticize their personal experience within our current system (interestingly, they don’t necessarily fault the System; rather they’re more likely to blame the insensitivities of subsequent generations). The irony, of course, is that they are already active and satisfied recipients of what they argue so vehemently against expanding– Medicare.

Why should they support change? I can’t think of any good reason - even the truth - as long as self interest prevails. They are one of two sets of beneficiaries in our flawed system (the other beneficiaries are those on the receiving end of the $1.7 trillion transfer that takes place every year in the United States). How did this happen? What makes Americans over 65 so special, that their health and well being is somehow more important than say children 16 and under, or pregnant women, or perhaps young adults with multiple sclerosis? Like most things, you have to go back to the beginning:

What we fondly and simply know as Social Security began as our nation was just rising in 1935 out of the first major dip in the Great Depression. After experiencing the inhumanity caused by failed financial systems, the concept was simple; provide a base line of income to a class of citizens who, as a result of age, no longer had the capacity to earn income. Like insurance, the cost would be borne by all working people in order to contain cost, but unlike free market insurance (as with annuities) participation could not be an option. However, in order to pass the legislation with the votes of those who raised the specter of Socialism, the taxes and benefits would be restricted to working Americans. Of course, as it gained in popularity and, therefore, became politically attractive, it began to grow in complexity and benefits. Even as the projected benefits began to outweigh the projected “assets”, and even as the “assets” were in the form of purchased US Debt (Treasuries) during periods of overall deficits (a bit like an individual who puts $1 into savings for every $3 he puts on his credit card), the reality of Social Security became sacrosanct to Conservative politicians (Republican or Democrat). None…I repeat none would openly argue against it today. Why? Because, even with it's flaws, the nation sees it's value. Enter Medicare.

The Social Security Act of 1965 was the first (and really the last) attempt in dealing with the problem of health care in the US. Other major laws since, such as the Balanced Budget Act of 1997 which included Medicare Advantage, or the Medicare Prescription Drug (et al) Act of 2006 were attempts at fine tuning (often for votes) and whose primary beneficiaries ended up being the Medical Insurance Industry and the Pharmaceutical Industry. The idea of the Medicare law of 1965 (which included state controlled Medicaid for the indigent) was to address the growing need to provide nationally guaranteed health care beginning with those most vulnerable to the costs (those with fixed incomes), and it had a vehicle to use – the Social Security System. It was fought vigorously by Conservatives. Ronald Reagan claimed it would rob us of our freedom, George H.W. Bush, while running for the Senate in 1964, echoed it as “Socialized Medicine”. Those who supported it openly saw it as a first step toward bringing health care to the US in line with what had already happened throughout the world.

In the post WW2 years, the developed democracies, other than the US, figured out that in a new free world, where there was a desperate overall need for health care by people rising from devastation, the overall cost had to be borne by everyone in order to make it work. Universal Health Care, or as often described now as a Single Payer System, either through direct payment or manditory public insurance, became the law of the land in these democracies. This was especially (and interestingly) true of the two nations for which the United States took the primary role in rebuilding, namely Japan and Germany. Only Canada, the other major Western ally whose homeland was physically untouched by war, did not adopt a true single payer system, but they offered public health insurance immediately after the War, which evolved into full universal coverage in 1984. The United States, the great engine of free enterprise, alone chose the road of a for-profit health care system, a system that now costs multiples of what the rest of the world pays and is rife with gross and tragic inequities, discouraging patients and medical providers alike.

Even so, going back to the beginning of that post-war period, such “radical liberals” as Harry Truman saw the need to create the means by which all citizens could have access to health care and that the key to access was cost. They and others understood the obvious, that health care is a commodity that does not fit ordinary economic models. In economic terms, the demand is inelastic; it does not decline when the price increases. Therefore, in the absence of a system which includes everyone, and with an exponentially rising population, they saw that the Government (Federal, State, and Local) would become the de facto payer of last resort, and there was absolutely nothing to restrain costs from rising by those benefiting from that revenue.

The need for Universal Health Coverage was advocated during the Roosevelt administration, but attempting to create law really started during the Truman administration. Truman, for his efforts, was given the honor to sign up as the first participant in the new Medicare program in 1965. The widespread belief at that time was that an expanded version of Medicare provided to the entire American populous was only a matter of time. Of course, few foresaw the huge industry that would balloon as a result of stratospheric revenues, and how that industry would fight to keep that cash flowing. It was aided by tax law which allowed companies providing health insurance benefits to bury the costs (borne by their employees) out of their worker’s sight.

Still, Medicare/Medicaid made it under the wire, and although it is an imperfect public insurance program it pretty much accomplishes what the supporters wanted – universal health coverage for the participants funded through general payroll taxation. What it never did nor could ever do was impact general health care costs, because it controlled less than 15% of all Americans (albeit a larger percentage of cost). Which is why Medicare is now essentially funded through debt. The participants don’t care, they’re not paying, and all in all they’ve been pretty happy with the result; ergo you won’t hear a Republican advocate the dissolution of Medicare - even as they deride the idea of Medicare expanded to the rest of the population as socialistic mania.

There is nothing special about the 36 million Americans over age 65 (74 million by 2050), at least not when it comes to health care. In less than 5 years I will be 65 and be invited under that protective umbrella. If the Republicans, Conservative Democrats, and the financial recipients of the largest transfer of wealth any nation has ever seen succeed in thwarting any changes, then I will be forced to watch my children and grandchildren suffer under this system, even as I benefit. I can’t call that a benefit.

My gut winces a little each time I hear a Republican or Conservative Democratic politician announce that we have “the best health care (system) in the world” as I heard Rep. John Boehner (R-Ohio) recently said at the March 2010 “Health Summit”, shrouding his obstructionism in patriotism. I feel that way because I know many believe him, just as they believe the rhetorical lie that describes attempts to reform health care as a “government takeover”.

We do not have the best health care system in the world, or even the best health care for that matter (by published international standards), although we pay many times what everyone else does. If we just reduced our per capital spending on health care to that of Germany’s, the second most expensive nation, we would save enough money in ONE YEAR to pay the current health care costs for the 3 billion people in China, India, Russia, and Indonesia for the NEXT FIVE YEARS!!! We do not have the best health care system in the world, but we may have the worst. Why? Because it is a system in which the above statement on cost does not resonate at all with those who, contrary to their own best interest, have been manipulated to oppose health reform, including those contented senior beneficiaries who already enjoy guaranteed health care. In a world where access is inextricably and inversely depended on cost, what kind of vile system is that?