MEDICARE – History of and What to Review


Article Contributed by
Katie Smith

Medicare has provided health insurance to America’s senior population for more than 40 years but the actual idea of a national health care system was first proposed in 1912 by Teddy Roosevelt. Teddy’s cousin FDR continued to champion this cause by including health insurance language in his plan for Social Security.

The 1935 Social Security bill did contain language authorizing a study of universal health insurance for seniors but the private sector lobbied against this government intervention. In the interest of preserving Social Security and the New Deal initiatives that were so important to the growth and survival of the U.S. economy, FDR agreed to drop his plan for universal coverage.

President Truman reintroduced the idea of national health insurance but America still resisted the idea of socialized medicine, so the supporters needed to find another way.

Selective – Not Universal
Advocates of national health insurance decided to focus their efforts on one group only – senior citizens. When this group retired their employer sponsored health coverage ended. They were considered ‘high risk’ making private insurance too expensive or not available at all. A majority of citizens and politicians viewed senior citizens as ‘hard working, deserving people’. The lack of health insurance wasn’t their fault. This was a group that the general public could sympathize with, understand and support helping.

The proposals for Medicare were built on the Social Security model. Retirees with a history of working and paying into the system could be eligible and guidelines related to financing the plan and administering it were put in place. Advocates avoided the stigma and opposition often associated with ‘welfare, public assistance programs and government handouts’.

The private medical sector continued its opposition, so original Medicare only covered hospital insurance, not doctor bills. In an effort to satisfy the senior population the part B provision was added to cover doctor bills, but this part of the insurance plan was covered by beneficiary premiums and monies from general revenue.

Medicare as we know it today has successfully maintained stability while changing to meet the needs of the senior population. It remains the primary insurance coverage for Americans over 65, the major financing has stayed in place and the hospital and doctor divisions remain intact.

Americans turning 65 now look to Part A automatically for hospital coverage, their Part B premiums are income based to be affordable, drug coverage is available through Part D and a wide array of supplemental plans are offered to cover costs outside the Medicare umbrella.

New Challenges
According to local insurance counselors the challenges this year are different.

“Independent Health has moved away from the $0 premium plan, but Univera has stepped in with plans to fit that need,” one counselor reported. Another was quick to remind seniors, especially those just now turning 65, about the need to look over all the plans, do the research to determine what plans their doctor will accept and what upcoming therapies, surgery or rehab they might need moving into 2017.

Study Recommended
The initial enrollment can be confusing with many factors to consider, according to local counsellors. Agents are not always aware of individual needs, so it is important for individuals to study the plans for themselves.

Local Medicare counsellors agree it’s not a quick process. It takes some time and research to find the best plan, but it can be done “It’s like buying a car, an appliance or any other big ticket item… there are plans out there that can fit the majority of the over 65 population. Just do your homework,” they advise, “take your time and don’t hesitate to ask questions and request some clarification.”

Seniors Speak
Seniors at a local housing unit were quick to praise the overall concept of insurance but weren’t shy about the frustration they experience.

“… I can’t imagine how I would have paid my bills.” Marilyn said. “I’m a cancer survivor with a lot of complications but the Medicare and my supplemental insurance have been a huge help to me. My chemo was covered, the ongoing tests and the follow-up I need have all been paid. This has been a huge benefit to me, I’m happy with all the coverage I have.”

For every success story shared, however, there were complaints and concerns about continually rising premiums, reduced coverage and the frustration of working through the bills.

Local seniors willing to discuss their situations, Mabel, Bill and Harry, were quick to voice their opinion about the entire issue of health insurance and supplemental plans.

“Seems like we’ve paid in enough, worked hard our whole lives and should just have coverage without all the fuss…” Bill said. Another added, “way too much paperwork, questions and prying just to end up taking more of our money.” But when pressed on the issue of insurance, their health and having the protection, they all agreed it was better to have the insurance than to worry about paying the bills and possibly losing everything.

Seniors no longer have to worry whether they will have health insurance, counsellors say. They simply need to understand how they will be covered and take the needed steps to complete any applications or enrollments.

Open Enrollment Coming
Medicare enrollment is open until December 7th for those turning 65 or considering changing plans. The Center for Medicare/Medicaid suggests that seniors and their families review their health needs and the plans they currently have. Consider what’s important to you – extensive coverage, lower premiums, physician choice, out of state coverage or more affordable co-pays. Seniors will need to think about what costs that might need to be covered – deductibles, medications, co-pays, tests, treatments or therapies, look for benefits that could help cover premium costs or actual medical bills.

Learn More
Insurance companies all offer seminars and workshops related to Medicare, there is a TV station inviting viewers to “Tune in for a Medicare Plan”, the federal government supports the site, the Chautauqua County Office for the Aging has counselors available and Lutheran offers a geriatric case manager to help answer questions.

As Medicare moves into its second 50 years, counselors say there is every reason to believe it will survive the continued political pressure. There will still be ongoing controversy about health care and budget restrictions will impact the program. The question, however, will not be if Medicare will change but how.