Happy Birthday Medicare & Medicaid!

by Michael Sean Winters

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Today, in addition to being the Feast of St. Ignatius of Loyola (happy feast to all my Jesuit friends!), is the 50th anniversary of the signing into law of two landmark social programs, Medicare and Medicaid. Both were – and are – part of the “war on poverty,” much maligned by the right, but one of the notable, if incomplete, achievements of modern American politics.

The adoption of Medicare and Medicaid was a political response to a real problem, the origins of which were entirely happy. People were able to live longer and healthier lives because of advances in medical knowledge and technology. But, many people, especially the elderly and the poor, could not afford to access these new medical advances that were now available. Either the government was going to leave the prospect of better health care to the vagaries of the market entirely, or it was going to step in and make the determination that this prospect should be widely available to everyone. Thankfully, they chose the latter course – and one wishes they had made that choice for everyone, not just for the poor and the elderly.

This was politics in the best sense of the word, the polis, acting through its elected representatives, to shape the socio-economic culture in ways that advanced the common good. We don’t hear much about the common good in our political life these days. Few are the politicians who call the American people to a sense of obligation. But, Medicare and Medicaid did so call Americans to concretize the common good in this instance. The adoption of Medicare was also an example of inter-generational solidarity: Younger, working Americans, would pay into a system to care for our elders, as we had decided to do in 1934 when we created Social Security. In Laudato Si’, Pope Francis calls us to extend this commitment to the common good and, specifically, to inter-generational solidarity, as we craft our environmental policies, so that “our common home” will be preserved and healthy for future generations.

Medicaid, which assists the poor, has always been the less politically attractive step-sister of Medicare. The elderly vote in high numbers than the poor, so it has always been easier for budget cutters to go after Medicaid. In recent years, Republican ideologues in state government have declined to extend Medicaid under the provisions of the Affordable Care Act because they did not wanted to be tainted by any association with Obamacare. Shame on them. Ohio Governor John Kasich will not be getting my vote for president next year because of his stances on other issues, but hats off to him for staring down the ideologues in his own party in order to extend Medicaid in his state. As he said at the time:

I had a conversation with one of the members of the legislature the other day. I said, “I respect the fact that you believe in small government. I do, too. I also know that you’re a person of faith.”

“Now, when you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor. You better have a good answer.”

Medicaid is not perfect. But, it is “a good answer” to the problem of poverty in America and I am sure Gov. Kasich is right that St. peter will consider it a good answer when we are all called upon to give an answer.

At the time President Lyndon Baines Johnson signed Medicare and Medicaid into law, the programs were denounced as socialism. Lawrence O’Donnell, on his show last night, accepted the charge and embraced it. This is nonsense. There are many instances of social solidarity that do not flow from the materialistic premises of socialism, nor employ its analysis of social and economic forces. Lyndon Johnson was many things, but a socialist was not among them.

Today, ideologues of libertarianism continue to see every exercise of social solidarity as one more step down the road to serfdom. This, too, is nonsense. In real life, Medicare and Medicaid liberated millions of Americans from crushing poverty or from cruel choices: Do I pay the rent or do I get to the doctor? Do I pay for my kids’ food or for their physical? In a country as rich as ours, in a world as rich as ours, no human person should have to make such a cruel choice.

The next time you hear an economist or a politician fret about the exploding costs of Medicare and Medicaid and other entitlement programs, you should listen to their economic prognostications to be sure. These programs are costing more and more as inflation in the health care industry continues to outpace other sectors of the economy. But, those who fret about this tend to lack a robust moral imagination. These programs must be paid for, they must not be curtailed, or privatized, or cut back. Marginal tax rates at the time LBJ signed Medicare and Medicaid into law were far higher than they are today, and the economy was humming along just fine. This foolishness about increased taxation robbing the economy of its strength only makes sense because of the off-shore tax havens that exist, and because investors have come to believe that they are entitled to high rates of return. The entitlement of investors to a high rate of return does not trump the entitlement of all human persons to adequate, life-sustaining health care. It is the job of politics, of government, to enact programs that exemplify and make real this moral truth. Happy Birthday Medicare and Medicaid.  

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