Evaluating 40 Years of Medicare and Medicaid After four decades of Medicare and Medicaid, two of the men who originally debated its implementation in 1965 join us to talk about their views on the programs.
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Evaluating 40 Years of Medicare and Medicaid

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Evaluating 40 Years of Medicare and Medicaid

Evaluating 40 Years of Medicare and Medicaid

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This is TALK OF THE NATION. I'm Neal Conan in Washington.

Tomorrow it's "Science Friday" and guest host Joe Palca will be here to talk about the space shuttle mission which is off to a tense start with news that pieces of insulating foam broke away from the fuel tank during takeoff, the same culprit that caused the Columbia disaster. The Discovery mission so far tomorrow on "Talk of the Nation/Science Friday."

Forty years ago this week, President Lyndon B. Johnson signed into law a bill to create Medicare and Medicaid. Ensuring a level of health care for the nation's poor and elderly. the two programs became the strongest legacy of Johnson's Great Society, but they were not an easy sell. In his State of the Union address in 1964, President Johnson pressed for the legislation that would create the programs a little more than a year later.

(Soundbite of 1964 State of the Union address)

President LYNDON B. JOHNSON: We must provide hospital insurance for our older citizens financed by every worker and his employer under Social Security...

(Soundbite of applause)

Pres. JOHNSON: ...to protect him in his old age in a dignified manner without cost to the Treasury against the devastating hardship of prolonged or repeated illness.

(Soundbite of applause)

CONAN: Joining us to tell us more about the creation of Medicare and Medicaid is Robert Ball, who served as commissioner of Social Security in the Johnson administration. He helped plan and helped later run Medicare. He joins us from his home in Mitchell, Maryland, and welcome to TALK OF THE NATION.

Mr. ROBERT BALL (Former Commissioner of Social Security): It's good to be here.

CONAN: Where did the idea for these programs come from?

Mr. BALL: Well, originally, everybody who was for Medicare as it developed had originally been for a national health insurance plan, covering everybody. That goes back to the Truman administration. But when we couldn't get anywhere with that, we backed up and said, `Well, what group could we cover? What could we get?' And the elderly were selected, really, because they were a group that was politically easy to get--or easier to get, I should say.

CONAN: And there was the precedent of Social Security, of course.

Mr. BALL: Yes. The slogan, actually, was `Medicare through Social Security,' and that made it--that helped make it a popular program. But it--private insurance just couldn't cover the elderly for health care. The elderly used more than twice as much hospital insurance and had only half the incomes. So they were priced right out of the market. And since most were retired, they didn't get coverage under employer--the plans that employer has for their own workers. So this was a fall-back position. And I must say that it has been all I ever expected it to be and more. It's just been a very, very successful program. It's partly, I think, responsible for extending the lives of people over 65, but, even more important, is to make those lives quality lives. It's been a huge success in paying for the kinds of care that people couldn't have afforded without it. The cataract operations, artificial hips, hip replacements, and one thing after another that made it possible for the longer lives of the elderly to be fruitful, useful and more satisfying lives.

CONAN: Once the programs were passed by Congress and signed by President Johnson, you were involved with running Medicare as part of the job as commissioner of Social Security. What issues did you run into in putting Medicare into place?

Mr. BALL: Well, it was a fantastically massive job. The--Part B of Medicare, the coverage of doctors, is a voluntary plan. We had to try to reach every elderly person in the United States, like 19 million elderly people, and get an informed reaction from them. They had to file a claim if they were for it, and the way we set it up, they had to turn it down if they didn't want it. So that we sent punch card applications all over the country. We followed up three different times. We had groups interviewing them. And one of the most remarkable things about this job, not just beca--getting in touch with all the elderly, had to prepare the hospitals, and explain to them what conditions they had to meet, all the doctors had to be talked with about their responsibilities, and many, many things like that, setting policy. We had to expand to about 8,000 new employees all in a very short time, set up 100 new offices.

