January - February 2018

Written by Don Walter
From his column A Minute with Don

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On July 30, 1965, President Lyndon Johnson signed H.R. 6675 into law in Independence, Mo., and presented former President Truman with the very first Medicare card. That year, the budget for Medicare was around $10 billion, and 19 million people signed up.

After decades of debate and failed efforts by several presidents, a major step had been taken. With the enactment of Medicare in 1965, Congress effectively declared, “If you are old and sick, you have a right to be cared for.” Before that, public policy had been, “If you are old and sick, you have a right to whatever health care you can afford.” More than 50 years later—despite the problems one could blame on Medicare programs—it is difficult to imagine life in the U.S. without them. And any politician wishing to announce his or her unintended retirement from politics need only mention reducing or eliminating Medicare.

Recently, three leading business leaders announced a partnership between their companies to address the cost of healthcare benefits for corporations. In an article in The Wall Street Journal, one of the three, Warren Buffett, referred to rising healthcare costs as a “hungry tapeworm on the American economy.” The article went on to cite a 2015 article in the Harvard Business Review which found that “‘clinical waste, administrative complexity, excessive prices, and fraud and abuse’ amounted to 40% of total health-care spending in the U.S.” With 18% of gross domestic product going for health care, that’s a lot of room for potential savings.

When health care is discussed, it is easy to get caught up in the details of who gets what, who pays, how much it will cost, and how un-American the people are who oppose our ideas. Politicians who make speeches are not usually the same ones who are trying to figure out how to complete a form appealing an insurance claim decision. I am reminded of the poignancy of a favorite quote from John Galsworthy: “Idealism increases in direct proportion to one’s distance from the problem.”

Ultimately, the conversation about health care in the United States is about to what degree we see it as a right or a privilege.

We continue to grapple with a couple of challenges to the assumptions of the ‘60s. First, the affordability of health care is beyond the reach of most Americans who find themselves with even modest health issues. Second, “young” and “healthy” are not synonymous. Our public policy appears disjointed. In effect we’re indicating that if you’re old and sick, you have a right to be cared for in our current health care system. However, if you’re not old enough to cash in on that promise, you have different rights. I don’t like reading what I just wrote, but I’m having a hard time believing it isn’t true.

Most of us seniors would say, “We paid for this, and now we’re cashing in!” But, like most insurance plans, Medicare isn’t fully funded by those who immediately benefit from it. Contributions by persons not currently receiving benefits underwrite the payments of those who are. In the case of Medicare, payroll taxes (contributions) of persons not eligible for benefits help cover the costs. It is an expanded variation on the principle of the healthy providing resources for care of the sick. In this case, the enlightened self-interest of those paying the tax is a promise that at some point in the future they too will benefit from this social contract. And frankly, for most younger or middle-aged Americans, it is less burdensome to pay the Medicare tax than to assume the full medical cost for aging parents and grandparents.

Ultimately, the conversation about health care in the United States is about to what degree we see it as a right or a privilege. And we have to answer big, difficult, and potentially divisive questions, such as: Is it a right for all, or just some? If it is a right for all, how are we going to pay for it? If it isn’t a right for all, how do we determine who benefits and who doesn’t? Is providing for the health care of Americans the job of the government or of the private sector and free markets? I can respond to each of those with a resounding “I’m not sure!”

However, without being too dramatic, I believe that how we answer these questions will be a mirror into our national soul. Because whatever we decide will be the foundation of the next debates related to how we care about and for each other. In 20 years, the major pressure point on care of the sick and vulnerable in our society will be the large group of seniors (most of them women) in their late 80s and early 90s. At that point, we’ll be deciding whether a long life is a right or a privilege. We are laying the foundations for that debate today.

Don Walter is director of Pensions and Benefits USA for the Church of the Nazarene.