Opinion: Will Medicare make it to 65?

Published: 8/2/2022 6:03:11 AM
Modified: 8/2/2022 6:00:02 AM

Ahmed Kutty MD lives in Peterborough.

Medicare turned 57 this week. But will it attain the venerable age of 65, a sought-after milestone that millions fervently hoped to get past since President Johnson signed the act into law in July 1965?

Its chance of surviving and savoring the ‘golden age’ by 2030 is hanging by a thread in these times fraught with peril for any and all things serving the public good.

The answer to the sixty-four dollar question hinges on whether we as a society allow the grand larceny now underway in the guise of market-centered innovations like REACH (Realizing Equity, Access and Community Health) and its earlier iteration DCE (Direct Contracting Entity), vigorously championed by Center for Medicare and Medicaid Services (CMS), to succeed unhindered.

The current effort is only a continuation of schemes for privatization of Medicare begun in the early 80s, yielding Medicare Advantage, its crown jewel crafted to crowd out original Medicare.

A plethora of alphabet soups like Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Provider Sponsored Organization (PSO), Medicare +Choice (M+C), Medicare Advantage(MA), Independent Practice Association (IPA), Pay for Performance (P4P), Medical Loss Ratio (MLR), ACO(Accountable Care Organization), PA(Prior Authorization), HDDHP(High Deductible Health Plan) and MMC (Medicaid Managed Care Companies) are but a tiny sampling of the discombobulated lingo unleashed on the practitioners and their patients by CMS, Department of Health and Human Services, the healthcare insurance industry and other actors in the epic saga of the American healthcare system of the past half-century.

Viewing Medicare, a social insurance as ‘original sin’ is a catechism for a substantial section of our polity. Private ownership is the sole path to virtue. Having society provide for any public purpose, in their weltanschauung is to promote sins of sloth and dependency; unmindful of the fact that the burden is shared equitably by the whole community and the benefits are disbursed based on needs of the sick.

As the theology of ‘primacy of me over us’ is reaching its ascendant zenith, it will take a leap of faith to remain optimistic about Medicare’s life expectancy remaining sustainable to the proverbial age. A program that has kept a generation of American seniors reaching 65 from penury and indignity occasioned by illness is heading towards its deathbed.

Recently a trio of prominent healthcare economists of the free-market persuasion publicly admitted that many of the ‘innovative’ funding and delivery mechanisms ushered in over the past four decades, ostensibly for cost control and quality improvement were ineffective (Sullivan, Malinow and Tillow.)

They said they were wrong. The current Senate measure to remove the Bush-era ban on Medicare negotiating drug pricing is a hopeful step. These are silver linings, albeit thin amidst the dark and heavy clouds.

We, of the current generation, cannot sit on the sidelines. Our utmost and all must be expended in efforts to bend the political economy to our will in order to protect traditional Medicare. And we must act with resoluteness to expand the foundational impulses that birthed Medicare three score minus three years ago and must rededicate ourselves to its original goals.

We may yet redeem ourselves to bequeath to future generations the major gains in affordable, equitable, and quality healthcare we wrought.




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