Our Federal Health Programs Can Be Saved

With the enactment in 1965 of legislation creating Medicare (for the elderly) and Medicaid (for the poor), Congress established a covenant with the American people: that access to quality health care shall not be limited by age or wealth. 

Though there is little doubt that the elderly and poor have benefited greatly from both these programs, expenditures have now reached such high levels that some suggest that we must break that covenant and shift the burden of caring. Total health care expenditures in this country have increased by 750 percent since Medicare was enacted. Per capita costs have risen from $211 in 1965 to more than $2,000 in 1984. The share of health care costs that is paid by the federal and state governments has climbed from 26 to 42 percent. 

Yet senior citizens are forced to spend an ever-increasing percentage of their available funds on medical bills as health care costs rise more than twice as fast as their incomes. 

The Congressional Budget Office estimates that, as a result of these increasing costs, the Medicare trust fund will be depleted by 1993. Obviously, a critical need exists to ensure the long-term solvency of the system. The current administration has proposed several stop-gap measures that they claim will shore up Medicare. Unfortunately, these "solutions" place undue strain on beneficiaries, yet result in only short-term savings for Medicare. 

Beginning in January 1981, the Reagan administration made the decision that cutting taxes and expanding defense were more critical than protecting the elderly and poor. They followed that decision with four years' worth of proposals and pressure to reduce the federal government's responsibility to the elderly and poor. Had the Congress not rejected many of the administration's proposals, the situation today would be much worse. 

Hard work and tremendous creativity on the part of our nation's health policy experts will be needed if we are to deal with the problems feeing Medicare. To this end, I introduced on January 7, 1985 a bill to provide for the establishment of a bipartisan commission to study and recommend changes in the Medicare program that will ensure both its solvency and the appropriateness of its benefit structure. A similar commission in 1983 was able to ensure the solvency of Social Security for at least 75 years. 

Solvency is not the only problem with Medicare. We know that it covers less than half of the total health care expenditures of the elderly, as senior citizens pay more and more out of pocket to participate. For the most part, both Medicare and private insurance programs finance health care treatment only when illness is associated with periods of hospitalization; they virtually rule out assistance for other care — such as immunizations, home care, and other supportive services — that might prevent or postpone costly institutionalization. 

Furthermore, when institutional care is needed, neither Medicare nor private insurance offers appreciable coverage of custodial nursing home care. Although Americans spent about $25 billion for nursing home care in 1981, less than 1 percent was covered by Medicare and private insurance. Medicaid, the federal/state program for the poor, paid the lion's share — about 50 percent. Almost all the rest came out of the pockets of the families of those afflicted by long-term illness. 

Nowhere in our society are families left so unassisted as when they are meeting the financial and emotional burdens of caring for a chronically ill relative. This is the largest gap in our health and social service programs, underscoring the sad truth that we have no meaningful long-term care policy in the United States today. 

I have briefly laid out the problems. We have a Medicare system feeing possible insolvency. We have a health care system that fails to meet the needs of many of our citizens, even though we are one of the richest nations on earth. We have poor people who still must choose between whether to eat or to attend to their health needs. We are at a crossroads. We must review the purpose and structure of Medicare and Medicaid and explore what the federal role might be in structuring a comprehensive continuum of care — a long-term policy — capable of addressing the preventive, acute, and chronic health care needs of our nation's citizens. 

I believe my proposal for a Medicare reform commission is one important step. But we need to take others. Through continued research and hearings, the Subcommittee on Health and Long-Term Care of the House Select Committee on Aging will continue to seek creative solutions. We will examine fraud and abuse, and unnecessary surgery. We will delve into a relatively new but promising option, home health care. We will examine the way Medicare provides larger-than-average reimbursements to for-profit hospitals; and we will explore preventive medicine and health education efforts — anything that will keep our population healthier and slash away considerable health spending. 

Your representatives in Congress need to hear from people who want them to solve these problems. I urge our nation's elderly, and all others who want to start working now to ensure the quality of their future lives as senior citizens, to flex their political muscles. I urge you to work on behalf of candidates who truly care for the elderly and who also are concerned about the quality of old age for future generations of Americans. 

Demographic trends indicate that the proportion of elderly Americans will almost double by the year 2030 — when those now 20 will turn 65. This will create a crushing burden on society unless intensive planning begins now. 

Yet the numbers are a strength as well. If seniors mobilize their support for candidates who favor a health care system that will meet the needs of all Americans, they really can make a difference. Older Americans are the most active voting bloc: in 1980, one-third of all votes cast were by those over 55; 70 percent of those aged 55 to 74 cast ballots. 

Our federal health programs can be saved. They also can be greatly improved. I am hopeful that we in Congress, aided by others involved in health care, and with active nudging by voters, will be able to reason together to make the changes that will ensure affordable, quality health care for older Americans, today and into the long-range future.