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Medscape
a day ago
- Health
- Medscape
Dire Warnings, Rosy Future: Medicare at 60
The creation of Medicare in 1965 was hailed as a watershed for the social safety net, offering millions of older Americans financial security and freedom from worry about their medical expenses. But critics of the legislation cast dire warnings about what the law would do to the nation's physicians, the doctor-patient relationship, and even the country's way of life. Who was right? To mark the 60th anniversary of Medicare, Medscape asked leaders in healthcare, American history, and public policy to reflect on the words of the program's earliest champions and critics. Comments have been edited for length and clarity. Democratic presidential nominee John F. Kennedy, August 14, 1960. Then-Senator John F. Kennedy , spoke in support of a national insurance program for the elderly at an event on August 14, 1960: "Three out of every five of these [people over age 65] — more than 9.5 million people — must struggle to survive on an income of under $1000 a year. …This poverty and hardship turn into heartbreak and despair when illness threatens. Medicines and drugs are more expensive than ever before — hospital rates have more than doubled — doctor bills have skyrocketed. …Those over 65 suffer from chronic diseases at almost twice the rate of our younger population — they spend more than twice as many days restricted to bed — and they must visit a doctor twice as often." Commentary Keith Wailoo, PhD, Henry Putnam University professor of history and public affairs at Princeton University and past president of the American Association for the History of Medicine: "An important backdrop behind JFK's comment is reflecting 10 years prior on the failure of President Harry Truman's national health insurance proposals. The frustrations and the stories he's telling were evident after World War II. Keith Wailoo, PhD "He's describing a landscape where — in the course of the war — private insurance became more attached to employment, wage freezes meant that companies couldn't raise wages, unions lobbied and employers argued that benefits could be increased, and as a result of a momentous Supreme Court ruling, health insurance became increasingly a byproduct of employment. Healthcare costs were rising, and insurance was becoming a passage point to getting hospital care. "The face of the poor and medical needy were the elderly by 1960. They were not working, and because of advancing life expectancy, there was more infirmity and yet they were locked out of the system. "So we've recreated the world, and with that we have also changed people's expectations about what they can hope for." Ronald Reagan and the American Medical Association, 1961 audio recording on LP. In 1961, Ronald Reagan released a speech against a proposed bill that would cover hospital costs for the elderly. The effort was later revealed to be part of a campaign by the American Medical Association (AMA) to quash efforts to create a national health insurance program. Reagan said: "[The bill] was simply an excuse to bring about what they wanted all the time, socialized medicine. … First, you decide that the doctor can have so many patients, they're equally divided among the various doctors by the government. But then the doctors aren't equally divided geographically. So a doctor decides he wants to practice in one town, and the government has to say to him, 'You can't live in that town. They already have enough doctors,' and from here, it's only a short step to dictating where he will go." Commentary Reid B. Blackwelder, MD, associate dean for graduate medical and continuing education, DIO, Quillen College of Medicine, East Tennessee State University, and past president of the American Academy of Family Physicians: "Reagan's warning that nationalized health insurance would lead to government direction for where physicians practice has not happened. Physicians have the freedom to accept insurance or not and to practice anywhere they want. Sadly, our country is facing increasing healthcare deserts for various reasons. Reid B. Blackwelder, MD "We already had a serious and growing access problem for patients. Now, patients in rural areas especially are losing even more access to primary care physicians and specialists as rural hospitals shut down and physicians like obstetricians stop practicing outside of urban areas. "Ironically, Medicare is perhaps the most lenient health insurance in terms of providing that freedom of choice Reagan described for patients. Because Medicare is popular and widely accepted by patients and physicians, patients can readily choose the physician they want, including subspecialists. On the other hand, for-profit insurance has created significant limits on which physicians a patient may select based on acceptance of that insurance and cost. It can be difficult for a patient to see the physician of their choice." Dr