In the United States the Medicare system provides health insurance coverage for those who are above 65 years of age. Medicare is a social insurance program, a single-payer health care system, and it operates in a similar way to the Medicare systems in Canada and Australia, except that in the US it is restricted to those above 65, plus some other groups of people such as the disabled. This article reviews the history of Medicare in the US, from its founding in the Sixties, to the funding crisis faced today due to demographic changes, and to spiraling health care costs.

In a single-payer health care system there is one large insurance fund which covers the health care costs of the entire population, or a large group of the population. The single payer, which is usually the national government, collects the insurance premiums, usually in the form of a health tax. This money is then paid into the insurance fund, where it covers the health costs of the nation’s population.

In the United States in 1961 the former commissioner of Social Security, Robert M. Ball, examined the problem of funding health insurance for senior citizens. He concluded that the major issue was that the elderly often required expensive medical treatment because of their age, but were not able to pay health insurance costs because they were no longer working, and they relied on a pension for income.

Ball then concluded that the only possible way to finance health care for the elderly was to employ the same mechanisms which are used to finance pension provision. This means that payments are collected from those of working age, and the benefits are provided after those people have retired.

Those who support Medicare would say that it is not an unearned entitlement. They would say it is social insurance, where people pay into the scheme when they are young, healthy, and in work, and they receive the benefits when they are old and sick.

However many conservative politicians, including Barry Goldwater, Ronald Reagan and George Bush Senior, opposed Medicare. They argued that such a scheme would lead to the end of individual responsibility, and perhaps even to the advent of socialism in the US.

Medicare became law in 1965. At the time Lyndon B. Johnston was president, and he enrolled the first two Medicare members: Harry S. Truman, and Mrs. Truman, the former president and first lady.

Now in the 21st century Medicare is facing a severe funding crisis. There are two reasons for this. Firstly people nowadays tend to live much longer: an increasing proportion of the population are over 65, and receiving benefits from the scheme; a reducing proportion of the population are under 65, and paying taxes into the scheme.

Secondly the costs of medical treatment have increased very rapidly, particularly for many new treatments which were not available when the scheme was set up in the 1960s.

It has been predicted that the scheme will run out of money in 2019 unless something is done. Fixing this crisis must therefore be a major domestic policy priority for US governments over the next decade.

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