Celebrating a birth, anticipating a rebirth


Happy 54th birthday, Medicare! You increase our life expectancy and quality of life. You’re our most trusted health care program.

We want to extend the gift of life you have given us down through the generations — for our children and grandchildren — now.

President Lyndon B. Johnson signed you into law on July 30, 1965. Millions of elderly Americans were dying, unseen by doctors, either unable to afford health insurance, or denied it because of pre-existing conditions.

To get you passed, Johnson compromised, guaranteeing for-profit insurers a continued role in Medicare and in the federal-state partnership of Medicaid, created at the same time. Pharmaceutical companies also got a win: a drug plan for seniors got scrapped.

Within 11 months (all records kept on paper and transported to the U.S. Postal Service), 19 million elderly Americans got Medicare cards, starting with Harry Truman, on July 1, 1966.

A federal agency, with only a handful of staff, was tasked with certifying full integration across more than 1,700 hospitals. That agency’s director and volunteers criss-crossed the nation to do inspections for compliance with civil rights laws. Their courage in facing danger — and hospital boards unwilling to risk windfall federal payments — desegregated American hospitals in less than six months.


Racial disparities — health justice

Today, hospitals and physicians get paid based on the income of their patients. Patients who can afford insurance and out-of-pocket costs are disproportionately served by New York “academic medical centers” — teaching hospitals which attract federal funds, and over $6 billion per year from Medicare. Our poorest and sickest neighbors, those eligible for Medicaid and disability payments, are served by rotations of medical students in public hospitals and clinics.

“Separate and not equal” health care disparities remain. Residents in Fordham, Mott Haven and the South Bronx have, for years, had the worst health in the state, rated 62 out of 62 New York counties in health care outcomes. The mortality rate for mothers and infants in the Bronx area known as “asthma alley” is the highest in the nation.

Data demonstrates our income-segregated system creates de facto racial segregation. In New York City, more than 80 percent of patients on Medicaid identify as black or Latino. Medical students who work at such clinics recognize Medicaid patients by the color of their skin, and Medicare/Medicaid dual-eligibles by the color of their hair.


Bad fixes in Medicare

In 2003, Congress “modernized” Medicare, creating a Part D prescription benefit and a Part C Advantage option. The “reform” proved to be disappointing.

Despite Part D, Medicare patients often can’t get the prescriptions they need, or are offered generics when the brand name would be more suitable. Doctors spend hours appealing. Worse, insurers change Part D formularies constantly: You choose a plan in December that covers your medications, the insurer stops covering your drugs in January, and you pay full price until October.

Worse, Congress prohibited Medicare from negotiating volume discounts for medications.

The Veterans Administration, covering 9 million veterans, pays 40 percent less than Medicare, which buys for 41 million seniors. By negotiating discounts, Medicare could provide essential medications to all seniors — without co-pays or doughnut holes — and save billions of dollars.

Another 2003 “Medicare modernization” is a wolf in sheep’s clothing, harming both Medicare patients and taxpayers. Medicare Advantage plans are great — when you’re healthy.

The wolf appears when you get sick. Weeks ago, a close friend learned on the day of his scheduled cancer surgery that his surgeon was “out of plan.” Initially fearing cancer, he began fearing bankruptcy. Luckily, appeals succeeded. Time wasted.

Traditional Medicare (with gap insurance) gives you choice of hospital and physicians — and no fears about paying.


Fraud control: Multi-payer upcharging

Recent headlines described Medicare Advantage plans overbilling Medicare by $30 billion since 2016. The for-profit insurers falsified patient “risk scores,” reporting patients as more seriously ill than they actually were to justify higher billing — likely since 2007.

Medicare has built an “audit tool” to identify such fraud, but insurance companies want Congress to prevent its use.

Let’s improve Medicare — and offer it womb to tomb.

Assessed as financially sound by the Rand Corp., the New York Health Act would provide every New York resident with better health care, covering all medically necessary services, including medical, hospitalization, mental health, substance abuse treatment, reproductive care, vision, dental, hearing and prescriptions.

One comprehensive plan. No networks. You choose your doctors.

Eliminating much of the 30 percent waste of the current system and allowing price negotiations with Big Pharma, New York Health will ensure 95 percent of New Yorkers pay less for better health care.

For seniors and those with disabilities, New York Health provides long-term home care. You can age in place, needed health care aid coming to you.

Let New York show our nation how we can save money, and save lives.


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Barbara Estrin,