Edward Annis ( left ), holding an anatomical model of a human heart, speaks with TV host Johnny Carson ( right ) on the The Tonight Show , December 11, 1963. Edward Annis, MD , chairman of the AMA 's speakers' bureau — and later president of the association — appeared in a televised May 21, 1962, address about the proposed King-Anderson bill, an early iteration of what would become the legislation that created Medicare. Annis said: 'It wastefully covers millions who do not need it, it heartlessly ignores millions who do need coverage. It is not true insurance. It will create an enormous and unpredictable burden on every working taxpayer. It offers sharply limited benefits. And it will serve as a forerunner of a different system of medicine for all Americans.' Commentary Jonathan Oberlander, PhD, professor of social medicine at the University of North Carolina at Chapel Hill, and editor of the Journal of Health Politics, Policy and Law: "The AMA's overheated rhetoric against Medicare did not age well. Doctors would later face challenges to their clinical autonomy, as Annis had feared, but that intrusion came from private managed care insurers trying to control skyrocketing costs, not Medicare. "Yet the AMA was right about one thing. Although they didn't admit it during the 1960s, Medicare's architects saw the program as the first step to universal health insurance, and after covering the elderly, they hoped to next turn to children and eventually cover everyone via government insurance. Medicare for All was the aspiration. "That did not happen, and although Medicare expanded eligibility in 1972 to cover persons with permanent disabilities and end-stage renal disease — six decades after the program's enactment — its primary beneficiaries are still older Americans, an outcome that would have stunned its creators. "After Medicare's enactment in 1965, the AMA's opposition to the program faded, much to Annis' consternation. Forty years later, he still expressed regret that the association did not take a more 'militant' stand highlighting the program's problems." Dr Edward Annis (right) with Dr Arthur Fleming. Annis continued: "This King-Anderson Bill is a cruel hoax and illusion. … It will come between the patient and his doctor." Commentary Reid B. Blackwelder, MD, associate dean for graduate medical and continuing education, DIO, Quillen College of Medicine, East Tennessee State University, and past president of the American Academy of Family Physicians "The special and powerful relationship between patients and physicians is a real thing. Medicare did not damage it. Other insurance coverage did not damage it. Having any insurance coverage is one of the foundations of getting to good health outcomes. The other is having a source of comprehensive care. Patients need both. "The very real threat to the physician-patient relationship that is accelerating today is from legislative intrusions into the patient room. When laws are passed that make even just exploring options with patients around things like reproductive health a criminal offense, government has overstepped. "When laws are enacted that require a physician to call their lawyer rather than a specialty consult before providing life-saving care, we have entered a new and dangerous era of governmental oversight. Recent laws have done more damage to the sanctity of the physician-patient relationship that Medicare actually helped improve." Rep. Durward Gorham Hall, 1969 Representative Durward Gorham Hall, MD (R, Missouri), made these remarks below during debates on Medicare in the House of Representatives: "This conflict is testing whether art and science of medicine will be permitted to grow and flourish in freedom and competitively, or whether progress in medicine will be stunted and shriveled by an excess of Government control." Commentary Jonathan B. Jaffery, MD, MS, MMM, chief healthcare officer at the Association of American Medical Colleges: "By supporting the training of physicians, Medicare helps create the physician workforce for future generations of Americans, crucial for the care of an aging population. And through iterative developments over the last 60 years, such as Coverage with Evidence Development or the Center for Medicare and Medicaid Innovations, the Medicare program — coupled with federal investments in biomedical research — has been able to support innovations in both medical technologies and models of care delivery that continue to improve the lives and well-beings of millions. Jonathan B. Jaffery, MD "The reality is, prior to 1965, many elderly Americans with healthcare needs were forced to rely on financial support from their families or spend all their life's savings, hope for charity care, or forego care altogether. And of course, the cost of care has only skyrocketed, so that in 2025 even very high-net worth individuals would struggle to cover the costs of a lengthy hospitalization or extended illness, let alone the price tag