Book Review

Medicare's Midlife Crisis

Sue A. Blevins, RN

(136 pp., $8.95, ISBN: 1-930865-08-2, Cato Institute, Washington, DC, 2001.)


Ms. Sue Blevins' condensed publication Medicare's Midlife Crisis presents an unvarnished, logical, factual and sensible understanding of the multiple contributing factors leading to the crisis facing Medicare today.

From the very beginning of this remarkable treatise, the reader is introduced to the real Medicare, how it came about and how it functions, burdened by thousands of rules and regulations which steadily and increasingly threaten quality medical care for the nation's elderly.

Each of the book's six chapters round out a complete story which should be required reading for anyone seriously concerned and determined to play a role in educating the public at large as well as those legislators ostensibly seeking "common sense and reasonable solutions" for health care reform.

By the time a reader has completed the first 25 pages, he will have been exposed to the real Medicare and will have attained a better understanding than the average American. This scholarly work illuminates the many hidden persuasions, the distortions, the myths and the untruths widely disseminated that prior to Medicare great numbers of the elderly were without available health care and devoid of means to obtain health insurance.

Ms. Blevins correctly recalls that five years before Medicare was enacted low income seniors were enjoying an ever widening growth of the Kerr-Mills program. This program, named after and energetically supported by the then two most powerful democratic congressional leaders, had enjoyed the strong support of the medical profession, because it was voluntary and helped those in need because of inadequate income. On August 23, 1960, the Senate passed the legislation by a vote of 89 to 2. On September 13, 1960, over President Eisenhower's signature, it became law.

There is persuasive evidence that, despite strong support of both Democrats and Republicans, top officials in the Department of Health, Education and Welfare (HEW; later HCFA) who were charged with the responsibility to help implement the law instead traveled the country making speeches opposing Kerr-Mills because it was voluntary and didn't cover all of the elderly.

There is also compelling evidence that those same government officials attempted to sabotage the program by concealing the true costs of the proposed Medicare because, for many of them, Medicare, if passed to cover everyone over 65, would provide the "foot in the door' toward their ultimate objective --- socialized medicine for all citizens.

In 1965, HEW officials told Congress that hospital coverage for their proposal, the King-Anderson Bill (Medicare), would require no more than a one-percentage increase in the payroll tax. They also declared that by the year 2000 annual costs would not exceed $2.5 billion. According to government figures, in 2000, workers paid $144 billion into the Medicare Part A hospital fund, 57 times the original projection for the Congress.

The American people were told that the wage base for taxation would be limited to $6600. Contrast those figures with today. The Social Security cap on income is $80,400 and there is no longer any cap on Part A Medicare taxes, which are now levied on total income however large.

It is significant that a renowned statistician, who for 35 years had conducted health and welfare costs for the federal government, projected for Nation's Business in 1964 that Medicare would cost at least three times what the bureaucrats estimated and eventually perhaps ten times as much. After his statistical staff was taken away without explanation, he retired from federal service and was quoted as saying, "If a sound realistic health program cannot be accepted by the public on its merits, it should not be imposed on them by government."

This brief review of Medicare's Midlife Crisis merely introduces the reader to the gems found in this important tome. I urge you to get it and read it!


Reviewed by Edward Annis, MD
Miami, FL

Dr. Annis is past president of the AMA, an AAPS member, and the author of Code Blue: Health Care in Crisis (1993).

Originally published in the Medical Sentinel 2002;7(1):32. Copyright©2002Association of American Physicians and Surgeons (AAPS)