Medicare turns 50, but some say its glory days have faded

July 30--The President's signature came with a promise.

"No longer will older Americans be denied the healing miracle of modern medicine," President Lyndon B. Johnson said in a July 30, 1965, ceremony at the Truman Library in Independence, Mo. "No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years."

Those were some of Johnson's words when he signed Medicare into law 50 years ago today. At that time, half of all Americans 65 and older had no health insurance. Hospital wards in some states were still segregated. And few people expected to live until 70.

A half century later, 55 million Americans carry a Medicare card, and more than 10 percent of those live in California. People are living longer, in part because they have better health care. And hospitals must follow federal guidelines or be penalized.

The milestone of both Medicare and its state version Medicaid will be commemorated today across the nation. In Los Angeles County, where more than 1.3 million people have Medicare, events are planned for Baldwin Hills, Pasadena and downtown Los Angeles.

That a federal health care program would be viewed with so much nostalgia among other emotions doesn't surprise David Seyan, U.S. Centers for Medicare and Medicaid Services regional administrator for California. The program was born during a decade of change, he said.

"In the '60s you had the space program, which meant you had a country that could do things," he said. "Here we are with the largest single-payer program in the world. The program is such a big piece of the health care world that it's taken on a lot of responsibility other than health care."

Medicare is the federal health insurance program for people who are 65 or older and some young people with disabilities. Its state version, Medicaid, also was signed into law on the same day. Called Medi-Cal in California, the program helps those who are low-income with medical costs. Statewide, 12 million people have Medi-Cal.

Americans pay into Medicare, which has evolved considerably, said Gerald Kominski, a health care policy professor at UCLA. But much like the Affordable Care Act, Medicare also faced challenges and criticism in its first few years, including heated debates about too much government involvement, he added.

Though the Civil Rights Act had been signed into law in 1964, hospitals in the south still had segregated wards. Medicare refused payment to hospitals unless they desegregated. Some facilities refused.

A half-century later, some states refuse federal subsidies as a result of the Affordable Care Act.

"Medicare was in a sense the vehicle for civil rights in the health care system," Kominski said.

But the program is still under criticism and attack. Republicans would like to see a voucher program to replace what they say is uncontrollable government spending, Kominski said. Still, he believes Medicare will continue and be sustained even as those in the millennial generation age.

"It has been a very popular, successful program," he said. "But I think we will have ongoing struggles and ongoing debates of the Medicare program."

Not all see it as a sustainable program, especially with the way health care in general has evolved.

"If you take a snapshot right now, patients who have Medicare are having trouble finding primary care doctors," said Dr. Samuel Fink, a Tarzana-based internist who also is past president of the Los Angeles County Medical Association.

"Medicare payments have been stagnant," Fink said.

And government is intruding more, he added.

"Not only are the rates not keeping up with inflation, but they penalize you if you don't use electronic records," Fink said.

He said as patients age, their health care becomes complicated. But Medicare seems to be encouraging them toward what he calls big box care.

Gary Hoover, a 72-year-old Porter Ranch resident who is Fink's patient, said he and his wife were on Medicare but moved into Medicare Advantage, which is a private insurance approved by the federal government. He's had mixed experiences, he said.

"Originally, we weren't too excited to go on Medicare because we were on private insurance," he said. "But it worked out well for us. We had to locate doctors that would accept Medicare and luckily we didn't have any problem with that."

But the rules changed this year, and he was steered toward Medicare Advantage.

"Now we have a lot of co-pays," he said. "Every time we go to a physician's office it's $15. For specialists it's $25. This is new to us, and it's pretty irritating actually."

He said while Medicare was supposed to ease the worries of Americans, its evolution, along with the Affordable Care Act, has only raised fears for his son, who is married and has two children. Hoover wonders what sort of costs they'll be facing.

"With all these changes going on, with doctors and hospital visits going up," he said, "we worry."

If you go

Health Care for All will hold rallies throughout the state, themed "Medicare is as American as Apple Pie," to celebrate Medicare's 50th birthday.

At 10 a.m., Baldwin Hills Crenshaw Farmers Market, 3650 W. Martin Luther King Jr. Blvd., Los Angeles.

At noon, southeast corner of Lake Avenue and Cordova Street, Pasadena.

At 4 p.m., Los Angeles Trade-Technical College, 400 W. Washington Blvd.

Contact: Maureen, Baldwin Hills event, 310-459-9763; Terry, Pasadena event, 626-280-0479; LATTC event, 800-745-3090; Millie Braunstein, 530-896-0380.

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