of many new life-saving medications." Hall continued: "The result will inescapably be third-party intrusion in the practice of hospitalization and medicine. His diagnostic and therapeutic decisions would be subject to disapproval by those controlling the expenditure of tax money." Commentary G. William Hoagland, senior vice president, Bipartisan Policy Center, former executive at Cigna, and former US Senate staffer "Representative Hall was prescient in his observation about the future of healthcare resulting from the creation of Medicare. The 60-year history of the Medicare program, particularly since the enactment of the Tax Equity and Fiscal Responsibility Act in 1982, the Medicare Modernization Act in 2003, and the Patient Protection and Affordable Care Act in 2010, has resulted in the 'corporatization' of healthcare. G. William Hoagland "Today, Medicare Advantage, dominated by 'third-party' corporate insurance companies, has transferred the physician's independent decisions to actuaries and corporate financial decision makers. The result has also been horizontal consolidation of what were locally controlled entities to nationally or regionally controlled corporations along with vertical consolidation of payers and care delivery entities. "The impact of these changes, along with dramatic scientific advances in diagnosis with advanced treatment protocols, precipitating higher healthcare utilization, has not been to reduce costs but to in fact increase healthcare costs." President Lyndon Johnson ( left ) flips through the pages of the Medicare bill so former President Harry Truman ( right) can see it. Following passage of the Social Security Amendments of 1965 out of the Senate by a vote of 68-21, President Lyndon B. Johnson said: "It will help pay for care in hospitals. If hospitalization is unnecessary, it will help pay for care in nursing homes or in the home. And wherever illness is treated — in home or hospital — it will also help meet the fees of doctors and the costs of drugs." Commentary Bruce Leff, MD, professor of medicine and director of the Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine in Baltimore: "Johnson's statement regarding care at home was appropriate for the mid-1960s. To this day, skilled home healthcare remains the most used home-based service by Medicare beneficiaries. "Since Medicare was enacted, a bevy of evidence-based home care delivery models have been developed and proven. These home-based models span the care continuum including home and community-based services, home-based primary care, transitional care, and home-based palliative care. Bruce Leff, MD "Unfortunately, Medicare payment policies incentivized the centralization of care in facilities and a facility-centric culture of care delivery. Care delivery hasn't kept pace with the needs of an aging population with a high prevalence of homebound older Americans or with the advances that enable even hospital care to be delivered to patients in their preferred setting, their homes. "The hospital of the future will comprise of emergency departments, operating rooms, and intensive care units. Most other care can and will be provided in the home setting. We have all the pieces to develop this future home-based care vision. Achieving this vision will require a culture shift with associated payment and regulatory enhancements, ongoing attention to improvements in technology, logistics, and data management." An elderly woman shows her gratitude to President Lyndon B. Johnson for his signing of the Medicare healthcare bill in April 1965. Johnson continued: "Older citizens will no longer have to fear that illness will wipe out their savings, eat up their income, and destroy lifelong hope of dignity and independence. For every family with older members, it will mean relief from the often-crushing responsibilities of care." Commentary Gretchen Jacobson, PhD, vice president, Medicare program, Commonwealth Fund: Gretchen Jacobson, PhD "One third of Medicare beneficiaries said in 2023 that it was difficult to afford healthcare costs. More than 1 in 5 beneficiaries reported in 2023 delaying or skipping needed healthcare because of the cost. Similarly, some Medicare beneficiaries trade off paying for other necessities to pay for needed healthcare. The lack of a limit on out-of-pocket spending on hospital and physician services for traditional Medicare has, for most traditional Medicare enrollees, necessitated purchasing supplemental insurance coverage. Yet, the limited availability of this supplemental coverage has resulted in more beneficiaries enrolling in Medicare Advantage and high underinsurance rates among those in traditional Medicare without supplemental coverage. "Medicare beneficiaries who do not have a family caregiver and cannot afford to pay out-of-pocket for a formal caregiver are typically forced to deplete their financial resources to qualify for Medicaid coverage, the largest payer for long-term care in the US."
