HJAR Jan/Feb 2020

50 JAN / FEB 2020 I  HEALTHCARE JOURNAL OF ARKANSAS DIALOGUE COLUMN COMMUNITY HEALTH AMONG OTHER FACTS, Johnson likely considered that 1) President Franklin Roo- sevelt included no health insurance plan in the landmark Social Security Act, which he signed into law in 1935; and 2) a congres- sional committee killed President Harry Truman’s 1948 healthcare proposal to close what he called, “the greatest gap in our social security structure.” Our nation had come a long way by the time Johnson cemented his plans for a “Great Society”— he envisioned fewer people suffer- ing a lifetime of poverty and other forms of lack — whose provisions included Medicare for seniors and Medicaid for low-income persons. As Election Day 2020 approaches, how to further widen healthcare access and refine our healthcare system is much a part of the presidential debate. Several Democratic pres- idential hopefuls are promoting Medicare for All. It is a bold idea that draws mixed opinions. Some insist that such a plan would help fix the country’s imperfect health system. Others say it would destroy the very foundation of the for-profit healthcare system they prefer. So, what exactly does Medicare for All mean? Is it enrolling everyone in the current Medicare program? Creating a single-payer, government-sponsored universal system that covers absolutely everyone? As is, Medicare is complicated. Part Adeals with hospital costs, Part B, physician costs, and Part D, prescription drugs. Each part mandates its own insurance premiums and deductibles, and sometimes, its own co-pay- ments. Higher-income seniors often choose to buy supplemental insurance to cover those out-of-pocket expenses. Seniors of lesser means, including those on fixed incomes, still struggle to afford good healthcare, and are especially hard-pressed at securing their necessary prescribed medicines. It is nice to hear presidential candidates support doing away with co-payments, pre- miums, and deductibles. Even if signed into law, those changes would yield results quite different from what our current Medicare system now delivers — and they would take a big bite out of our national budget. No can- didate has shown how this country would cover such huge costs. What’s more, none of these candidates are talking about access to healthcare services, MEDICARE FOR ALL? How about ACCESS FOR ALL instead? Before President Lyndon Johnson, in 1965, signed into law landmark legislation assuring medical insurance for our nation’s poorest citizens and its most senior ones, it is likely that he took a long, hard look at what his predecessors had won and lost in the battle over U.S. healthcare.