58 Years of Medicare and Medicaid: Reflection and Future Aspirations

July 30, 2023

By Trevor Lyford, MPH, M2 at Eastern Virginia Medical School and AMSA National Health Policy Chair

I’ve been studying the American healthcare system for roughly ten years. I majored in Public Health with a focus in Health Policy in graduate school before starting Medical School last year. My years of education came in handy when I realized I couldn’t afford the mandatory health insurance required to be an enrolled medical student by my institution. Enter Medicaid. I used my graduate education to stumble my way through an application for Medicaid. To be honest, I struggled to fill it out. The irony of that is not lost on me. Nevertheless, I qualified and received Medicaid while in medical school.  Sunday, July 30th marks 57 years since President Lyndon B. Johnson signed into law the bill that led to both Medicaid and Medicare. Drawing from my recent personal experience, I have chosen to honor this milestone by delving deeper into the current state of the American health insurance system. The verdict: while there have been improvements, our healthcare system still falls far short of achieving true equity.

Medicare: A Lifeline for the Elderly

With the passage of the Social Security Act of 1965, the “original Medicare program”, comprising Part A (Hospital Insurance) and Part B (Medical Insurance), was set into motion. As the first federal health insurance program of its kind in the United States, it primarily served elderly individuals that were aged 65 and over. Of course, Congress has made changes over the years to expand eligibility and coverage for those disabled, people with end-stage renal disease (ESRD) requiring dialysis or kidney transplant, and people 65 or older that select Medicare coverage. More benefits, such as prescription drug coverage, have also been incorporated. This resulted in roughly 65,748,297 people have health insurance thanks to Medicare, as of March 2023.

The importance of Medicare cannot be overstated. Seriously. Just imagine what our, already dysfunctional, healthcare system would look like if we had over 65 million elderly Americans without comprehensive coverage. Not only would it have negative health implications for many of our loved ones, but it would also lead to a surge in individuals who are unable to afford essential medical treatment. After all, Medicare serves as a safety net for seniors, protecting them from financial ruin and ensuring they have at least some access to much needed medical care. 

Medicaid: A Shield for Low-Income and Disabled Individuals

Medicaid, also created under the Social Security Act, is a joint federal and state program designed to offer healthcare coverage to those who need it most. When first introduced, Medicaid gave medical insurance to individuals getting cash assistance. Today, a significantly larger group is covered under Medicaid which includes low-income families, pregnant women, people of all ages with disabilities, and people who need long-term care. Although not all 50 states have expanded Medicaid with the Affordable Care Act, there’s a wide variation in the services offered. 

Regardless, the significance of Medicaid lies in its ability to provide healthcare coverage to vulnerable populations who would otherwise struggle to afford essential medical services, like myself. For many low-income families, Medicaid is a lifeline that ensures access to at least the bare minimum of services like primary care, preventive services, and treatment of chronic conditions. Medicaid covers 1 in 5, and is an important source of insurance coverage especially for pregnant people and children in our country. 

Caution: More is Needed 

The stark reality is that improving access to healthcare in the United States of America has been a long, arduous, and sometimes frustrating process. While the statistics I’ve highlighted are significant, it’s critical to note that these figures do not imply complete insurance coverage for all people in the United States. Medicare and Medicaid have been pivotal in safeguarding the health and well-being of millions of Americans, yet additional measures are imperative. It’s time we all endorse the Medicare for All model. Yes, I am talking about universal access to quality, affordable healthcare, an idea that  the American Medical Student Association (AMSA) has supported since its inception!

By removing private insurance plan restrictions and providing coverage for all residents, equal access to essential medical services would be guaranteed. The Medicare for All model would eliminate financial barriers to care and would enable broader implementation of preventative measures, thus reducing chronic diseases. Studies have shown that countries with universal healthcare systems often achieve better health outcomes compared to the United States. By promoting regular check-ups, early detection of illnesses, and preventive care, Medicare for All can enhance health outcomes and increase life-expectancy. In addition, Medicare for All can help eliminate the perpetuation of disparities in healthcare access and outcomes. Imagine a world where everyone has a right to healthcare, regardless of how much they make, what color their skin is, or what state they call home. This is a win for public health and a world I, along with AMSA, want to build!

The current American healthcare system is notorious for its exorbitant costs, leading to financial strain for both individuals and the government. Our track record in delivering cost-effective care is nothing short of dismal. Adopting Medicare for All has the potential to streamline administrative expenses, reduce bureaucracy, and consolidate healthcare spending, resulting in substantial cost savings via enhanced bargaining power with pharmaceutical companies and medical providers. 

The key takeaways are Medicare for All saves money, improves overall health outcomes, and greatly reduces healthcare disparities. As a future physician, I wholeheartedly endorse Medicare for All and strive to promote a healthier and more equitable society. As a strong advocate for evidence-based medicine, I firmly believe that the time has come to make significant improvements in our healthcare system. It is time for Medicare for All! 

Call to Action

Stand with AMSA and passionate future physicians supporting H.R.3421 and S.1655, the Medicare for All bills that have been introduced to congress. Let’s use our voices to speak out about what patients need and hold our elected officials accountable. 

Find out who your legislators are here. Adapt the email template provided here, and let your law-makers know that you support Medicare for All and they should, too