Let me start with the last question:

-why, if this system was so efficient, the public supported the development of a government program to fund medical care of the elderly? People tend to leave a thing alone if it's not malfunctioning in some way.

Oh, get real. Like the government has never cobbled up an artificial "need" (sometimes created by its own bungling) and then proposed some gigantic, expensive program to "solve" it. Usually involving a new agency or two, and always resulting in more power to the centralized government and less power to the citizen. This is then enthusiastically shoved down our throats, accompanied by sincere and fervent lies about how much it will help and how much it will cost.

This is not limited to social programs either, or maybe you actually believe that every multibillion-dollar weapon system demanded by the military was really necessary for a proper defense of our nation, or every highway project or other similar pork load was vital to our nation.

As for the rest of your questions, if you are actually interested in Medicare and having your questions answered, and not just scoring points, find this book.

Here's a bit from a short review of the book. Please pay special notice to how a camel gets its nose under the tent, and then not only gets into the tent, but turns out to be a brachiosaurus instead of a camel (boldface mine):

Ms. Blevins correctly recalls that five years before Medicare was enacted low income seniors were enjoying an ever widening growth of the Kerr-Mills program. This program, named after and energetically supported by the then two most powerful democratic congressional leaders, had enjoyed the strong support of the medical profession, because it was voluntary and helped those in need because of inadequate income. On August 23, 1960, the Senate passed the legislation by a vote of 89 to 2. On September 13, 1960, over President Eisenhower's signature, it became law.



There is persuasive evidence that, despite strong support of both Democrats and Republicans, top officials in the Department of Health, Education and Welfare (HEW; later HCFA) who were charged with the responsibility to help implement the law instead traveled the country making speeches opposing Kerr-Mills because it was voluntary and didn't cover all of the elderly.

There is also compelling evidence that those same government officials attempted to sabotage the program by concealing the true costs of the proposed Medicare because, for many of them, Medicare, if passed to cover everyone over 65, would provide the "foot in the door' toward their ultimate objective --- socialized medicine for all citizens.

In 1965, HEW officials told Congress that hospital coverage for their proposal, the King-Anderson Bill (Medicare), would require no more than a one-percentage increase in the payroll tax. They also declared that by the year 2000 annual costs would not exceed $2.5 billion. According to government figures, in 2000, workers paid $144 billion into the Medicare Part A hospital fund, 57 times the original projection for the Congress.

The American people were told that the wage base for taxation would be limited to $6600. Contrast those figures with today. The Social Security cap on income is $80,400 and there is no longer any cap on Part A Medicare taxes, which are now levied on total income however large.

It is significant that a renowned statistician, who for 35 years had conducted health and welfare costs for the federal government, projected for Nation's Business in 1964 that Medicare would cost at least three times what the bureaucrats estimated and eventually perhaps ten times as much. After his statistical staff was taken away without explanation, he retired from federal service and was quoted as saying, "If a sound realistic health program cannot
be accepted by the public on its merits, it should not be imposed on them by government."



And now, ladies and gentlemen, here comes prescription drug coverage. This time they're telling us the truth. Really.

If you really can't find the book easily or cheaply (cripes, are you a librarian or not?) you might want to check out this transcript from a lecture by the author, which describes the systematic destruction of private alternatives (with the enthusiastic support, unfortunately, of many of those alternatives) and the hammerlock the program has on the elderly. A short quote:

(Blevins:) ...The first -- I like saying, "did you know" -- did you know that when you retire and you go to apply for your Social Security benefits that you will be forced to enroll in Medicare Part A in order to get your Social Security benefits? You cannot reject that entitlement. Now, I am not talking about you wanting to not have to pay taxes. Let's say you have already paid taxes, you go in, you sign up for Social Security; you have to take that Medicare Part A.



The only way you can forego enrollment is to forego all the Social Security benefits that you were taxed for
and promised your entire working lives.

Well, since giving up Social Security benefits is too costly for most seniors, most are not going to have a choice but to participate in Medicare. And then, once enrolled, they are going to be forced to abide by more than 100,000 pages of Medicare rules and regulations that dictate what services are covered for most seniors.