Business Wire
a day ago
- Health
- Business Wire
Viz.ai Announces CMS Reimbursement Pathway for Hypertrophic Cardiomyopathy via AI-Enhanced Electrocardiogram
SAN FRANCISCO--(BUSINESS WIRE)-- the leader in AI-powered disease detection and intelligent care coordination, today announced that the Category III CPT codes for AI-enabled electrocardiogram (ECG) analysis accepted and established by the American Medical Association (AMA) CPT Editorial Panel establish a national reimbursement framework for AI algorithms that perform ECG analysis for cardiac pathology, including conditions like hypertrophic cardiomyopathy (HCM), for which Viz HCM was designed. The Centers for Medicare & Medicaid Services established a Medicare rate of $128.90, effective January 1, 2025, for CPT codes 0764T and 0765T which apply to 'electrocardiograph, computerized analysis with artificial intelligence, for detection of cardiac pathology, with physician or other qualified health care professional interpretation and report' related to concurrently performed ECG or previously performed ECG respectively. These codes facilitate national reimbursement for AI algorithms like Viz HCM, which analyzes 12-lead ECGs to identify patterns consistent with HCM, a condition that often goes undiagnosed until serious complications arise. 'This is a major milestone for AI in cardiovascular care,' said Jamie Stern, senior director of Care Pathways at 'Reimbursement for AI-powered ECG interpretation empowers clinicians to identify high-risk patients earlier, before symptoms progress or serious events occur—supporting more timely diagnosis, specialist referral, and treatment.' Hypertrophic cardiomyopathy is one of the most common inherited heart conditions and a leading cause of sudden cardiac death, particularly in younger adults. Yet the majority of individuals living with HCM are undiagnosed. Viz HCM uses deep learning to flag patients at risk based on ECG data captured across a healthcare system in routine clinical workflows, advancing early detection and closing critical gaps in care. A recent study, published in JACC: Clinical Electrophysiology, demonstrated that Viz HCM achieved a high degree of accuracy in detecting HCM 1. The AI-ECG successfully identified 574 HCM patients, and in 691 cases where HCM was not identified the AI-ECG assisted in identifying alternate clinically relevant diagnosis, highlighting Viz HCM's value for more effective disease detection. "Reimbursement is a meaningful step forward for the uptake of novel technologies,' said Joshua M. Lampert, MD, FACC, cardiac electrophysiologist and medical director of Machine Learning at Mount Sinai Fuster Heart Hospital. 'This development can provide institutions with a sustainable means to build and maintain the necessary infrastructure to provide safe and effective care for patients during an actively evolving healthcare modernization process." The CPT codes 0764T and 0765T were first published in the CPT 2023 code set, effective for use on or after January 1, 2023. However, CMS had not established a national payment for these codes until January 1, 2025. This development enables physicians and health systems to integrate reimbursable AI-based ECG interpretation into routine care delivery. Viz HCM is part of the One Platform, which connects disparate data and care teams in real time to accelerate diagnosis, streamline care coordination, and improve outcomes across a range of cardiovascular and neurological conditions. 1 Desai, M. Y., Rutkowski, K., Ospina, S., et al. (2025). Real‑world artificial intelligence–based electrocardiographic analysis to diagnose hypertrophic cardiomyopathy. JACC: Clinical Electrophysiology, 11(6). About is the pioneer in the use of AI algorithms and machine learning to increase the speed of diagnosis and care across 1,800 hospitals and health systems in the U.S. and Europe. The AI-powered One® is an intelligent care coordination solution that identifies more patients with a suspected disease, informs critical decisions at the point of care, and optimizes care pathways and helps improve outcomes. Backed by real-world clinical evidence, One delivers significant value to patients, providers, and pharmaceutical and medical device companies. For more information visit
Axios
2 days ago
- Health
- Axios
FTC probes trans care claims and risks
