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Social Justice in Health Care for Older Adults Is More Important Than Ever

Ann Oldenburg June 10, 2019

How has Medicare delivered on its promise in the past—and what will be its role in the future?

Two great social justice movements were born in the 1960s—civil rights, which promised equality to a divided nation, and Medicare, which promised access to medical care to an aging nation.

Today, battles are still being waged on both fronts.

“We are particularly concerned that health care be honored and known and fought for as a human right, as a civil right,” says Judy Stein, executive director and founder of the nonprofit Center for Medicare Advocacy. She recently led an inspiring, daylong, annual Center for Medicare Advocacy 2019 National Voices of Medicare Summit.

A key theme of the event was looking back at the birth of Medicare, assessing it now, and looking ahead to the future, all with an eye toward the importance of social justice in health care for older adults.


Medicare’s impact on our country has been significant in many ways, but one of the earliest had to do with equal access to quality care. Until 1965, nearly 7,000 hospitals in the country were segregated. “It was shameful,” said Stein.

Few speak more eloquently about that era than Rep. John Lewis (D-GA), who mesmerized summit attendees.

“My time began in rural Alabama, 50 miles from Montgomery, outside of a place called Troy,” said Lewis. “Back in 1944, when I was four years old, my father had saved $300 and a man sold him 110 acres of land. My family still owns that land. In those days no one ever heard of preventive care,” he said. “Medicine was just not an option for us. Our preexisting condition was poverty.”

Lewis recalled that the only insurance he ever heard of was burial insurance, offered by peddlers door-to-door. “It was a scam,” he said. “We never thought about it—how to be healthy. We could only be prepared to die.”

President Lyndon Johnson’s signing of Medicare into law in 1965 ushered in a new era, one where people were entitled to protection for their hospital and physician services. “All of a sudden, families could be treated at their local hospital. With the passage of Medicare, service became available,” said Lewis.

And it provided peace of mind. “Before Medicare, half of all people 55 and over didn’t have hospital insurance,” said Tricia Neuman, director of the Kaiser Family Foundation’s Program on Medicare Policy.

“It was a very different situation growing old and getting sick. Medicare made an enormous difference—in terms of providing health care and also in terms of retirement security,” said Neuman. “I still hear it today: ‘I can’t wait until I turn 65. I just want to be on Medicare.’”


Medicare isn’t perfect, obviously. There are programs around the world that do a better job.

Ben Belton, director of Global Partner Engagement for AARP’s Office for International Affairs, cited three countries with universal healthcare systems that have particularly successful programs for older people—Costa Rica, which features a single national health insurance that costs $95 per couple a month; Australia, where 92% of people over 65 have no cost-related barriers to health care; and Mauritius, a small African nation where universal health care coverage is free and there is a health facility within 3 kilometers of every home. 

In the U.S., state programs can be a way to provide what Medicare lacks. Josie Kalipeni, director of Policy and Partnerships for Caring Across Generations, an organization devoted to the intersection of family caregivers and the work force, cited Washington’s newly passed Long Term Care Trust Act, a statewide benefit that will provide $100 a day to utilize for homecare, transportation, meals, etc.—whatever has to do with care—for a lifetime benefits is $36,500, paid for by a small tax.

“Ultimately I think it’s important that the thing that we align on is the fact that everyone should age with dignity,” she said.


“The Medicare of tomorrow could look more like a marketplace of public plans and less like a national insurance program,” said Neuman, who pointed out that Medicare Advantage plans are heavily marketed and drawing in Baby Boomers, who are turning 65 at the rate of 10,000 a day and will continue until 2030, according to Pew Research.

Other health programs are always in the offing, particularly as we head into the 2020 election cycle. At the summit, Rep. Rosa DeLauro (D-CONN) touted her Medicare for America bill, which has 16 co-sponsors. “The aim is universal, affordable, high-quality healthcare coverage,” she said in a video. The plan expands Medicare’s benefits and services to include: prescription drugs, dental, vision and hearing services, and long term services and supports. It’s a government plan, but with sliding scale premiums.

“A benefit of all the new suggested plans—Medicare for Older Adults, Medicare for All, Medicare for Americans—is that they have brought attention to Medicare,” said Neuman, and are forcing people to really pay attention to options.

Cathy Hurwit, former chief of staff for Rep. Jan Schakowsky (D-ILL), co-author of the Medicare for America plan, said that despite the many different proposals, “the prospects of actually moving anything in this Congress – are zero.” Too many other battles over existing Affordable Care Act issues are being fought right now.

But no matter what the details are of any program, Medicare or otherwise, Hurwit said the healthcare battle is still all about the basics.

“The debate gets back to health care as a human right,” she said, “Despite all the wonderful work of all of the civil rights activists and President Johnson, we still see a lot of discrimination in health care, so I think the real question is: How do we want to go as a country in terms of healthcare? There are debates about the social insurance way, the publicly accountable way, or the market way.”

She said, “Let’s think about what kind of healthcare system is really going to translate the vision of human rights into the actual provision of medical and long-term care services on the ground.”

Photo credit: Don Napoleon www.napoleoncomplexproject.com

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Ann Oldenburg

Ann Oldenburg, who started her career at The Washington Post and was a longtime culture writer at USA Today, is assistant director of the Journalism Program at Georgetown University. An advocate of lifelong learning, she is a member of the first cohort of Georgetown's new Aging & Health master’s program.

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