If you’re an endocrinologist who takes care of seniors with diabetes, you should say “Thank You!” to Lyndon B. Johnson.

Yesterday marked the 50th anniversary of Medicare (see: https://www.medicare.gov/anniversary/index.html). And while the politics and questions about this program continue (see: http://www.huffingtonpost.com/entry/medicare-was-born-50-years-ago-today-and-its-still-under-attack_55b93d85e4b095423d0db7f9?), it marked a healthcare ethics milestone in the United States.

Medicare has had an especially profound impact on ethical care for people with diabetes, and end-stage-renal disease (see: https://www.annanurse.org/download/reference/health/esrdReimbursementFactSheet.pdf)

But Oh — The Times They Are A-Changin’…

When Medicare was signed into law on July 30, 1965, just 1.2% of the population had diabetes, which translated then into 2.39 million Americans. In 2014, the CDC reported that 29.1 million Americans (9.3% of the population) have diabetes, but of those, 8.1 million remain undiagnosed (see: http://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html). You can view the growth in diabetes prevalence from 1958-2013 here: http://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf

The sharp increase in diabetes was likely never foreseen, but we now know how much this is tied to obesity and our toxic diet, particularly the aggressive marketing of sugary drinks. (http://endocrineethicsblog.org/mad-men-finale-and-type-2-diabetes-what-happened-when-we-bought-the-world-a-coke/)

Countless people with diabetes may not be diagnosed until they have access to primary care and health coverage, which is why last month’s SCOTUS ruling on the Affordable Care Act is so important. (http://endocrineethicsblog.org/bench-to-bedside-how-the-supreme-court-decisions-this-week-affect-endocrinologists/)

It was also reported yesterday that only 1 in 3 seniors are actually well controlled http://consumer.healthday.com/diabetes-information-10/demographic-diabetes-news-177/seniors-diabetes-control-diabetes-care-jhbsph-release-batch-1857-701577.html), and some of these reasons may have to do with continuing health disparities.

One thing is certain: LBJ did the right thing 50 years ago. And your patients are still benefiting.