[Congressional Record Volume 161, Number 2 (Wednesday, January 7, 2015)]
[Senate]
[Pages S51-S53]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     MEDICARE/MEDICAID ANNIVERSARY

  Mr. WYDEN. Mr. President, I rise to highlight a Presidential message 
that was delivered to the Congress 50 years ago today. But before I go 
into the importance of Medicare and Medicaid--facts that I think all my 
colleagues and I can agree to--I would like to take a brief look back 
at where America has been and recall what life was like for so many of 
those who were poor, disabled, vulnerable, and uninsured or unlucky 
before these programs, which today are a lifeline, Medicare and 
Medicaid, were in place.
  Those were the days of the ``poor farm'' and the ``almshouse.'' These 
were the places where the poor and uninsured would go for care, very 
often on the outskirts of town--out of sight, out of mind. It was not a 
happy choice, and more often than not for seniors and the poor it was 
the only choice.
  These were places that provided care and was often very basic and 
very often it carried a stigma. The accommodations were sparse at best. 
In return for health care and housing, residents were expected to work 
on an adjoining farm or do housework or other chores to offset the 
costs of their stay. This was the primary option for someone whose 
extended family could not offer care--or didn't want to offer care. 
This was not thousands of miles away from the shores of our country, it 
was right here in the United States. Not very many Americans remember 
those days. In fact, I think it is fair to say hardly anybody under 50 
remembers those days.
  President Johnson submitted his message to the Congress 50 years ago 
today, and fewer than half of America's older people even had any 
health insurance. In that era, it was not uncommon for older people who 
got an illness to be treated like second-class citizens, and many older 
people without family to care for them and no health care coverage 
ended up destitute and would often end up on our streets.
  It was a time no one wants to revisit. It is a time sociologists 
described as another America--where 40 to 50 million Americans were 
poor and lacked adequate medical care and were socially invisible to a 
majority of the population.
  I bring this up because I wish to spend a few minutes this evening 
talking about how far America has come. I want to make sure that we in 
the Congress--as we look to this anniversary of these critical 
programs, Medicare and Medicaid, and the vivid difference they made in 
the daily lives of Americans, we should all spend just a few minutes 
talking about the health care advances we have seen over the years.
  Here are a couple of facts: Today with rock-solid essential medical 
services, 54 million Americans--or virtually every senior and those 
with disabilities--now has access to what we call--and I remember this 
from my days as director of the Gray Panthers--the Medicare guarantee. 
It is a guarantee of secure Medicare benefits for our old people.
  Medicaid has made a critical difference for 68 million of the 
Nation's most vulnerable, including more than 32 million kids, 6 
million seniors, and 10 million individuals with disabilities. Because 
Medicare and Medicaid made health care possible for millions of people, 
they have also been the catalyst for innovation in treatment that 
benefits people of all ages. I emphasize that fact because it is often 
not appreciated that Medicare, as the flagship Federal health care 
program, often is the spark, the catalyst for innovations that get 
copied in the private sector.
  For example, in the first 30 years of Medicare alone, the Medicare 
Program helped to reduce deaths from heart disease by one-third for 
people over age 65. By providing coverage and access for millions, 
these programs became catalysts for change in how medicine is practiced 
and paid for Americans across the age spectrum and helped us to find 
the root causes of disease and perfecting better therapies to treat. As 
time has marched on, these programs evolved and improved and the rest 
of the health care system followed.
  In 1967, Early and Periodic Screening, Diagnostic, and Treatment 
programs, comprehensive services for all Medicaid youngsters under age 
21, was created, and that has helped to improve our country's health, 
starting with our children. In 1981, home and community-based waivers 
were established so States could provide services in a community 
setting, allowing individuals to remain in their home for as long as 
possible.
  Every State uses this option to facilitate better care and services 
to the Medicaid population, and I think it is fair to say that every 
single senior--and this is something I heard again and again and again 
in the those Gray Panthers days--would say: Why can't we

[[Page S52]]

