Even before Medicare was created in 1965, more than three out of four seniors were protected by a safety net for medical assistance financed by federal and state government revenues. The average life expectancy for older Americans was on the rise long before Medicare began paying their health care bills. Today, Medicare’s insurance coverage is so limited that it doesn’t protect seniors against catastrophic medical costs. It also fails to cover many routine health services outside the hospital, such as prescription drugs, dental care, eye examinations, and physical examinations. Seniors now are paying nearly as large a share of their income for out‐of‐pocket health care costs as they were before Medicare. But they cannot refuse Medicare’s hospital coverage unless they forfeit all of their Social Security retirement benefits. And the federal government effectively prohibits Medicare beneficiaries from paying physicians privately for Medicare‐covered services.
Most Americans, and even most seniors, know little or nothing about Medicare and the efforts being made to reform it. Blevins examines the program’s origins, evolution, and future policy options. She recounts how Medicare was created as part of a larger plan for universal health insurance. Blevins points out how Medicare costs grew far beyond the original estimates used to muster political support for the program. She finds that Medicare restricts health care choices, jeopardizes the doctor‐patient relationship, and threatens to invade the medical privacy of seniors. We won’t regain control over our health care until we learn the lessons revealed through an examination of Medicare’s history and consider the steps Blevins recommends for dealing with Medicare today.