Medicare Makes A Start

Press, Volume CVI, Issue 31121, 26 July 1966, Page 16

Medicare Makes A Start

In his State of the Union message in January President Johnson told Congress and the American people that the Great Society would not be sacrificed to the mounting cost of the war in Vietnam. Mr Johnson, in resisting pressures to keep Budget spending on domestic programmes to a minimum, is being as good as his word. The social security legislation passed last year, commonly known as the Medicare Act, became operative on July 1 for persons of 65 years of age and over and for others classed as “ medically indigent,” a category which includes children as well as adults. The scheme for which Americans have waited so long had its origin 20 years ago, during President Truman’s incumbency. Pressure for its improvement, in broadened coverage and added benefits, is already making itself felt. That was to be expected, in line with experience elsewhere, notably in New Zealand. In the United States Social Security started with the provision of retirement benefits for people aged 65 and over. Later, women became eligible for reduced pensions at 62, and widows for full benefits at the same age. Then the self-employed, including the fanners, came into scheme; and disability insurance was added. Medicare is confidently expected to follow much the same pattern, in a gradual extension of coverage and benefits. A major hurdle was overcome after the passage of the legislation through Congress when the American Medical Association abated its hostility—again a repetition of experience in other countries. The association represents 214,000 practitioners out of a total of approximately 300,000 qualified doctors. Before the passage of the Act the familiar argument was heard that “ socialised medicine ” would mean a lowering of standards. Liberal and progressive elements were, however, able to defeat proposals for a boycott of Medicare. The annual A.M.A. convention tn Chicago at the end of June responded to an appeal for “ adaptability,” while insisting on adherence to at least a portion of traditional doctrine. Thus, although the Act permits doctors to draw fees from a local administrative agency, the House of Delegates (the A.M.A. “parliament”) decided to recommend doctors to bill the patient direct, requiring him to pay the whole fee and then apply for his refund. In this way, it was argued, the doctor-patient relationship would be best preserved. It will be surprising, nevertheless, if that arrangement lasts—in a context of tardy payments by patients and the opportunity of quick payment through the direct channel. One or two major problems associated with the Introduction of a scheme of such magnitude are expected to resolve themselves in due course. There may be, for example, some initial overcrowding of hospitals, resulting from a demand for beds by elderly people who delayed seeking treatment until they could get the full benefit of the scheme. So far, It seems, fears of an embarrassing demand for accommodation have not materialised. The timing of the scheme’s inauguration, in the American mid-summer, the period of lightest hospital load, will no doubt help it to get under way. More serious may be the impact of racial feeling on hospital capacity, particularly in the South, where integration is bitterly opposed. Institutions that practise racial segregation are denied financial aid under Federal law. Many southern institutions are continuing to resist the admission of patients regardless of race, especially where Negro patients might be expected to share a room, or even a wing, with whites. Federal canvassing, it is said, has broken down some of this resistance; but there are still hospitals which are refusing to conform, regardless of the financial disqualification.

Another section of the Act awaiting the test of experience is that providing for Federal grants to the assis } them t 0 pay for the health care of the elderly and the indigent. It is felt that the poorer States may have special needs in this field, and thus require special compensation. The States have four fr ° m S he be ? innin g of this year, to frame their St m** admission to the Federal scheme: some have a!r S ady done so. The danger that Jt, u Can . afford ,0 be much more generous S’aFe whwS alreadv been highlighted in New York h,ch ha ? a P° rove d a law described as “so sense dkrri S i T* t 0 Start a Danic ” ™ s ’ in a s™ d, fS r ? m * na, on'’ aspect of the Medicare plan snonsoreT 3 !? tO , hasten thp demand for a Federalsponsored, all-embracing national health service