The Federal Trade Commission on Monday launched an inquiry into whether health providers are failing to disclose risks connected with gender-affirming care or are making false claims about its benefits. Why it matters: The action could help make the case for using unfair competition laws to crack down on health providers, by asserting gender-affirming care involves deceptive claims, legal analysts say. Driving the news: The FTC solicited public comment through Sept. 26 from consumers who "may have been exposed to false or unsupported claims about 'gender-affirming care,' especially as it relates to minors." The move followed a public workshop the FTC held in early July to "gauge the harms consumers may be experiencing" surrounding gender-affirming care for minors that featured prominent critics of youth gender-affirming care. The agency justified its involvement by saying its role is to assess whether medical professionals have violated parts of the FTC Act by failing to disclose risks connected with gender-affirming care or making false or unsubstantiated claims about its benefits or effectiveness. Reality check: Gender-affirming care for minors is supported by major medical organizations including the American Medical Association. Drugs like puberty blockers and hormone therapy are prescribed based on individuals' needs and surgeries for minors are rare. Most people who accessed transition-related care as adolescents are happy with that decision as adults, research shows. Zoom out: The Trump administration has used threats of federal funding cutoffs and law enforcement against providers of gender-affirming care, especially to minors.
Time Magazine
2 days ago
- Health
- Time Magazine
A Woman Says She Was Denied Prenatal Care For Being Unmarried
A pregnant woman in Tennessee said her doctor declined to treat her because she's unmarried, citing a newly enacted state law that broadly allows health care providers to refuse to perform or pay for a service if it goes against their religious or ethical beliefs. At a town hall earlier this month, the 35-year-old woman said she's been with her partner for 15 years, though they're not married. When she had her first visit with her provider after she found out she was pregnant, she recalled, the provider said 'they were not comfortable treating me because I am an unwed mother and that goes against their Christian values.' 'I'm traveling to Virginia for my prenatal care, scared out of my mind that I will go into labor and have to deliver in this state with a provider who feels that that child's life is more valuable than mine,' she said. 'While we do love and want this child, I also have a 13-year-old and I can't leave her behind.' The woman, whose remarks at the town hall can be seen in a widely shared video, later spoke with TN Repro News on the condition of anonymity due to concerns of retaliation, saying that she fears being pregnant in her home state because of its near-total ban on abortion. She also told the outlet that she has filed complaints regarding the provider who denied her care with the Department of Commerce and Insurance and the American Medical Association. Tennessee's Medical Ethics Defense Act went into effect in April. The law 'prohibits a healthcare provider from being required to participate in, or pay for, a healthcare procedure, treatment, or service that violates the conscience of the healthcare provider.' It applies to doctors, health care institutions, and insurance companies, among others. So-called 'conscience' clauses have been considered or enacted in a number of U.S. states. These clauses have typically been quite narrow and tended to focus on a specific service, like abortion. But health law experts say that some states have, in recent years, been passing what they call very broad conscience laws, like the one in Tennessee, which they warn could lead to care denials for a wide range of health care services. 'It was exactly what I feared,' Valarie Blake, a professor at the University of Tennessee Winston College of Law, says about the story of the woman being denied prenatal care. 'Because what the law does is it essentially allows any health care professional, very broadly defined, to refuse care based on their ethical or moral beliefs for any kind of service, and there's really no limitations to that,' with very narrow exceptions. Blake says that 'there is nothing to stop a health care professional from denying care on any basis at all that they see as conflicting with their moral or ethical beliefs' under this new law—whether that be objections to providing reproductive care, or other factors, such as marital status, obesity, poverty, diet, cigarette use, or vaccination status. The law stipulates that a patient can't be denied care for services mandated under federal law, such as the Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals that receive Medicare dollars to provide stabilizing treatment to patients who are experiencing medical emergencies or transfer them to a hospital that can provide that care. But Blake says that's a narrow exception, since EMTALA only applies to patients in those emergency situations. Reproductive