Medicare and Medicaid Turn 50. Now What?

Nearly fifty years ago President Lyndon Johnson signed the law that created Medicare and Medicaid, delivering on his promise that America would provide care for those who need it most. Johnson called for an end to a system that denied aging Americans the "healing miracle of modern medicine." He rejected the idea that illness should have the power to "crush and destroy" an older person’s lifetime savings, or that young families should see their "incomes and hopes eaten away" by the expense of caring for ailing parents or other loved ones.

Those words still hold true today. Medicare and Medicaid started as a bold idea to provide Americans with the peace of mind and economic security that comes with having health care coverage. Half a century later, that idea remains the driving force behind these programs, and the more recent efforts to reform health care in the United States.

To celebrate this golden anniversary, the LBJ Presidential Library together with the Aspen Institute and the Robert Wood Johnson Foundation is sponsoring a Medicare and Medicaid Summit in Washington DC today, April 15. We won’t be resting on our laurels, however; we still have a ways to go to ensure that everyone in America has access to quality, affordable health care. Rather than just celebrating the past, we must commit to an even more inclusive future.

As a geriatrician who practiced for years in some of Philadelphia’s most disadvantaged communities, I have seen the profound impact that Medicare and Medicaid can have. These two safety net programs help mothers, fathers, grandparents, and children get the care they need, when they need it most. I’ve seen the relief on patients’ faces when they know it’s going to be all right.

Today, more than 100 million people are covered by Medicare and Medicaid. Were President Johnson to know how much a part of our national identity Medicare and Medicaid have become, he’d probably flash that big Texas grin he was so famous for. The fundamentals of these programs have withstood the test of time, eliminating hardships and promoting well-being. And they are at the heart of a new era of health care that we are building today.

From the health insurance marketplaces established under the Affordable Care Act, to expanded Medicaid eligibility, to the drive to get more value from our health care spending and lower health care inflation, we are undergoing some of the most significant changes in our health care system since 1965.

In the two years since the ACA went into effect, the number of people who are uninsured has decreased by 43 percent. That means15 million more Americans have coverage than before the ACA went into effect. According to the Urban Institute's Health Reform Monitoring Survey data released on April 15, the share of U.S. adults who lack insurance dropped to 10.1 percent as of March 2015, the lowest level since that survey began tracking the uninsured in the first quarter of 2013.

That’s great news, but there are still millions of Americans who lack health insurance. We need to close the coverage gap in those states that have not expanded Medicaid, and reach the millions who remain uninsured. We need to help consumers choose, and understand, the optimal level of coverage for themselves and their families. We need to be steadfast in examining and improving, the value we get from every dollar we spend on health care.

I believe we must make caring for each other a shared American value, continuing the mission laid out by President Johnson. We must create healthier, more equitable communities and strengthen the integration of health systems and services to better serve all the people, no matter where they live, work, learn, or play.

By working together, we can build a Culture of Health that enables all in our diverse society to lead lives that are as healthy as they can possibly be, so that achieving wellness will no longer be seen as a luxury for many, and impossibility for some.

Even as we celebrate the values that Medicare and Medicaid were built upon, let’s get to work making these programs even better, so that 50 years from now, Americans will be able to point with pride at 100 solid years of care and caring.

Any thoughts on how we can extend the values embodied in Medicare and Medicaid to all? If so, please share in the comments.

Photo: President Johnson signs Medicare and Medicaid bill into law, July 30, 1965