50 years of Medicare

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Richard Troeh joined a very busy solo family medicine practice in 1966 but even with two doctors, their offi ce in Independence, Missouri, seemed just as hectic. The year before, President Lyndon Baines Johnson came to town to sign the Medicare legislation into law at the Truman library. Former President Harry Truman—an advocate of national health insurance since the 1940s—and his wife attended the event and were among the fi rst Americans to receive Medicare cards. “No longer will older Americans be denied the healing miracle of modern medicine”, Johnson said at the signing ceremony on July 30, 1965. “No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.” 50 years later, the Social Security Amendments of 1965 provide health care for 55 million people older than 65 years or disabled receiving Medicare and nearly 73 million low-income adults, children, pregnant women, and people with disabilities receiving Medicaid, an optional programme also created under the same law. And in the process, the government programmes have transformed health care in the USA. Medicare is the nation’s largest single purchaser of health care, consuming 14% of last year’s federal budget, or US$505 billion. And it also has a fi ercely loyal following that opposes efforts to cut benefits. Speaking earlier this month at the White House Conference on Aging, President Barack Obama drew laughs when he said, “And now we’ve got [protest] signs saying, “Get your government hands off of my Medicare”. “Almost initially, Medicare achieved its primary goal of providing nearly universal coverage among the elderly population”, Tricia Neuman, director of the Kaiser Family Foundation’s Medicare policy programme told The Lancet. “It was a great comfort to my parents”, Belle Likover, 95 years of age and a long-time advocate for older adults in Ohio, told The Lancet. “They knew that no matter what serious illness they might face in the future, they were never going to be bankrupt by it because of Medicare.”