The Great Society and the High Tide of Liberalism

Chapter 12 - Medicare: The Great Society’s Enduring National Health Insurance Program

Medicare The Great Society’s Enduring National Health Insurance Program Edward Berkowitz 320 Ahigh official in the Johnson administration described Medicare as a “real jewel in the crown of the federal government.”1 President Lyndon Johnson, who readily agreed, put Medicare in the company of the Social Security Act of 1935 and the Elementary and Secondary Education Act of 1965 as the most “comprehensive and constructive and beneficial” public acts in the period between the New Deal and the end of his term in 1969.2 With great pride, he signed the Social Security Amendments of 1965 into law on July 30, 1965, in an impressive ceremony at the Truman Library in Independence, Missouri. This comprehensive piece of legislation included significant provisions related to Social Security and public assistance. Most important, however, it initiated a social insurance program that paid many of the hospital and doctor bills of the nation’s elderly, and it started Medicaid, which was federal assistance to the states to help pay for the medical care of welfare recipients and other indigent individuals. It was President Johnson’s pride that prompted him to sign the Medicare bill in the presence of President Harry Truman. Like a dutiful son, Johnson wanted to share his triumph with one of the fathers of national health legislation. Truman had chosen to highlight health insurance in his postwar domestic program and had delivered an unprecedented message on the subject to Congress in November 1945. Fighting for political survival in a nation that knew little about him, Truman hoped that advocating national health insurance would show his desire to embrace and expand President Roosevelt’s New Deal agenda. Roosevelt, after all, had never found the right moment to endorse national health insurance . Truman could, in effect, do it for him. The results were less than salutary. Truman won a few points with liberals for his advocacy of health insurance but failed to get Congress to approve the measure. Even the labor unions, whom Truman courted through such actions as vetoing the Taft-Hartley bill, despaired of the federal government’s prospects in passing health insurance and deserted the cause by seeking alternatives within their collective bargaining agreements. As he traveled to Independence, Johnson could lay claim to finishing what Truman had started (and, of course, succeeding where Truman, and Kennedy, for that matter, had failed). At last Congress had agreed to national health insurance.3 Not all the president’s advisers thought it was a good idea to highlight Truman at the signing ceremony. Wilbur Cohen, the assistant secretary of health, education, and welfare who had done much of the staff work on Medicare, worried that Truman’s presence would send the wrong signal. People might compare Johnson’s law with President Truman’s proposals and get the impression that the administration advocated the same things as had Truman. Medicare covered only the nation’s elderly, and Medicaid covered the nation’s poor. Truman had wanted a program that reached everyone, regardless of age or financial condition.4 Johnson brushed such objections aside, and the ceremony went off without any untoward political incidents. It was a moment of triumph for Johnson that marked the apex of his mastery of Congress. Although other victories would follow the passage of Medicare, urban riots, including one in the Watts section of Los Angeles that began only a few weeks later, and foreign wars would tarnish the president’s popularity and strain the government’s administrative capacity.5 Easy in retrospect, with a popular president confronting a compliant Congress, the passage of Medicare required consummate political skill. Throughout the original debate over Medicare, conservatives and representatives of the medical profession harbored two fears. One was that Medicare was only a way station on the road to national health insurance; the other was that the passage of Medicare would provide an opening through which the federal government would regulate the practice of medicine. Medicare proponents went out of their way to assert that Medicare 321 neither fear was justified. They repeatedly stressed that Medicare, once passed, would not become the basis for a national health insurance program that covered people of all ages. “The problem of the aged is a unique problem and . . . I can think of no practical way to meet this problem than through the Social Security approach. The younger members of the population do not have the same...