The central San Joaquin Valley is a good place for an assessment of Medicare and Medicaid on their 50th anniversary Thursday.
Nearly 58% of the people in Fresno, Kings, Madera, Merced and Tulare counties rely on the government insurance programs to pay their medical bills.
A breakdown: More than 900,000 low-income children, adults and people with disabilities are enrolled in Medi-Cal (California’s name for Medicaid); and nearly 253,000 older adults and disabled individuals are on Medicare.
The two insurance programs were controversial on the day President Lyndon Johnson signed them into law 50 years ago and remain so today. California legislators are meeting this summer in a special session called by Gov. Jerry Brown to hammer out funding for Medi-Cal that has grown exponentially since full implementation of the Affordable Care Act last year.
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55 millionNumber of Medicare beneficiaries in the U.S.
Medicare’s long-term solvency is an ongoing national debate.
But health experts say Medicare and Medi-Cal have weathered storms before and likely will again.
“Despite the 50 years of controversy, I think they really are regarded as bedrocks of the American medical system,” said Keith Wailoo, a professor of history and health policy at Princeton University and in the Woodrow Wilson School of Public and International Affairs. Wailoo is a co-editor and contributing author to a new collection of essays, “Medicare and Medicaid at 50: America’s Entitlement Programs in the Age of Affordable Healthcare,” published by Oxford University Press.
“Politicians across the political spectrum, I think, appreciate and champion and support these programs, even if they’re skeptical about whether we are getting value for our dollar or whether they could be designed differently,” Wailoo said.
Balancing costs and care will be the challenge for decades to come, he said. “That will be the battle — politically, economically, socially and morally.”
Medicaid was kind of an afterthought. Medicare was really the centerpiece of the Great Society’s promise for providing health care.
Keith Wailoo, Princeton professor of history and health policy
Valley thoughts on Medicare and Medi-Cal
On the 50th anniversary of Medicare and Medi-Cal, The Bee asked medical professionals, health-care advocates and health consumers in the Valley about the programs. Their observations, edited from interviews, are below.
Gene Roza, charter member of the California Alliance of Retired Americans
Roza said he would be getting on a bus Thursday with other Alliance members to be at a Medicare rally in Oakland.
“We consider Medicare a highly successful public program. We’re just trying to make it stronger. We think the thoughts of others who want to privatize the health care industry are entirely wrong. We want to expand it to cover everyone — a single-payer type Medicare for all,” he said.
“Every one of us, frankly, would be in poverty right now since the Great Recession if not for Medicare and Social Security. We would be flat broke or six feet under right now. There’s no way any normal person in the past decade who has retired…is going to be able to afford the medical costs without Medicare. I went through a cancer operation and thank goodness I had coverage.”
Dr. Alan Birnbaum, Fresno neurologist, St. Agnes Stroke Program medical director and member of the St. Agnes Integrated Leadership Team
Birnbaum has been in practice in Fresno since 1979.
For the most part, doctors like Medicare, he said. “At least in this area, physicians are not totally unhappy with Medicare reimbursements. A well-organized primary care physician can make a reasonable living seeing patients at Medicare rates.”
But Medi-Cal is limping along, he said. “Really, what happens is most of the time, the great majority of doctors in private care just can’t afford to see anyone on Medi-Cal.”
Tramont Givins, 27, of Fresno, a Medi-Cal health consumer
“I had asthma growing up as a kid. Without Medi-Cal, I would be dead.”
Sandra Celedon-Castro, manager of Fresno Building Healthy Communities, a coalition to improve health
“Medicare set us on this road for establishing a social health-care program. I think it has been extremely beneficial in keeping our older individuals and those with disabilities, added in 1972, out of poverty,” she said.
70 millionNumber of Medicaid beneficiaries in the U.S.
“I think 50 years later, we’re still tweaking it, adding to it, making sure folks have access to providers, making sure that folks have access to prescription drugs through Medicare. Or making sure that folks are able to access Medicare services without additional paperwork barriers. We really shouldn’t make it harder for them to use their benefits.”
Medi-Cal has benefited a lot of people, she said, “but 50 years later, we’re still fighting to make sure everyone has access to health care. Now we’re adding more folks to our social health care program, but in California we’re still fighting to include all Californians despite documentation status.”
Minerva Torres, 63, of Fresno, a Medi-Cal health consumer
“When I got Medi-Cal, they helped me a lot. I have a lot of health issues,” she said.
“The times I didn’t have it, I couldn’t see a doctor or do anything.”
Dr. Gene Kallsen, UCSF-Fresno clinical professor of emergency medicine
Kallsen, 68, graduated from medical school in 1972.
Medicare and Medi-Cal are “collectively wonderful programs for people who otherwise would not have insurance,” he said, but the programs are not without problems. “There’s a lot of feeling in the medical community that reimbursement for Medicare has gone down significantly over the last several years. A decade ago, just about all physicians accepted Medicare patients. Now there are more and more physicians who don’t accept Medicare patients or limit how many patients they see.”
The problem with Medi-Cal is that the reimbursement is so low that many physicians — maybe even most — don’t accept Medi-Cal patients. “Medi-Cal patients are always the highest utilizers of emergency departments. There are not enough doctors accepting Medi-Cal for those patients to go somewhere else. Or they have a doctor who accepts Medi-Cal, but they can never get into them on short notice when they need to get into them.”
Beverly Johnson, 75, of Fresno, a Medicare health consumer
“I believe Medicare should be a supplement, not a way of life like it is for so many people,” she said.
“But if they took it away right now, it would be rough because we haven’t prepared ahead.”
Dr. William Winn, a Visalia pulmonary specialist
Winn, 78, began medical practice in Visalia in 1969. He is semi-retired and volunteers one morning a week at a free clinic.
“I would rather donate my care for nothing than struggle to get reimbursed for Medi-Cal,” he said.
But without Medicare and Medi-Cal, Winn said, “there wouldn’t have been the money to pay for the high-tech medicine and probably people wouldn’t live as long…and people would have had to be happy with less medical care.”
Joyce Williams, 83, of Fresno, retired nurse and Medicare health consumer
Since Medicare became law in 1965, “I’ve personally seen the benefit of it and with others,” she said.
“I just got out of four months of rehabilitation for a fractured leg. I had insurance from retired military TriCare and Medicare. It covered everything.”
Nancy Hollingsworth, registered nurse and CEO at Saint Agnes Medical Center
Hollingsworth graduated from nursing school 33 years ago. In 2007 she became chief nursing officer at Saint Agnes, and four years ago she became the hospital’s chief executive officer.
Medicare has helped the health-care industry “create all sorts of technology and interventions that help save lives,” she said. “I think the challenge has been controlling costs. Giving the right kind of treatment in the right location and at the right time, that’s the challenge today.”
More Californians have Medi-Cal as a source of coverage today, she said. “Our challenge is having enough providers who can take Medi-Cal.”
Dr. Dominic Dizon, an internist and director of ambulatory care at Community Regional Medical Center
Dizon has been in practice for 17 years.
When Congress approved Medicare in 1965, “I don’t think they ever thought it would have such a big impact. But it has. It’s kept a lot of senior citizens healthier,” he said.
Overall, Medicare and Medi-Cal are very much needed, he said. “I think we need to make sure they don’t run out of money. They do provide health care for the frailest of us, the elderly, the low-income children, the pregnant women. Hopefully they will continue for another 50 years and beyond.”