47 Years of Medicare, Elderly, Disabled Living Longer } GOP Fighting it More than they DID 47 yrs ago

Forty-seven years ago, Congress authorized a safety net to ensure seniors could pay for hospital care without going broke. In the decades since, the Medicare program has grown into as entrenched an entitlement as any in American history.

In Florida, where nearly one in five residents is a Medicare beneficiary, politicians who sound a false note on Medicare can risk losing election.

“It’s hard for people to imagine life without Medicare or life with a scaled-back Medicare,” said David Certner, AARP’s legislative policy director.

Over the years, Medicare has expanded, initially to include less urgent care, such as doctors’ visits, and most recently prescription drugs.

Seniors view it differently from other domestic spending programs, Certner said.

“‘They refer to it as ‘my Medicare’,” he said. “Most people feel pretty strongly that they have paid in and earned this program.”

As the political season heats up, Floridians can expect to see plenty of political ads warning that President Obama or challenger Mitt Romney will destroy the program.

Indeed, the battle already is underway as both men seek voter support in this battleground state.

In a campaign swing through Florida last month, Obama used the issue to galvanize older voters against Republicans, warning that Romney’s proposal to repackage Medicare as a fixed benefit is a “voucher” system that “will end Medicare as we know it”. He said his health care reforms have helped seniors receive discounted prescription drugs and get access to free preventive care.

Romney, meanwhile, has vowed to repeal the Democrat’s 2010 health care law that he says cuts Medicare by $500 billion.

Medicare was controversial from its outset.

President Harry Truman tried but failed to get universal health care passed. Later, President John F. Kennedy made a national pitch for health care for seniors at Madison Square Gardens. The American Medical Association, which opposed the plan, accused Kennedy of trying to fool seniors. The group rented the empty amphitheater a day later for $6,000 and paid $75,000 to broadcast its counter argument, according to press accounts.

President Lyndon Johnson had to fight off not only the AMA, but Southern Democrats and Republicans, to get a scaled-down medical plan passed. The original program covered only hospital care or similar treatment at a nursing home or the patient’s home.

Medicare was as much a lightning rod then as today, said Theodore R. Marmor, a Yale Professor emeritus, who has written extensively about Medicare.

“It went from as ideologically controversial a subject … as you could find — even though it was only about 60 days of hospital care — because the conservatives rightly understood that that’s not where it was going to end; that’s where it was going to start.”

The program served roughly 19 million Americans at first and cost less than $12 billion. Enrollment has more than doubled to about 47.7 million. The program cost more than $480 billion last year.

In Florida alone, nearly 3.5 million residents are on Medicare.

Finding a way to sustain Medicare, as costs have ballooned and as a surge of Baby Boomers swell the rolls, has become among the toughest questions facing Washington.

Current seniors and those depending on Medicare are not getting a genuine solution from either party, Marmor said.

“They’re being condescended to by all political parties. “Republicans are lying through their teeth about (changing Medicare to) save Medicare,” he said. And Democrats seem to offer nothing at all.

“The Democrats simply wave the flag of ‘Medicare, it’s a wonderful thing. They’re against it.’ ”

There are some legitimate reasons that Medicare has grown so much more expensive that the original program. For one, it covers much more.

At the time Medicare was passed, prescription drugs were limited and not that costly. Doctor’s visits were not terribly expensive either, said Dawn Sherling, a Jupiter internist.

“We didn’t have CAT-scanners when Medicare came around. We didn’t have too many fancy blood tests. What cost money was going to the hospital,” she said.

While the medical establishment staunch opposed Medicare at first, politicians looking to “fix” the system may find doctors allying themselves with seniors worried about the ramifications.

Medicare has become indispensable income for many doctors, particularly in Florida, where reimbursement rates are higher than in some other states.

“Doctors get very antsy about changes to Medicare, in this area, because Medicare makes up a huge percentage of what we bill,” Sherling said.

Medicare services make up 46 percent of her billing, she calculates.

“It turns out this public system that we all claim to dislike so much actually turns out to the one that pays its bills the quickest and gives you the least trouble when ordering tests for patients,” Sherling said.

In its 47 years, cost have surely grown, as have enrollees. The political discourse, however, have changed very little.

“Medicare in the early part of the 1960s was a huge domestic political issue that split the country between its liberal inclinations about the role of the government and the conservative inclinations about the role of government,” Marmor said. “Now it’s equally as divisive an ideological issue and fiscal issue that is not being presented in a way that illuminates anything.”

By Laura Green

Palm Beach Post Washington Bureau

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