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June 13, 2013 8:16 AM Health Care Reform: The Sky Didn’t Fall Before, and it Won’t Fall Now

By Aaron Carroll

One of the things I’m fascinated by is the way history repeats itself when it comes to health care reform. Everyone acts as if what we’re doing is crazy new, as if it’s never been done before. This kind of thinking was the subject of one of my favorite Huffington Post columns (which I encourage you to go enjoy).

I think we’re seeing the same thing again with respect to Medicaid and the Affordable Care Act. Many of the claims about the expansion’s imminent failure involve arguments that aren’t new. In fact, they were the same as those being employed against traditional Medicaid decades ago. So I had awesome college student TIE-assistant Jaskaran Bains look up media coverage of Medicaid when it was passed. See if any of it sounds familiar.

Let’s start with Time Magazine, in a piece entitled , “Medicaid: Chaotic but Irrevocable”, from 1967:

Medi-Cal and other Medicaid programs may well have been overambitious. New York’s certainly was. Most are shot through with manifold abuses and inefficiencies… As with Britain’s National Health Service, repeal is unthinkable, though Medicaid may have to suffer some amputations in order to survive.

Here’s Time Magazine worrying about states’ future share of the program. “Medicaid’s Maladies“, from 1969:

In theory, the four-year-old Medicaid program gives states what amounts to a blank check from the U.S. Treasury. In practice, the program—designed to finance medical care for the needy—has proved to be a tremendous drain on state treasuries as well. Even though federal handouts cover at least 50% of the costs, several leading Medicaid states —including New York, California and Michigan—have been forced to slash aid to their “medically indigent” because the runaway rise in hospital, drug and doctors’ bills threatened to engulf their budgets in red ink. Now Medicaid’s first state dropout has taken place.

The Columbia Journal of Law and Social Problems had a lot of in depth coverage. Here’s a bit from, “Medicaid: The Patchwork Crazy Quilt“, from April, 1969:

In the four years since its inception, Medicaid has suffered extremely severe growing pains. Expenditures required to finance the plan were surprisingly high. The classes of persons covered and the types of services provided have varied substantially from state to state. Too many doctors and hospitals have been unwilling to participate in the program.

Even then people were screaming that no one would participate. I expect doctors will abandon the program any second now….

Have you heard the one about how Obamacare is really just a slippery slope to single payer? From the Syracuse Law Review, “Medicaid: Has National Health Insurance Entered by the Back Door“, from 1966:

As the scope of the program became more widely known, and the implications of the regulations [of Title XIX] were more carefully studied, a storm broke… Politicians cried out that the Medicaid tail would soon be wagging the Medicare dog; that a system of national health insurance such as in Great Britain or Canada was being created surreptitiously.

The New York Times, October 17, 1971, “Medicaid: Why the Program is Mortally Ill”. This could be written about Obamacare, right now:

Medicaid appears to have some economy-minded antagonists and a great many disappointed lovers, but no friends.

And lest you think that anything has changed with people complaining about Medicaid itself, here’s the Davis County Clipper, April 7, 1978, “Medicaid Cost Rise“:

“The near-universal feeling persists that some remedial action is urgently needed in Medicaid,” The Foundation notes. “While virtually everyone is seriously concerned with the high and steadily-increasing cost, every group that provides services to the program believes that its own efforts are not adequately repaid.”

I could do this all day, but I hope you get the point.

Let’s all take a deep breath and appreciate what’s going on. Health care is expensive, and changing the health care system is scary. But when Medicaid was passed, tons of people panicked. They claimed that it would bankrupt the states. They claimed that the feds would renege on their promises. They claimed that it was a backdoor to socialism. They claimed that doctors would be paid much less. They claimed that doctors would leave the program in droves. They claimed that no one liked the law. They predicted doom.

It didn’t happen.

It’s easy to scream that the sky is falling. Remember when Ronald Reagan told us that Medicare was the death of freedom? At some point, though, you have to look around and realize that things just ain’t that bad. We’ve heard these arguments before. They didn’t come to pass. States have all embraced Medicaid. The feds never broke the bargain. Docs made a fortune in the 80′s. There are more medical school applicants than ever before. At some point, we have to stop giving these arguments so much weight.

Obamacare will not be perfect. Neither will the Medicaid expansion. We’ll need to fix them. But neither will bring about the end of the republic, just as no health care reform in any other country resulted in the end of democracy itself.

All of these quotations were from 40-50 years ago. Not only is Medicaid thriving, but just last year, the Supreme Court decided it was so “apple pie” that threatening to take the program away was coercive. I think it’s more likely that’s how we’ll think about the ACA 40-50 years from now, than that any of the doomsday scenarios will come to pass.

[Originally posted at The Incidental Economist]

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Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.