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The U.S. population was older and poorer than usual during the 1950's, poverty rate at 35% and 10 mil people age 65+ (highest ever)

The country had been debating about a health care system of this kind since 1915 with Roosevelt but really became popular under Truman, finalized under LBJ.

The country felt it was time for a health care program for the elderly and the poor. They thought it was only right.

Social Security Amendments of 1965

Creation of Medicare and Medicaid

Legislative Process

Possible Reform

It is clear that these programs need reforming because they are become exponential more expensive by the year,

The Progressives v. The AMA

House Committee on Ways and Means was crucial to the passing of the bill

Senate Finance Committee was the biggest hold up in the process but eventually approved the bill

Pro-Medicare/Medicaid

There are many ideas being tossed out about how to reform these programs however it seems that Medicare is the only one that will change.

Ideas range from raising the age of Medicare to reducing benefits.

No matter what it is, something is going to have to change but politicians don't want to lose their elderly votes.

Roosevelt: Part of his progressive platform

FDR: Wanted to include in New Deal but sensed a lack of support

Truman: Medicare true hero, planted the seeds

LBJ: Finalize Truman's work as apart of Great Society

Democrats as a whole, AFL-CIO, Association of Social Workers, etc.

Anti-Medicare/Medicaid

Truman and Kennedy were big advocators for the bill but faced trouble with Congress. LBJ passed it because of a more democratic Congress. However, each president was very influential in the process

The Republican Party but more specifically, the American Medical Association

The AMA fought this until the very end

Eventually realized it was inevitable, so tried to create it themselves

So it appears that politicians are going to have to make a choice very soon. Either allow the debt to continue to exponentially increase or lose reelection. Lets hope the make the right one.

Alternative Approaches?

Three final bills emerged:

Byrnes'

John Byrnes, a Wisconsin Rep at the time, proposed a bill in which services and drugs be financed but not for all elderly, only those in need and amount would be proportional to Social Security benefits

The Problem?

Eldercare

Proposed by the AMA, it provided government financing for physician’s services, surgical charges, drugs, nursing home costs, x-ray and lab services.

Medicare

Proposed by the LBJ Administration, was the current law as it stands

Implementation

The Ways and Means Committee considered Byrnes' proposal but ultimately went with the Medicare proposal. They was not real alternative or way around it.

After the amendments were signed into law by LBJ, the Social Security Administration became responsible for Medicare and the Social and Rehabilitation Services became responsible for Medicaid.

Both agencies were apart of the larger Department of Health, Education and Welfare (HEW).

In 1997, the Health Care Financing Administration was establish under HEW and became responsible for the coordination of both Medicare and Medicaid.

HCFA is now know as the Centers for Medicare and Medicaid Services

Is Medicare/Medicaid Effective?

NO

Medicare and Medicaid are definitely worthwhile and necessary systems in theory, however, as they currently exist, they are far to costly and need to be reformed.

Cue the graph

Current Law

Cost of Medicare and Medicaid

Added two amendments to the Social Security Act of 1935

Medicare and Medicaid, when first enacted, cost the country a large sum of money, totaling at more than 30% of the country's entire spending.

This large number was because of the need to insure a large number of elderly and poor that were previously uninsured (this was unaccounted for in the calculation process).

The cost slowly declined over time, until the start of the 21st century, where the costs have been increasing and are currently at all time highs.

Title XVIII (Medicare)

Health Insurance for the Elderly

A) Hospital Insurance

B) Medical Insurance

C) Medicare Advantage

D) Prescription Drug Coverage

Requirements

Title XIX (Medicaid)

Health Insurance for the Poor

A state and federal run system that provided health coverage for lower-income people and those with disabilities. Each state has different requirements and is funded by both state and Federal

Medicare

Medicaid

Bibliography

One Federal standard

Each of the four parts has its own eligibility

But in general (part A), you must be 65+ and apply to one of the following:

Receive Social Security

Worked long enough to be eligible for Social Security

If Spouse is 62+ and qualifies for Social Security

Worked long enough in any type of Gov't job to qualify for Medicare.

Federal Gov't sets certain minimums and then states can expand off of those

As of 2010 (ObamaCare), minimum eligiblity is 133% of Fed. Poverty Line ($29,700 for a family of 4) FPL is updated annual

Other Federal requirements must be met besides income: residency, immigration, citizenship

http://www.ssa.gov/pgm/medicare.htm

http://www.healthcare.gov/using-insurance/low-cost-care/medicaid/#whatmed

http://www.socialsecurity.gov/disabilityresearch/research.htm

http://www.sp2.upenn.edu/america2000/wp7all.pdf

http://www.census.gov/prod/2002pubs/censr-4.pdf

http://www.ssa.gov/policy/docs/ssb/v28n9/v28n9p3.pdf

http://www.kff.org/medicaid/upload/key%20Medicare%20and%20Medicaid%20Statistics.pdf

http://rs9.loc.gov/medicare/history.htm

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