National Health Insurance and Medicare

The Social Action Committee of the Congress of Secular Jewish Organizations, CSJO, consisting of affiliate groups in the United States and Canada holds that the Medicare program is an expression of CSJO’s vision of what government can and should do for people. It is a tool for social justice. Today there are millions of people in the United States under 65 who do not have health insurance. Before the passage of Medicare in 1965, approximately half of all people over 65 did not have health insurance, either because it was too expensive or it was not available at any price from private insurers. However, as a result of Medicare, once we turn 65 we no longer have to worry about health insurance for doctor and hospital care. While there are significant gaps in Medicare, particularly its failure to cover the costs of long term care, CSJO believes that the structure of the program is the right model on which to build a universal health care system that would assure that all people in the United States have access to affordable health care. Unlike welfare programs that treat those receiving services in demeaning ways, there is no shame associated with participation in the Medicare program. Virtually all Americans pay into the program during their working lives and begin receiving benefits when they turn 65. Medicare’s passage in 1965 contributed to ending segregation in hospitals, because facilities that receive Medicare funds cannot discriminate on the basis of race. Also, Medicare is more efficient than private insurance, because it uses the market power that comes with directly covering 35 million people to demand reasonable prices from doctors and hospitals. Also, it does not have to pay out profits to stockholders. Finally, unlike most private insurers, Medicare allows people to see the doctor of their choice and receive care at the hospital of their choice.

Unfortunately, this Congress and this administration do not share our affection for the Medicare program. They want to turn the program over to private insurance plans. At the end of 2003, Congress passed and the President signed into law legislation “reforming” the Medicare program. That legislation aims to lure more people into private plans. The legislation gives private plans large government subsidies to participate in Medicare. While seniors have long had the option of choosing to receive Medicare-covered health care services from a private plan, for the first time the new law creates a Medicare benefit that is only available through private plans.Under the new law, in order to get coverage for prescription drugs people must sign up with a private plan. They can either get their drug coverage from a private, stand-alone plan and continue to receive coverage for doctor and hospital services through traditional Medicare, or they can join an HMO or a PPO and receive coverage for all of their health care needs from a private plan.

The law also calls for a dangerous experiment with a voucher-like program beginning in 2010. In 2010 in selected parts of the country, people with Medicare will no longer have access to guaranteed health insurance at a set price as they do now under Medicare. Instead, they will receive a set amount of money that they can use to buy health insurance on the private market.

One of the most sinister elements of the new law is a provision that aims at capping the amount of general federal revenues that can go to the Medicare program. This means that future Congresses will either have to increase premiums or payroll taxes, cut benefits, or payments to providers. It is sadly ironic that this administration and the leadership in Congress are attempting to reduce spending for the health care of our seniors at the same time that they have enacted tax cuts that benefit mostly the wealthy worth hundreds of billions of dollars over the next ten years.

Finally, the legislation prohibits the federal government from negotiating lower prices for prescription drugs directly with the drug companies. This provision was supported by the drug industry, which will do anything to preserve its ability to charge high prices. If Congress and the administration allowed Medicare to negotiate directly with the drug companies, the Medicare program would be able to get large discounts off the cost of drugs. That would have made it possible for the drug benefit included in the law to be much more generous. As it is, the 2003 Medicare bill leaves large gaps in people’s prescription drug coverage. For example, under the bill most people with Medicare will have to pay 100 percent of their drug costs between $2,251 and $5,100 in total costs/per year.

We believe that the original, government-run Medicare program must be preserved. For the sake of our nation’s seniors and people with disabilities, the program must not be turned over to private insurance companies. We know that the priority of private insurance companies is profit, not the provision of health care. Medicare should be provided all of the resources it needs to make affordable health care available to those covered by the program. Finally, the traditional Medicare program should be given the ability to offer drug coverage directly to seniors and it should be given the ability to negotiate with the drug companies for lower prices.

Beyond what it does for people with Medicare today there is another reason that the Medicare program must be protected and strengthened. If Medicare’s enemies succeed in destroying the program, the task of creating a universal health insurance program becomes much more difficult. Advocates for universal coverage would no longer have a model on U.S. soil of guaranteed coverage to point to as proof of the government’s competence in this area. Also, if Medicare were destroyed, then the apparatus to run a universal health insurance program would have to be created from scratch. If Medicare is preserved, then we can create a universal health insurance program by building on the Medicare program.

The CSJO and its affiliates in the United States strongly support the strengthening of Medicare as a government operated program. All health care, including coverage for prescription drugs, should be funded adequately and be available to all seniors and people with disabilities throughout the country. We look forward to the expansion of Medicare and to the creation of a universal health care system for all Americans modeled on the traditional Medicare program.