Before I joined Health Access in January 2006, I worked for the federal government in a variety of jobs. I began my career when I was hired to take applications for retirement, survivor’s and disability insurance benefits for the Social Security Administration and ultimately worked in 17 Social Security offices across the U.S. I also served as the Regional Administrator for the Centers for Medicare and Medicaid Services (CMS), formerly HCFA, in San Francisco. The regional office was responsible for Medicare and Medicaid in the four western states (including California) and the Pacific Territories. While these programs are complex, they remain important and are widely respected.
Government programs have many detractors. All programs have coverage gaps and other flaws because of the compromises that arise out of the legislative process. In addition, agencies can have imperfect administration, due to inadequate funding or for other reasons. However, I had the good fortune to work on those programs (Social Security, Medicare, and Medicaid) that are esteemed by Congress and the public as National Treasures to this day. They are consistently admired as having a strong programmatic purpose, an unwavering commitment to beneficiaries, and consistent, professional, and relatively low-cost administration.
So, as we approach a new chapter in the current health care reform debate, it is interesting to look back at the legislative history leading up to the passage of Social Security and Medicare/Medicaid. Since our Congressional representatives all point to those programs as hallmarks of our social fabric and essential to our financial underpinnings, it is interesting to see if those revered programs passed Congress with virtually monolithic, or at least bi-partisan support. Not so much. The Social Security Act of 1935 passed with overwhelming Democratic support, but only 16 Republicans voted for it in the Senate. The Medicare/Medicaid legislation in 1965 similarly had broad support among Democrats in the Senate, but only 13 Republican Senators voted for its passage. While these programs remain part of our foundation, and few legislators would vote for their repeal today, they had little support across the political spectrum at the time they were signed into law.
However, as we attempt to build on their foundation for health care reform, no one remembers the fierce opposition those programs encountered, and the fairly one-sided and sometimes grudging support they received in their day. These days legislators from both political parties acknowledge the critical importance of these programs to the American people. So, let’s hope as we re-examine our commitment to passing health care, we continue to go about the business of building on these National Treasures.