57 years of Medicare & Medicaid

If you like anniversaries, here is one to remember. Saturday, July 30, is the 57th anniversary of LBJ going to the Truman Library to sign the Social Security Amendments of 1965. They were Title 18 and 19. The legislation has been described as two compromises and an afterthought.

Part A was a compromise with American Hospital Association. Part B was a compromise with the American Medical Association. Medicaid was an afterthought, added at the end of the debate.

It was going to be a really small program (were they wrong). At the signing, LBJ spoke about Medicare but not a word about Medicaid. Harry got Medicare card #1 and Bess #2. Their Part B premium was $3 per month. Mine is higher.

Prescription drugs were considered for Medicare, in 1965, but did not make the legislation. Prescription drugs were an option for states and, eventually, all added them to the benefits package for their Medicaid programs.

I have a copy of a letter from Joe Califano (Special Assistant to the President) to John Gardner, Secretary of HEW dated August 21, 1967. It is labeled as ADMINISTRATIVE CONFIDENTIAL and EYES ONLY. I got it from the archives at the LBJ Library. Joe wrote:

“Review the report of the Task Force on Prescription Drugs and make recommendations relating to the inclusion of prescription drugs in Medicare and on ways to reduce the cost of drugs.”

W signed MPDIMA in 2003, adding prescription drugs to Medicare. That did not solve the problem and the Senate is debating the subject this week. After 57 years you would think the Congress would get it right. Not likely.

Salud y Buen Suerte!

Leonard Kirschner MD,MPH

Colonel USAF (Retired)