Medicare Is Turning 50. Now What?

In July, 50 years will have passed since President Lyndon B. Johnson signed the bill creating Medicare, transforming the lives of millions of older adults for the better. Today, more than 90 percent of seniors have health insurance and, as a consequence, are living longer and in better health than ever before. But with the number of seniors in the United States projected to double by 2050, Linda P. Fried, Dean of Columbia University’s Mailman School of Public Health, says that Medicare must evolve to reflect new science on healthy aging and disease prevention.

Dr. Fried’s “A Prescription for the Next Fifty Years of Medicare” appears in the journal Generations. In this special issue titled “Medicare at 50,” Dr. Fried is joined by other thought-leaders and experts in aging, healthcare, and retirement policy. Many of the contributors, including Dr. Fried, participated in a public event yesterday at the Kaiser Family Foundation in Washington, D.C. to discuss their perspectives on what we can expect from the next 50 years of Medicare.

“In sharp contrast to 50 years ago, we now know that prevention matters for most disease and conditions, and works into the oldest ages,” writes Dr. Fried. “Investing in prevention and health promotion is a 21st century opportunity—and responsibility—of Medicare, in synergy with the U.S. public health system,” she adds. “Such investment will better preserve health and lower costs: healthier seniors translates into fewer costly medical inventions. This is great news for ensuring adequate funding of Medicare over the next half-century.”

Dr. Fried points to one projection that shows that joint clinical and population-based investments in preventive strategies saves 90 percent more lives and reduces costs by 30 percent after only ten years. After 25 years, that investment would save 140 percent more lives and lower costs by 62 percent.

While Medicare has put a tentative toe in the waters of disease prevention, a deeper commitment is needed to meet the needs of our aging population, according to Dr. Fried. Her article presents four strategies for incorporating public health goals into Medicare:

1. Start at Age 50. Medicare should extend clinical prevention to cover adults from age 50 with the full set of vaccinations, screenings, and preventive services, oral healthcare, vision and hearing examinations, glasses, and hearing aids. Medicare must also support complementary needs: adequate incomes and affordable and safe housing. “This life-course approach to prevention will help ensure that people reach age 65 in good health, and that their health is optimized into their seventies, eighties, and beyond,” writes Dr. Fried.

2. Prescribe Prevention. Medicare providers should prescribe community-based programs that support physical and cognitive health like the “walking school bus,” in which older adults get exercise by walking children to school each day or an Experience Corps-type service. Coordinated support for these and other prevention programs should come from all levels of government Medicare, Medicaid, the Administration of Aging, and public health.

3. Create a Cadre of Geriatric Health Professionals. Currently Medicare helps fund graduate-level medical education for hospital residents. Medicare should expand this support to both geriatricians and public health training in order to “create a critical mass of health professionals who are experts in geriatric health needs,” notes Dr. Fried. This investment would help fill a gap for health professionals with the knowhow to extend care for seniors in and beyond the doctor’s office and into the community and home.

4. Coordinate Efforts. Medicare must work with the Centers for Disease Control and Prevention, as well as state and local partners, to track seniors’ needs and share information on the effectiveness of specific prevention programs through a shared database accessible to everyone, including seniors themselves. “It is unfortunate that some practitioners know about innovative community programs and make appropriate referrals, while others do not, and that health-producing community programs are not financially-covered services of Medicare,” says Dr. Fried. “And it is unacceptable that isolated older adults suffer alone from inadequately treated chronic conditions when they are eligible for care and support just beyond their reach.”

These added goals for the next 50 years of Medicare will help build and sustain the health of seniors, not just through medical treatments but also through prevention programs. Along with longer lifespans and the greater accumulation of society wealth as a result, Dr. Fried proposes that Medicare investment in preventive health strategies could help unlock a third demographic dividend. “Preserving the health of seniors unlocks a huge potential for valuable contributions in all corners of our culture, putting their knowledge and wisdom to use to the betterment of everyone,” says Dr. Fried.