The story of Medicare and Medicaid is one in which the public sector has helped to finance the growth and development of the private sector, Wilson school professor Keith Wailoo, co-editor of the new book “Medicare and Medicaid at 50: America's Entitlement Programs in the Age of Affordable Care,” said in a panel discussion onMonday.
The panel discussed the original vision behind Medicare and Medicaid, the momentous transformation events since their initiation and how the two programs are likely to unfold in the future.
Wailoo explained that Medicare was initially designed to evade criticisms that had been built up against national healthcare.
“So the elderly were identified as a deserving part of the population, out of the workforce and unable to afford healthcare; benefits were defined very narrowly and linked to social security,” he said.
He added that the motivation for Medicaid stemmed from the federal system becoming a limiting factor; the federal government had to negotiate state by state the benefits of the program because the rubrics for benefits were not standardized.
Wailoo explained that although it was well defined what would fall under the rubric of Medicaid coverage, Medicaid ended up covering gaps that any national policy had been reluctant to cover over the decades, including HIV/AIDS in the 1980s, children’s health in the 1990s, disability and mental health.
Speaking of the challenges faced by Medicare and Medicaid, sociology professor Paul Starr, a contributor to the book, said that there were many elderly who believed that Medicare was “their” program and were not open to the idea of it being expanded to everyone.
Wilson school professor Uwe Reinhardt, another contributor to the book, also explained that financial profit amongst private health care providers was a strong barrier to repealing the program.
Wilson school professor Julian Zelizer, co-editor of the book, added that once the policies were in place, health spending per elderly person grew less rapidlyover timecompared to health spending per young person. He also spoke about doctor fee inflations, saying that what was unreasonable one year would become reasonable the next.
“Fifty years ago, no one would have said this is exactly how the system should look,” Wailoo added.
His thoughts were echoed by Starr, who said, “If we have to do it all over again, there would be some better ways to do it.”
Speaking of the way forward for Medicare and Medicaid, Starr said he believes that the outcome is not at all stable and depends very much on which political party controls Congress in 2016. He added that there will likely be a slow degrading of the whole program if individual projects are not funded enough and highly dependent on the political climate.
Moderator Heather Howard, Lecturer in Public Affairs and Director of State Health Reform Assistance Network, added that a good test case would be the new governor in Kentucky, Steve Beshear, who has said that he opposes expanding Medicaid.
“He has been saying all along that he’s opposed to the expansion of Medicaid, but will he actually repeal it?” she said.
The discussion took place in Robertson Hall at 4:30 p.m., and was sponsored by the Wilson School.
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