Activists celebrate 50 years of Medicare

Marchers rally outside UPMC and Highmark for affordable coverage

Insisting that the 5-year-old Affordable Care Act doesn’t go far enough, activists in Pittsburgh and several other cities seized the 50th anniversary of Medicare on Thursday to reignite marches and rallies for nationalized health insurance.

Skeptical onlookers outside the U.S. Steel Tower, Downtown, suggested that advocates Kittanningat the midday rally would do better moving to a Marxist country ratherFord City than try to change the United States, where lawmakers have bucked universal Medicare proposals for decades.

Still, organizers with labor unions and other groups vowed to lobby again to dismantle commercial insurers, invoking the late President Lyndon B. Johnson as they said the federal program that insures more than 55 million

elderly and people with disabilities should grow to welcome any citizen, no matter the cost.

“We’re a rich country. There’s no reason anyone should have to go without affordable health care. It has to be a will of the people,” said Linda Goncalves, 72, of State College, one of about three dozen demonstrators who rallied outside the UPMC offices in the Steel Tower.

They then walked to the Fifth Avenue Place headquarters of Highmark Health, the largest health insurer in Pennsylvania, arguing that policies sold under the Affordable Care Act online marketplaces remain too expensive for too many people. Individual premiums can eclipse $300 a month for middle-income enrollees on the exchanges.

A Supreme Court decision last month affirmed tax credits for more than 6 million lower-income Americans enrolled through those marketplaces.

UPMC spokesman Paul Wood said single-payer concepts like universal Medicare lost out to the Affordable Care Act, which grants commercial insurers a key role in structuring coverage.

Mr. Wood said UPMC Health Plan offers one of the best-priced policies through the online exchanges, “proving that people can receive some of the best medical care available anywhere at low costs.”

Highmark declined to comment.

Profits for commercial health insurers and managed care providers run about 3 percent, a fraction of the margins at pharmaceutical and other health companies, according to industry calculations. Some studies suggest overhead expenses at insurance companies can approach 20 percent, well above the 2 percent to 3 percent estimated for traditional Medicare overhead expenses, although the industry challenges the Medicare figures.

“Culturally, I think the U.S. just has a really hard time accepting a singlepayer system or the idea that you would expand this openended entitlement to people who don’t really need it,” said Yevgeniy Feyman, a fellow with the Manhattan Institute for Policy Research in New York.

He called it unrealistic to expect any comprehensive expansion of Medicare, a centerpiece of the Great Society social policies introduced in the mid-1960s. Mr. Johnson enacted Medicare and its sister program for the poor, Medicaid, on July 30, 1965. About half the nation’s elderly at that point had no health insurance, and a third lived in poverty.

Now, U.S. Census estimates suggest about 14 percent of seniors are impoverished while nearly all have access to health care, trends that Medicare boosters attribute largely to the program.

Life expectancy in the United States jumped from about 70 years to more than 78 years in the same period, but it’s tough to gauge how much credit Medicare can claim.

“It’s hard to estimate because there are so many other changes occurring at the same time” in medicine, said Julie Donohue, an associate professor in health policy and management at the University of Pittsburgh.

She said the Affordable Care Act, which mandated health insurance and has helped cover nearly 17 million people, will probably diminish any momentum for Medicare expansion.

“I think we have accepted the political reality that employer-based health insurance works pretty well for about 160 million people, that no one really wants to disrupt that system as you would to expand Medicare for all,” Ms. Donohue said.

Lawmakers allocate more than $600 billion a year to cover Medicare benefits, a figure that could soar under an expansion plan.

Countries with more centralized health care, such as France and Israel, have healthier populations than the U.S., said Karen Wolk Feinstein, CEO at the Jewish Healthcare Foundation, Downtown.

“But mostly I think that’s because they’ve put a lot of their resources into primary care and, frankly, because they have healthier lifestyles,” she said. “You’re talking about countries where people walk.”