Health Not a Privilege of the Few But an Opportunity for the Many

On July 30, 1965, President Lyndon Johnson traveled to Independence, Missouri, to the Harry S Truman Presidential Library to sign legislation forming Medicare and Medicaid. Former President Harry Truman and First Lady Bess Truman attended the event and were issued the first two Medicare cards. Since then, these programs have saved countless lives. Health ForwardGKC was proud to join representatives from HHS, CMS and President Truman’s grandson Clifton Truman Daniel in celebrating the 50th anniversary of Medicare and Medicaid. Health Forward President/CEO Bridget McCandless was honored to return to her hometown and present remarks during the 50th anniversary event held at the Truman Library. The following is her speech, with minor edits for brevity and formatting.

Good morning. I am delighted to be here. I’m an Independence girl so it makes my heart swell with pride to think of my hometown at the intersection of history and health.

The 50th anniversary of Medicare and Medicaid has made me reflect on my years as a physician practicing here in Independence. I have had the great privilege of serving those who were beneficiaries of government-sponsored health insurance and the special responsibility of taking care of those with no insurance. These perspectives have shaped me.

Mr. Harry Truman’s perspective on health insurance was shaped by his experiences as well. Many of you know that he was the Jackson County judge and saw firsthand the devastating effect that illness had on working families.

He was also bothered that many army recruits were rejected during World War II because of malnutrition and treatable health problems. He remarked on the need to respect the “the right to adequate medical care and the opportunity to achieve and enjoy good health.”

The fact that President Johnson wanted to sign this bill in the presence of his friend, after 20 years of work, speaks to the effort and diligence it takes to craft and enact this kind of historic legislation.

At this point, I have a story about how hard acceptance of change is even after legislation is enacted, and shows what a master Johnson was. The American Medical Association was clear that doctors were not going to participate in Medicare. They wanted patients to continue to pay directly for health care services. You can imagine how impossible that would be today with the prices of health care.

Mr. Johnson invited members of the AMA to meet with him in the cabinet room. He asked if they would be willing to help recruit doctors to provide care to soldiers injured in Viet Nam. The doctors agreed, and Johnson stood up and asked for the press. When addressing the press, he praised the doctors for their dedication to the country for serving these wounded men. A reporter asked whether these same doctors would be taking Medicare. President Johnson said that these men were patriots in service of their country and that Medicare was the law of the land. Of course, they will uphold the laws of the United States, and then he turned to the stunned doctor from the AMA who said, “Of course we will, Mr. President.” And that is how doctors began participating in Medicare.

These men created Medicaid as a state and federal partnership. The majority of the funds come from federal government but each state runs its own program. When Medicaid was born, it was only the outline of a great idea. The meat was put on the bones over the last five decades. Each state is invited to propose how the program could be crafted to best suit the needs of its residents. There are more than 300 of these special agreements between the states and the federal government. This speaks to the adaptability of this program over time.

But Medicaid is not just a funding arrangement, fundamentally, it is a means to address the needs of the most vulnerable and those who have been left out of the traditional health care insurance system.

I know I don’t have to clarify in this room the difference between Medicare and Medicaid. But it helps my kids to know the difference. I tell them that

Medicare is how we care for seniors.
Medicaid is how we aid those who are in need.

In the states of Missouri and Kansas, Medicaid is designed as a categorical system. That means that being poor alone is not enough to be eligible. You have to also fit into a category that I describe as, “poor and.”

Poor and pregnant, poor and disabled, oor and elderly, and very importantly, poor and child.

You may remember the bible story about feeding the 5,000. The part of that story that always struck me was the phrase “not counting women and children.” Medicaid is where we count and care for women and children.

Children are often the silent beneficiaries of Medicaid. Right now, there are more than 30 million children who get their coverage through Medicaid and CHIP. Starting as recently as the 1980s, Medicaid began providing care for pregnant women and now covers half of all pregnant women and their babies in the United States. This was a wise investment; providing early care in pregnancy means children start off on the right foot.

We have made such a concerted effort to get kids who qualify, enrolled in Medicaid that we have cut the number of uninsured kids in half, but that means that seven percent of America’s children still remain uninsured. Having coverage is only part of that story—there is growing evidence that those children who had access to Medicaid live in better health, have more family stability, do better in school and have higher future incomes than those who are left behind.

Medicaid and Medicare stepped in to protect those with no other options — those with kidney failure, those who were disabled, those who suffered from cancer and were uninsurable, those with AIDS.

It has meant that AIDS is no longer a death sentence, that dialysis is available to people who can continue to work, that parents are healthy in body and mind to support their families, and children who have access to dental care and vaccines and preventive services can reach their full potential.

Sometimes overlooked in Medicaid, are the vital services to low-income seniors. Right now 20 percent of Medicare beneficiaries also are in need of Medicaid based on their income: 1.5 million people in nursing homes can be there because Medicaid helps with the costs, and 3 million seniors are able to stay out of nursing homes because of in-home services.

I told you earlier that I have spent much of my career working with those who are uninsured. Both the patients and I were delighted and frankly relieved when they finally qualified for Medicaid coverage. It meant that they no longer feared the unexpected catastrophic illness that would be so threatening to their families.

My friend Cynthia had several strokes, including one where she bled in her head. When she was well enough to leave the hospital, she was so grateful that she had been declared “disabled enough” to qualify for Medicaid because she wanted to be sure that she would be able to take her blood pressure medication every day. The successful part of that story is that she has not had another stroke. This is one of the stories of how Medicaid works.

And yet, there is work to be done.

The Affordable Care Act means that all states have been given the opportunity to cover more of those who are socially and economically vulnerable. There has been such great progress that 30 states now removed the categories of “poor and,” and are now serving all of those who are poor. In this state, we again face an historic opportunity, and I know that there will be many who continue to work on behalf of the vulnerable to allow them to benefit from the possibilities of Medicaid.

There will be a time in the United States when your health will not be determined by the state in which you live.

So I leave you with these thoughts:

  • Historic undertakings take time and persistence.
  • We must keep in the forefront of our minds that we design these programs to address the needs of real people.
  • And we pledge, that when those who come behind us to look back at these next 50 years, that Mr. Johnson and Mr. Truman will know that we upheld the good work that was done before us.

Mr. Truman would be proud that we stand in his library and on his legacy to remind ourselves that we will NOT be the ones who did not count the women and children or the disabled or the elderly or those living in poverty. And that will help make it true that health is not a privilege of the few, but an opportunity for the many.

Health Reform

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