Ah, an America where every one of today's and tomorrow's Medicare and Medicaid patients is a profit center for a commercial health-insurance company.
What a wonderful Republican, Fox News, Rush Limbaugh nirvana. And it is tantalizingly close, only a Republican Senate and Republican president away.
Most people have never known our country before Medicare and Medicaid, which was enacted 46 years ago. Those of us who were practicing medicine before 1965 knew it well.
About half of older people did not have health insurance. Only unionized or government employees whose employment contracts provided for retirement health insurance were so lucky. But there weren't many such people in small-town Kansas.
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Then, just as today, many seniors were living at or below the poverty line. Half of Medicare recipients today are living on $28,000 a year or less. But they do have Medicare Part A for hospital services.
To have Part B, physician services, and Part D, the drug benefit, they must buy them. Also, they must pay deductibles and co-pays unless they purchase an insurance policy that pays for what Medicare doesn't cover.
It costs a Medicare recipient $7,000 to $10,000 a year for complete coverage. That's a lot for someone whose income is $28,000.
But that's so much better than before Medicare. If you were among those without insurance, you either delayed care for as long as you could or you asked for charity — never a pleasant task for elderly people who always have taken pride in paying their bills.
Many died from delaying care. For those who finally sought care and were treatable, getting hospital care went something like this:
"Sister Kathleen, I have a woman with large uterine fibroids who is almost bleeding to death each month. Neither she nor anyone in the family has any money. Can you help her?"
Sometimes the sister would suggest we admit the woman next month when the census would be down. Or she would say to admit her Sunday for Monday surgery.
I also could call Carl Lamley, the former administrator at Stormont-Vail Hospital in Topeka, and get the same result.
Both knew that I was not charging these patients a penny. Nor were other doctors in our fine medical community. They took special pride in providing care for anyone who needed it, in contrast to physicians today who will not accept Medicare patients.
Some tax money was involved in the Shawnee County system. The commissioners appropriated limited funds based on an estimated number of poor in the county. Hospitals and pharmacies got the first cut, and any amount left over was for the doctors on a care-point basis. The amounts were so small that we rarely turned in points for payment.
Before Medicaid paid for medical and nursing-home care for the poor, there was a poor farm north of Topeka and there were a very few nursing homes. But most old folks ended up being cared for in the homes of their children, or were out of luck.
There were a few commercial homes. There may have been some affordable good ones, but the ones that stick in my memory were just plain horrible.
I don't think we want to go back to where we were before Medicare and Medicaid. Yet all but four Republicans in the U.S. House believe they can limit federal responsibility, and squeeze a few more dollars out of the sick and the poor and pass them on to billion-dollar health-insurance executives — in further tax cuts for the rich.