have the option to have good, quality, affordable care at home because 
it will also save money compared to the alternative, which is 
institutional care.
  In 1983, Medicare took one of many big leaps away from fee-for-
service with the advent of a new reimbursement system for hospitals. It 
was called prospective payment--a system that pays hospitals based on a 
patient's illness and how serious it is and not solely on how much it 
costs to treat them. This was a radical change at the time. Today it is 
commonplace and acceptable.
  In 2003, the prescription drug coverage benefit was added to 
Medicare, providing access to necessary medications to those most 
likely to need them. As a result of greater access to prescription 
drugs, senior health has dramatically improved.
  In 2010, as a result of health care reform, preventive services 
became free to patients, prescription drugs became cheaper for 
beneficiaries who fell into what was known as the doughnut hole, and 
again Medicare moved further away from fee-for-service, volume-driven 
care and on to paying for quality and value. Not only was that good for 
seniors, it was good for taxpayers because it helped to extend the life 
of the Medicare trust fund.
  Finally, in 2012, the Centers for Medicare and Medicaid began 
releasing for the public to use actual claims data. Access to this 
information, in my view, is a key element of the challenge with respect 
to understanding the costs of care, the variations and the way medicine 
is practiced across the country. Clearly, access to Medicare claims 
data is part of the path to improving quality and holding down the 
costs of health care in our country.
  These examples are easy to forget--the most recent ones--because now 
they are commonplace, but that makes them no less remarkable.
  I will close with one last point that I hope will be part of what 
guides the work of the Senate in this session.
  I see the distinguished Senator from Illinois, Mr. Durbin. He is to 
be joined by the majority leader, Senator McConnell, shortly.
  I will just close my remarks with respect to these critical programs 
by pointing out--and I hope it will be remembered frequently as big 
issues are tackled in this Congress--Medicare and Medicaid were 
bipartisan efforts, and the enactment of these programs shows that the 
Congress can craft bipartisan solutions to complex and politically 
difficult problems. That is what happened in 1965 when the Senate 
passed a legislation creating Medicare and Medicaid by a 68-to-32 vote 
after the House approved it 3 months earlier on a 313-to-115 vote.
  As this Congress gets underway, and as the leaders come to the floor 
to discuss a critical aspect of how we move ahead, I hope all of us 
take a page from that particular playbook. Let us recognize that with 
Medicare and Medicaid there was an opportunity to come together to 
tackle a big issue, and my hope is that this Congress will not use 
partisan tactics when the solutions have to be bipartisan, and that is 
the lesson.
  Despite sharp differences and partisanship, the Congress of the days 
I have been speaking of was able to rise above the culture and those 
challenges to find agreement and make our country a better place.
  As this new Congress begins, I hope we can use that 50-year-old 
spirit to strengthen, protect, and improve Medicare and Medicaid to 
keep that guarantee strong, ensure health care to those who need it 
most, and protect a program that has been a lifeline to millions of 
Americans.
  With that, I yield the floor.
  The PRESIDING OFFICER. The acting minority leader.
  Mr. DURBIN. Mr. President, I commend my colleague from Oregon for 
reminding us of this 50th anniversary of President Johnson's 
recommendation to Congress to create Medicare and Medicaid. Today, as 
we witness 54 million people benefitting in America from Medicare--in 
my State some 2 million--and 68 million from Medicaid--in my State 3 
million--we understand the importance of this program. Almost half the 
people who live in Illinois are covered with health insurance by 
Medicare and Medicaid. When we add in the Affordable Care Act, we have 
literally half the population of my State.

  It is a testament to the fact that when we made a commitment and 
followed through on a bipartisan basis, as the Senator from Oregon 
said, we created programs that had vibrancy and really served people 
for a long time.
  I read something the Senator from Oregon is, I am sure aware, of, 
which is that because Medicare was a complete Federal payout, it was 
implemented throughout the United States almost within a year. It took 
17 years for every State to join the Medicaid Program. It wasn't until 
1982 that the last State joined into Medicaid--Arizona--because there 
was a State contribution. Look at the experience we have now with the 
Affordable Care Act, where some States are reluctant to join in. So 
that is part of it.
  The point I wish to get to and which the Senator made so well is how 
it changed life for senior citizens and for those who were poor. It 
gave them a chance for quality health care that didn't bankrupt them in 
the process.
  Medicaid has been a dramatic success. For critics of government 
health programs and critics of Medicaid, the 2011 survey found that 70 
percent of physicians across America accept Medicaid patients. People 
would believe from some of the critics that the opposite is true. 
Seventy percent accept Medicaid patients. So it is a good program. The 
reimbursement attracts 70 percent of physicians willing to treat them.
  The last point I will make to the Senator from Oregon particularly, 
if he happens to know a good bookstore, I would suggest he consider the 
new book by Dr. Gawande entitled ``Being Mortal.'' I am virtually 
through it, and he really challenges us to look beyond health care for 
the elderly to where they are living, how they are living, and how they 
are being treated.
  So I am hoping we can rise to another level of conversation beyond 
Medicare and Medicaid, celebrating this anniversary but accepting a new 
responsibility to that generation of seniors who served America so 
well.
  I thank the Senator from Oregon for reminding us of this anniversary.
  I am proud to stand with my colleague Senator Wyden today in support 
of his resolution honoring President Johnson's commitment to creating 
the Medicare and Medicaid Programs.
  Fifty years ago today, President Lyndon Johnson sent a message to the 
Congress which he titled ``Advancing the Nation's Health.''
  In that message the Johnson quoted President Thomas Jefferson who in 
1787 wrote, ``without health there is no happiness. An attention to 
health, then, should take the place of every other object.'' Those 
words were true then, true in 1965, and true now.
  President Johnson was concerned about the health of our nation 
because of the staggering effect that no insurance and chronic disease 
had on the elderly. At that time, 80 percent of people over 65 were 
disabled or lived with a chronic disease. Unfortunately, 50 percent of 
people over 65 did not have health insurance.
  From his concern and effort came the Medicare and Medicaid programs. 
Both programs created a social safety net that has improved the lives 
of millions of Americans.
  Today more than 54 million people are enrolled in Medicare, 2 million 
in Illinois. The vast majority of Medicare enrollees are seniors. They 
receive quality, affordable, care and access to prescription drugs 
because of the President Johnson's commitment. In this new Congress, we 
should work together to ensure this highly successful program remains 
in place for future generations.
  Medicaid has been a lifeline for millions of people, especially for 
children. Sixty-eight million people are enrolled in Medicaid, 3 
million in Illinois. And thanks to the Affordable Care Act, 600,000 
became newly eligible for the program last year. Medicaid makes it 
possible for more than half of the babies born in Illinois to be 
delivered with medical care. Some argue that Medicaid isn't working 
because physicians refuse to see people in the program. But the data 
says that isn't true. 2011 data shows that 70 percent of office-based 
physicians nationwide were willing to see new Medicaid patients. I call 
that a success.
  As we remember President Johnson's tireless effort today, we should 
also keep in mind our commitment to these vital programs and work 
together to strengthen them.

