On April 22, 2004 the LBJ Library and the Center for Health and Social Policy held forums on Medicare, one of the landmarks, among many of the LBJ Presidency. Remember this was a time when President Bush was moving toward greater privatization of Medicare. During those forums we looked at three approaches, including an approach very similar to that proposed in 2004:
- Approach 1: Defined Benefit—The Government as the Insurer
- Approach 2: Defined Contribution—Private Health Insurance Companies as Insurers
- Approach 3: Raising Revenue—We All Pay for the Benefits We Want
It is useful to review the results of these forums as they reflect the values that led President Johnson to push for Medicare in the first place. The following is an excerpt from the report on our findings.
The starting point for many of the participants was a recognition that Medicare could not be discussed fully without a broader conversation about the entire health care system in the United States. The participants in these forums leaned toward universal health care as a means of addressing equitable distribution of health care.
- Participants acknowledged that Medicare would have to be changed, but said that the current system reflected their values of fairness and an elderly person’s right to a basic level of health care.
- Participants wanted to see a greater emphasis on prevention in our health care system and expressed a willingness to endorse more prevention programs within Medicare.
- Participants recognized that some level of rationing is necessary in order to provide health care services for all elderly people; however, they were cautious about how rationing would be implemented and insisted that it should not be based on ability to pay.
- Participants strongly believed that government involvement is the best way to share costs across a larger pool of participants and ensure coverage for everyone. They were concerned that shifting coverage to private insurers would leave the sickest and poorest in the government pool.
- Participants would not support policies or plans that limited their choice of health care providers.
- Being able to choose health insurance plans was not a high priority for the participants, and they were skeptical that competition among providers would result in lower health care costs.
- Participants firmly acknowledged that health care costs were going to increase and that we would have to pay more, but both the elderly and the youth in the forums were concerned about the impact that raising revenue would have on the other generation.