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Ron W.
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  • Medicare/medicaid Anniversary

    by Senator Ron Wyden

    Posted on 2015-01-07

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    WYDEN. Mr. President, I rise to highlight a Presidential message that was delivered to the Congress 50 years ago today. But before I go into the importance of Medicare and Medicaid--facts that I think all my colleagues and I can agree to--I would like to take a brief look back at where America has been and recall what life was like for so many of those who were poor, disabled, vulnerable, and uninsured or unlucky before these programs, which today are a lifeline, Medicare and Medicaid, were in place.



    Those were the days of the ``poor farm'' and the ``almshouse.'' These were the places where the poor and uninsured would go for care, very often on the outskirts of town--out of sight, out of mind. It was not a happy choice, and more often than not for seniors and the poor it was the only choice.

    These were places that provided care and was often very basic and very often it carried a stigma. The accommodations were sparse at best. In return for health care and housing, residents were expected to work on an adjoining farm or do housework or other chores to offset the costs of their stay. This was the primary option for someone whose extended family could not offer care--or didn't want to offer care. This was not thousands of miles away from the shores of our country, it was right here in the United States. Not very many Americans remember those days. In fact, I think it is fair to say hardly anybody under 50 remembers those days.

    President Johnson submitted his message to the Congress 50 years ago today, and fewer than half of America's older people even had any health insurance. In that era, it was not uncommon for older people who got an illness to be treated like second-class citizens, and many older people without family to care for them and no health care coverage ended up destitute and would often end up on our streets.

    It was a time no one wants to revisit. It is a time sociologists described as another America--where 40 to 50 million Americans were poor and lacked adequate medical care and were socially invisible to a majority of the population.

    I bring this up because I wish to spend a few minutes this evening talking about how far America has come. I want to make sure that we in the Congress--as we look to this anniversary of these critical programs, Medicare and Medicaid, and the vivid difference they made in the daily lives of Americans, we should all spend just a few minutes talking about the health care advances we have seen over the years.

    Here are a couple of facts: Today with rock-solid essential medical services, 54 million Americans--or virtually every senior and those with disabilities--now has access to what we call--and I remember this from my days as director of the Gray Panthers--the Medicare guarantee. It is a guarantee of secure Medicare benefits for our old people.

    Medicaid has made a critical difference for 68 million of the Nation's most vulnerable, including more than 32 million kids, 6 million seniors, and 10 million individuals with disabilities. Because Medicare and Medicaid made health care possible for millions of people, they have also been the catalyst for innovation in treatment that benefits people of all ages. I emphasize that fact because it is often not appreciated that Medicare, as the flagship Federal health care program, often is the spark, the catalyst for innovations that get copied in the private sector.

    For example, in the first 30 years of Medicare alone, the Medicare Program helped to reduce deaths from heart disease by one-third for people over age 65. By providing coverage and access for millions, these programs became catalysts for change in how medicine is practiced and paid for Americans across the age spectrum and helped us to find the root causes of disease and perfecting better therapies to treat. As time has marched on, these programs evolved and improved and the rest of the health care system followed.

    In 1967, Early and Periodic Screening, Diagnostic, and Treatment programs, comprehensive services for all Medicaid youngsters under age 21, was created, and that has helped to improve our country's health, starting with our children. In 1981, home and community-based waivers were established so States could provide services in a community setting, allowing individuals to remain in their home for as long as possible.

    Every State uses this option to facilitate better care and services to the Medicaid population, and I think it is fair to say that every single senior--and this is something I heard again and again and again in the those Gray Panthers days--would say: Why can't we [[Page S52]] have the option to have good, quality, affordable care at home because it will also save money compared to the alternative, which is institutional care.

    In 1983, Medicare took one of many big leaps away from fee-for- service with the advent of a new reimbursement system for hospitals. It was called prospective payment--a system that pays hospitals based on a patient's illness and how serious it is and not solely on how much it costs to treat them. This was a radical change at the time. Today it is commonplace and acceptable.

    In 2003, the prescription drug coverage benefit was added to Medicare, providing access to necessary medications to those most likely to need them. As a result of greater access to prescription drugs, senior health has dramatically improved.

    In 2010, as a result of health care reform, preventive services became free to patients, prescription drugs became cheaper for beneficiaries who fell into what was known as the doughnut hole, and again Medicare moved further away from fee-for-service, volume-driven care and on to paying for quality and value. Not only was that good for seniors, it was good for taxpayers because it helped to extend the life of the Medicare trust fund.

    Finally, in 2012, the Centers for Medicare and Medicaid began releasing for the public to use actual claims data. Access to this information, in my view, is a key element of the challenge with respect to understanding the costs of care, the variations and the way medicine is practiced across the country. Clearly, access to Medicare claims data is part of the path to improving quality and holding down the costs of health care in our country.

    These examples are easy to forget--the most recent ones--because now they are commonplace, but that makes them no less remarkable.

    I will close with one last point that I hope will be part of what guides the work of the Senate in this session.

    I see the distinguished Senator from Illinois, Mr. Durbin. He is to be joined by the majority leader, Senator McConnell, shortly.

    I will just close my remarks with respect to these critical programs by pointing out--and I hope it will be remembered frequently as big issues are tackled in this Congress--Medicare and Medicaid were bipartisan efforts, and the enactment of these programs shows that the Congress can craft bipartisan solutions to complex and politically difficult problems. That is what happened in 1965 when the Senate passed a legislation creating Medicare and Medicaid by a 68-to-32 vote after the House approved it 3 months earlier on a 313-to-115 vote.

    As this Congress gets underway, and as the leaders come to the floor to discuss a critical aspect of how we move ahead, I hope all of us take a page from that particular playbook. Let us recognize that with Medicare and Medicaid there was an opportunity to come together to tackle a big issue, and my hope is that this Congress will not use partisan tactics when the solutions have to be bipartisan, and that is the lesson.

    Despite sharp differences and partisanship, the Congress of the days I have been speaking of was able to rise above the culture and those challenges to find agreement and make our country a better place.

    As this new Congress begins, I hope we can use that 50-year-old spirit to strengthen, protect, and improve Medicare and Medicaid to keep that guarantee strong, ensure health care to those who need it most, and protect a program that has been a lifeline to millions of Americans.

    With that, I yield the floor.

    The PRESIDING OFFICER. The acting minority leader.

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