[[Page S53]]

  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I rise to speak about the 50th anniversary 
of Medicare as well. I commend the remarks of both the senior Senator 
from Oregon and the senior Senator from Illinois about this 50-year 
anniversary since President Lyndon Johnson first sent his message to 
Congress that would later become both the Medicare and Medicaid 
Programs. As was referred to earlier, there are 100 million Americans 
benefiting, including over 4.8 million in my home State of 
Pennsylvania, when we consider both programs together.
  When President Johnson sent this message, he said:

       Our first concern must be to assure that the advance of 
     medical knowledge leaves none behind. We can--and we must--
     strive now to assure the availability of and accessibility to 
     the best health care for all Americans, regardless of age or 
     geography or economic status.

  So said President Johnson all those years ago, and how prescient he 
was and how knowledgeable he was as well to be thinking about the 
future and to be considering advances in technology and holding all of 
us to the highest possible standard when it came to health care for 
older Americans or health care for the poor and for children.
  We know that in the ensuing 50 years we have strived to make that 
vision of President Johnson a reality, first, of course, with Medicare 
and Medicaid; and then more recently--``recently'' meaning the last 20 
years or so--with the Children's Health Insurance Program, known by the 
acronym CHIP; and then followed by, a number of years after that, the 
Affordable Care Act, which included an expansion of the Medicaid 
Program, providing coverage to millions more Americans.
  We know that when Medicaid was created in 1965, the U.S. Government 
put forth a promise to ensure that the most vulnerable members of 
society would have access to health care. Whether it is our children or 
whether it is frail, elderly members of our family living in nursing 
homes or individuals with disabilities, Medicaid ensures they have 
access to health care. So we have made great strides.
  Let me quote again from President Johnson:

       Poor families increasingly are forced to turn to 
     overcrowded hospital emergency rooms and to overburdened city 
     clinics as their only resource to meet their routine health 
     care needs.

  Again, President Johnson was way ahead of his time in dealing with 
what was then a problem and still remains a problem but less so a 
problem because of Medicaid.
  This important lifeline--Medicaid--to health care, having been 
created 50 years ago, was strengthened in 2010 and helps ensure that 
millions of Americans have access to quality, comprehensive health 
care.
  We must continue to make sure that we guarantee Medicaid remains 
strong and provides such needed care to those in our society who often 
get overlooked. We must never forget that Medicaid is the program that 
many middle-class families and lower income older citizens who are on 
assistance and people with disabilities turn to when they need extended 
nursing home care, sometimes referred to as long-term care. So when it 
comes to long-term care for poorer families as well as long-term care 
for middle-class families, often millions of Americans are turning and 
have turned for their long-term care to Medicaid, and we should 
remember that.
  As we celebrate this 50th anniversary, let's always ensure that both 
Medicare and Medicaid remain strong programs that so many Americans can 
turn to. We must do our best to be true to Lyndon Johnson's vision 
``that the advance of medical knowledge leaves none behind.'' It is a 
very important anniversary, and it is a good reminder about our 
obligations in the Senate to protect both Medicare and Medicaid.
  With that, I yield the floor.
  The PRESIDING OFFICER. The majority leader.

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