By Piali De
This summer marked the 50th anniversary of the passing of the Medicaid and Medicare bills. Both government programs have transformed the delivery of healthcare in this country and have worked to eliminate abject poverty and homelessness. Before Medicare, old age and poverty went hand in hand; people over the age of 65 with healthcare complications were often unable to afford private health care and were forced to either rely on family members for support or go without care.
With Medicare, we have been able to keep the elderly out of debt and provide them with longer and healthier lives. Medicaid, passed the same year, set out to provide healthcare coverage for low-income families and children, pregnant women, the elderly, and people with disabilities. Medicaid has worked to keep people off the streets by providing them with access to housing and affordable health care coverage.
We have seen great success with the Medicare and Medicaid programs in the past 50 years. The amount of poverty that existed in our country has been drastically reduced, and we have also drastically reduced homelessness caused by crippling medical bills. Today, nearly 50 million elderly depend on Medicare for health insurance coverage and Medicaid covers 70 million of our most vulnerable citizens.
Advances in medical treatments have increased life expectancy significantly and the baby boomers are on their way to retirement. This will create a heavy burden on our healthcare system. Currently, the top five percent of Medicare enrollees—comprised mostly of the elderly and disabled—account for more than half of the $440 billion in Medicaid spending. About two thirds of that spending comes from the cost of acute care.
Some of today’s acute care needs to be shifted to lower-cost care settings to improve the quality of life and to lower the cost of care. There has in fact been a recent shift in Medicare and Medicaid services from institutionalized care to long-term support and services in the community. More attention still needs to be given to improving self-care and team-based care management for people with very complex health. Services, such as Ibis, provide the structure and support needed to improve self-management and to catch potentially aggravating health issues before they require acute interventions.
When President Johnson fought for the Medicare and Medicaid bills in 1965, he demanded that all of our citizens “be spared the darkness of sickness without hope.” We are still on the path to realizing Johnson’s dream. The next step is to give our most vulnerable citizens the ability to self-manage their care and to provide them with a clinical safety net that allows them to stay out of institutionalized settings and in their own communities longer.