LBJ signs Medicare into law, with Harry Truman looking on.
Medicare was signed into law 50 years ago to day, and
contra St. Ronnie hasn't killed free enterprise yet. Instead, it's made life infinitely more secure for millions of disabled and older Americans. It's also
going strong, in large part thanks to many of the reforms put in place through Obamacare. Not that the program's massive success and stability is going to stop Republicans from attacking it, still.
Granted, they're a lot smarter about it these days than Reagan was 50 years ago. No one is talking about looming socialism and the end to freedom as we know it because of Medicare, but they're just as committed to ending it as ever. Witness Jeb! Bush flatly saying the program has to be phased out. He's not going to say because fascism or socialism, but the basic impetus is the same. It's all about two things: funneling money that is now public into the private sector; and as Jonathon Cohn explains, to change its guarantee of health care to the disabled and elderly.
Medicare, as it exists today, is what the policy wonks call a "defined benefit" program. It entitles seniors to a specific set of protections and level of financial security. (The federal government regulates Medicare Advantage plans, to make sure those plans live up to these standards.) The alternative that many conservatives would prefer is what's called a “defined contribution” scheme. The government would provide seniors with a sum of money, usually according to some pre-determined formula, and then let seniors shop around for coverage. The best-known proponent of such schemes is probably Paul Ryan, the House Ways and Means Chairman who has made such proposals cornerstones of his controversial Republican budgets for the last few years.
Sometimes conservatives defending these proposals insist that they will leave seniors no worse off—that a combination of regulation and aggressive shopping by seniors will discipline insurers into providing adequate coverage at prices that seniors can afford. These arguments, though plausible in theory, are difficult to take seriously in the current political environment. For one thing, conservatives have been furious over similar insurance regulations in the Affordable Care Act. In addition, proponents of Medicare voucher schemes frequently envision huge savings from their proposals—the kind that seem unrealistic in a world where Medicare is providing the kind of protection it does now.
Turning Medicare into a voucher program is basically ending it. Republicans know that, the American people know that, which is why the proposal is
hugely unpopular. Yet the narrative that something has to be done to "save" Medicare—and future generations—from its ballooning costs still holds far too much sway among the Very Serious People, including some Democrats who want to be considered Very Serious.
Lots of pressure from true progressives, though, has started to turn that narrative around, particularly for Social Security. We've gone on offense on Social Security, as more and more elected Democrats call not just for rear-guard action to protect the program, but actually expanding it. We need to turn that momentum to Medicare. What does that mean? It means let's build on Medicare's success and start the fight to expand it. Medicare for All is what the program's creators had in mind from the beginning. It's time to start realizing that vision.