rights experts have also criticized the effectiveness of exceptions of this kind; many people have filed complaints against hospitals in states with abortion bans, alleging that they were denied care even while experiencing pregnancy complications, in violation of EMTALA. The Tennessee law was backed by the Alliance Defending Freedom (ADF), a conservative Christian and anti-abortion legal advocacy group. After Tennessee Gov. Bill Lee signed the bill into law, ADF Senior Counsel Greg Chafuen praised the move, saying in a statement that 'doctors and nurses have been targeted for caring for their patients by refraining from harmful and dangerous procedures' and claiming that the Act 'ensures that health care professionals are not forced to participate in procedures that violate their ethical, moral, or religious beliefs.' Mary Ziegler, a professor at the University of California, Davis School of Law, says she doesn't think the people behind the Tennessee law intended for it to be so far-reaching, but 'if you write a law this broad, you will discover lots of people who are involved in health care have all kinds of objections to all kinds of things.' Experts fear that the Medical Ethics Defense Act will make it even more difficult to access care at a time when the health care system is already facing a number of challenges. Many pregnant people living under abortion restrictions have been forced to travel across state lines to access care since Roe v. Wade was overturned in 2022. President Donald Trump's 'Big Beautiful Bill,' which he signed into law on July 4, includes sweeping cuts to Medicaid and is projected to cause millions of people to become uninsured by 2034. Rural hospitals across the country have been shutting down or fighting to stay open, leaving many community members struggling to access care. Read More: 'An Exodus of OB-GYNs': How the Dobbs Decision Has Shaken the Reproductive Health Landscape 'Tennessee is a place that has already banned abortion. There have been hospital closures. It ranks as one of the highest states with maternal mortality in the country,' says Israel Cook, legislative counsel at the Center for Reproductive Rights. 'I think [the law] is just pushing health care out of reach for so many people. Abortion care, prenatal care, postpartum care, all of these reproductive health care [services] are standard health care that should be accessible and available for everyone.' Health law experts say the 35-year-old woman's story was the first example they've heard of a care denial under the new law—but that they fear there may be more. 'I do think that it's only a matter of time before we hear more and more of these stories,' Blake says.
Medical News Today
5 days ago
- Health
- Medical News Today
Is obesity a chronic condition?
For decades, people thought being overweight was simply due to a lack of willpower. Nowadays, doctors worldwide see it as a serious, chronic (long term) illness that needs careful is a complex condition in which excessive fat deposits can negatively impact many aspects of to the Centers for Disease Control and Prevention (CDC), almost 42% of US adults over age 20 have obesity. More than 100 million adults have obesity and more than 22 milllion have severe such as the American Medical Association and World Health Organization (WHO), recognize obesity as a chronic condition that often develops gradually and worsens over is a risk factor for serious health conditions, such as type 2 diabetes, heart disease, stroke, cancer, and nonalcoholic fatty liver disease. It can affect both male and female fertility and increase complications during this reason, medical organizations recognize obesity as a chronic illness. Classifying it as this can affect:treatment approachesinsurance coverage and access to careresearch fundingpublic health policyweight stigma and discrimination»Learn more:Does insurance pay for weight loss surgery?Obesity is not simply due to a lack of discipline or poor lifestyle choices, and many factors interact to cause it. The following factors may contribute to obesity:a diet that provides more energy than the body usesphysical inactivitypoor sleepstressalcohol consumptionenvironmental factors, such as marketing and advertising, and an abundance of cheap, processed foodsgeneticshormonesmetabolic issues, such as an underactive thyroiduse of medications, such as antidepressants and steroidsadvancing agemental health conditions, such as depression and anxietyRecognizing the many contributors to obesity can help people manage the condition, lose excess weight, and improve their overall moreWhat are the effects of obesity?What are the treatments for obesity?How is obesity diagnosed?What are some of the risk factors for obesity?
