July 30, 1965: President Lyndon Baines Johnson signs Medicare into law. Also seated is President Harry Truman, recipient of the first Medicare card.

 
Medicare turns 44 years old today. It’s in good health.

The program remains efficient — Medicare’s administrative costs are about three percent, much less than that of employer-based private insurance (five to ten percent of premiums for large companies, 25 to 27 percent for small ones) or individual private insurance (40 percent of premiums). Medicare, of course, doesn’t devote administrative dollars to denying coverage or claims on a case-by-case basis. Also, unlike the private insurance industry, it doesn’t seek out profits.

And Medicare remains popular, so much so that weakening it is a legislative third rail that health care reformers are finding they have to avoid at any cost. That’s true even if some of its biggest fans are confused about how it works:

At a recent town-hall meeting in suburban Simpsonville, a man stood up and told  Rep. Robert Inglis (R-S.C.) to “keep your government hands off my Medicare.”

“I had to politely explain that, ‘Actually, sir, your health care is being provided by the government,'” Inglis recalled. “But he wasn’t having any of it.”

Actually, Inglis doesn’t have it right either: Medicare is national government financing for health care, not government provision of health care. Medicare-financed health care is provided by private doctors, clinics and hospitals. Medicare is an example of what journalist T. R. Reid calls the National Health Insurance model, like the health care systems of Canada, Taiwan and South Korea. Canada, in fact, calls its system “Medicare” too.

Here in the United States, Medicare is a model for treating health care as a public good rather than a commodity: a system in which benefits and contributions are fairly shared, one that works for everybody, rather than one in which health care is something to be bought and sold — and tough luck for those who can’t afford it. Medicare is like a fire department that protects everyone’s house — like the fire departments we actually have in this country. The private parts of our health care financing system are like fire departments that only protect the houses of people who can afford to pay.

The current health care reform process offers an opportunity to move towards establishing health care in this country as a public good and a human right. A key step is establishing a new Medicare-like public health care plan that guarantees access for all, something we’re calling on Senate leaders to do.

The Senate is the key battleground now. Of all the Congressional committees with health care jurisdiction, the Senate Finance Committee is least hospitable to a public plan, and has yet to pass a bill. The eventual Finance Committee bill faces a bruising reconciliation with the Health, Education, Labor and Pensions Committee bill that’s already passed. And there will be a further fight when the full Senate debates and votes on the merged bill. In honor of Medicare’s birthday, tell Senators Baucus (chair of the Finance Committee), Dodd (HELP vice chair, running the committee with chair Ted Kennedy ill) and Reid (majority leader) to ensure the final Senate bill provides a Medicare-like public health care plan for all.

Over the looming August recess — the Senate is scheduled to adjourn next Friday, August 7 — everyone with a vested interest in keeping health care a commodity will be working as hard as possible to close the window on a new Medicare-like public plan. Which makes the delaying tactics we’re seeing on the Hill that much more galling. Health care legislation doesn’t have to take this long. In 1965, after all, in the first year of Johnson’s second term, Congress passed Medicare in late spring, in time for the president to sign it into law on July 30 — 44 years ago today.