Medicare Part A is the hospital portion. People are familiar with that part. What is also important to recognize is the Federal Government also automatically enrolls seniors in Part B, which is the outpatient doctor portion, when they enroll them in Part A. Now, technically, seniors do have the freedom to reject Part B without losing their Social Security benefits. But here's the kicker. Although Part B is considered voluntary, you really do not have any other choice. And the reason is because there are not any other options for seniors to buy private, comprehensive health insurance in the free market.

This situation came about because when Medicare was created in 1965, insurance companies began canceling policies for seniors and encouraged them instead to enroll in Medicare. Today, there are not any health insurance companies that will sell, again, its comprehensive health coverage to Medicare-eligible seniors. And, in fact, Patrick Rooney of the Golden Rule Insurance Company, filed an affidavit in 1997, in a lawsuit, affirming that, to the best of his knowledge, there is no health insurance product available in the U.S. market to U.S. citizens who are 65 years of age or older that would provide coverage in lieu of Medicare. Now, of course, seniors who continue working can maintain their employee-based coverage, and those retirees in Medicare can purchase supplemental insurance to cover things that Medicare does not cover. But you are not going to be able to opt out of Medicare Part B because there is nothing else in the marketplace that exists to provide coverage.

Why is this first point so important? I think it is important because this is not the case in other countries. It is worth noting that even in socialistic countries like the U.K. and the Netherlands, they do not force their seniors to give up their private health insurance and join a government program when they turn 65. In fact, those countries allow seniors, and their marketplaces allow seniors, to maintain private coverage as long as they like.

Now, you might be thinking, well, what is the big deal about being enrolled in Medicare? I pay taxes to support the
program; of course, I want so-called free care when I retire. Well, the second point that I would like to highlight is the fact that once you're enrolled in Medicare, the Federal Government effectively prevents seniors from paying privately and spending their own money on things that Medicare covers. Consider this. You're 64; you're working. You are
free to go out and spend your own money on anything you want, assuming that the health care is legal. Your employers really don't care whether you spend your own money on services that your employer-sponsored health insurance would pay for. And, in fact, most employers would be quite happy for their workers to spend more of their own money on health care.

Yet, at age 65, when Americans become eligible for Medicare, and they are forced to enroll, at that moment you
automatically lose your freedom to spend your own money on services that Medicare covers. Now, this provision -- I call it the Canadian style Medicare system -- that was adopted in 1997, was adopted when Congress passed the Balanced Budget Act of 1997. And you probably recall that the United Seniors Association challenged that section of the Medicare law. And it went up to an appeals court. But the court never addressed the constitutionality of that provision. Instead, the court focused on whether or not seniors are free to spend their own money on things that Medicare does not cover, which, of course, you know they are free to spend their money on things that Medicare does
not cover. But the court never addressed what happens when you want to spend your own money on things that Medicare does cover.

What is the problem with this policy? I say it leads to what I call underground rationing. And I call it underground
rationing because many doctors do not want to have to admit publicly that they are currently rationing medical care to
seniors in the United States. However, I have had physicians admit to me personally, and regretfully I might add, that because government payments are inadequate in some cases to treat patients, and because physicians are not free to set their own prices, they simply cannot afford to provide some services to some of the oldest and sickest people in this country.

Now, what is interesting is that the government's rationale from restricting seniors from paying privately is that they are afraid that greedy doctors are going to defraud poor, innocent seniors. Yet, when you look at what happens under the currently federally regulated system, Medicare fraud and abuse, with the Federal Government watching our dollars, amounts to $32 million per day. That is $32 million per day, or approximately $11.9 billion per year.



More where that came from. Hey, you asked.

If you want a sure sign that a government "humanitarian" program is more concerned about gathering political power than actually serving humanity, try proposing alternatives that serve ONLY those people who actually need it (means testing, vouchers, etc.) instead of the usual proposed universal programs. A real humanitarian would jump at it. A power-seeker would realize that this would not control nearly enough people and fight it tooth and nail. Another tip is that the power-seekers are violently allergic to any solution that is voluntary. Keep this in mind as you watch the coming debates over prescription drug welfare.

As for your grandfather's situation, I recommend checking around with friends who have elderly in homes and seeing if the situation is that much better under Medicare.