All these things, the most remarkable thing, in my career, really, was the cooperation that we got everywhere. Other government agencies all put--pitched in to make this work. It ran from things like the US Postal Service truck having on the side of the truck that `Remember the deadline to sign up is March 31st.' We had the Forest Service looking for hermits in the woods, even. We had everybody helping. All the welfare agencies in the country looked through their rolls for people over 65. All the nursing homes, the hospitals, and both private and the public agencies just were fully cooperative. No one was looking to steal credit, no one was looking for anything but to make a success.

CONAN: Robert Ball, we appreciate your time today. Thanks very much for joining us. Robert Ball worked under President Lyndon Johnson to implement Medicare and he joined us today by phone from his office in Mitchellville in Maryland.

Joining us now on the phone is one of Medicare and Medicaid's chief opponents in the 1960s. Edward Annis fought against the socialized health-care programs as president of the American Medical Association and he's with us now from his home in the mountains of northeastern Alabama.

Good of you to be with us on TALK OF THE NATION.

Mr. EDWARD ANNIS (Former President, American Medical Association): Thank you; it's a pleasure.

CONAN: Now you vehemently opposed Medicare and Medicaid through both the Kennedy and the Johnson administrations. Tell us why.

Mr. ANNIS: Well, the American Medical Association, and I spoke for most of the doctors of this country, believed that anybody in this nation who needs medical care should have it when they need it as long as they need it, whether they can pay for it or not. We opposed the program that would put a tax on young workers of America to pay for everybody just because they had a birthday, millionaires as well as paupers. We indicated that many young people, raising a family, when they have an accident or an illness, they often would need help because of inadequate income.

And so our whole feeling was that the programs that should have been implemented and should have been carried on was one that started and operated under President Kennedy. It had been signed in law by President Eisenhower as one of his last things before he left office. That was the Kerr-Mills bill.

The Kerr-Mills bill was designed to help any elderly that were in need of income because of illness or accident. They didn't have to sell a house, they didn't have to sell their car. If they merely had inadequate income, it was working, and working well, and I reported it for the Ways and Means Committee in Washington on November 21st on the great progress of the Kerr-Mills bill to help the elderly who really needed it, but, unfortunately, that was the day before the assassination of President Kennedy, who had not opposed our presentation before him when I met with him in the Oval Office.

CONAN: Well, you just heard Robert Ball say that Medicare has fulfilled his fondest wishes for it 40 years later. Have you changed your mind at all? What do you think?

Mr. ANNIS: No, my position is that today Medicare is a--being controlled and run and doctors are being dictated to by non-medical people. Managed care, for example, has made multimillionaires. Each year they make more money. And they're ripping off hundreds of millions of dollars that should go for health care. Now these are people who are limiting doctors in the time they can spend with patients, limiting doctors to 15 minutes, for example, in my area. For visiting a family physician, they want to limit 15 minutes to a visit. No doctor can practice good medicine that way. And it's the limitations from non-medical people that jeopardize not only Medicare but the general health of the American people.

CONAN: In retrospect, Robert Ball was also mentioning this was a fall-back position, that, really, the idea that they'd hoped to get through was a national health-care plan. A lot of people might say they regret they didn't get that done back in the Truman and, later, the Kennedy administrations, or the Johnson administration.

Mr. ANNIS: Well, having visited the so-called universal health-care system in both Canada and in England, I can tell you that in England they always left it open for private patients. Patients could still go to their own doctor instead of a national health service. In Canada, however, no one can go to anyone except those that are dictated to by government. They limit the amount of money every quarter to the various provinces. And as a result of that, millions of Canadians have crossed the border into Michigan, into Detroit, where I was born and raised, to get health care that are denied them because of long waits under the system. What we opposed on that universal system--because wherever it has been tried, it is has led to less than quality medical care.

CONAN: Edward Annis, thank you for your time today. We appreciate it.

Mr. ANNIS: Thank you.

CONAN: Edward Annis is former president of the American Medical Association.

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