On July 30, 1965, President Lyndon Johnson signed into law the Health Insurance for the Aged Act, or as it is better known, the Medicare & Social Security Amendments of 1965. This established Titles 18 and 19 of the Social Security Act, which are better known to us today as Medicare and Medicaid.
Creation of these programs was not free of political and public resistance. Organized medicine was largely opposed and actively fought to prevent passage of the legislation. Twenty years prior, organized medicine had successfully defeated a similar proposal advanced by President Harry S. Truman.
The establishment of Medicare and Medicaid has its roots in the closing years of World War II. In 1943, Sen. Robert Wagner, Sen. James Murray, and Rep. John Dingell introduced the Wagner, Murray, Dingell bill -- better known as the WMD bill-- which would have expanded the Social Security Act to include a national health insurance system. The bill faltered in committee and never developed momentum. However, in 1944, President Franklin Roosevelt revived the WMD bill. After Roosevelt died, Truman continued the push for a national health care system as outlined in the legislation.
During the next five years, Truman fought a tireless campaign against Congress, the public and organized medicine. This public debate is captured in Monte M. Poen's book “Harry S. Truman Versus the Medical Lobby: The Genesis of Medicare.”
Despite his best efforts, Truman’s vision for the creation of a national health care system failed, largely due to the public outcry generated by organized medicine. The AMA spent more than $1.5 million on a national advertising campaign urging defeat of “socialized medicine.” The ads featured the catch phrase “guard your health, guard your pocketbook; socialized medicine would rob both.” In 1950, Truman gave up pursuit of his legislation.
The nation’s attention between 1950 and 1965 was largely focused on rebuilding the economy and the cold war. Health care, however, remained a prominent issue because more, and older, citizens faced daunting economic losses due to their health. In 1965, Johnson decided to refocus the nation’s attention on the issue. On Jan. 7 of that year, Johnson delivered a speech to the 89th Congress entitled “Advancing the Nation’s Health”
in which he called for the establishment of an insurance program for the aged and needy children. During the course of seven months, Congress developed and approved the Social Security Amendments of 1965 (H.R. 6675).
The purpose of the legislation, as written by its authors, was "to provide a hospital insurance program for the aged under the Social Security Act, with a supplementary health benefits program and an expanded program of medical assistance, to increase benefits under the old-age, survivors, and disability insurance system, to improve the federal-state public assistance program, and for other purposes.”
Despite strident opposition from many, including organized medicine, the legislation was approved 307-116 in the House of Representatives and 70-24 in the Senate. Johnson signed the legislation on July 30th in Independence, Mo., at the Truman Library, in the presence of Truman. President Truman, following World War II, had devoted his presidency to the creation of a national health insurance program, but his most sought-after goal was to create a medical and economic safety-net for older Americans. At the signing ceremony, Truman stated, “Mr. President, I am glad to have lived this long and to witness today the signing of the Medicare bill which puts this Nation right where it needs to be, to be right.”
In his comments on that historic day Johnson stated, “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles and their aunts.”
Eighteen million people were eligible for Medicare in Aug. 1965. By March 31, 1966, 17 million had enrolled. A majority of the remaining 1 million were enrolled by the end of May. On July 1, 1966, the programs began covering medical services for eligible and enrolled individuals.
Next month, these two programs will celebrate their 50th anniversaries
. Now, five decades removed from the heated political debate of the times, the programs are widely accepted as important components of our health care system and the social contract between our nation and its citizens. Today, more than 120 million people are enrolled in the Medicare and Medicaid programs. Enrollment in Medicare will continue to increase by 10,000 beneficiaries per day for the next decade as baby boomers become eligible.
By 2030, total enrollment in Medicare will exceed 80 million. Similarly, enrollment in Medicaid continues to increase as a result of the Patient Protection and Affordable Care Act, which extended eligibility to a larger portion of the population.
Both programs have undergone changes during their first 50 years. The most notable are the addition of the Children’s Health Insurance Program to Medicaid in 1997 and the Medicare Prescription Drug Benefit established in 2003. An overwhelming portion of the AAFP’s advocacy agenda for the past 50 years has been associated with these two programs. Looking forward, we see a continuation of this trend -- especially in Medicaid, which is now the largest health insurance plan in the nation.
I have spent my professional career arguing for and against policies that would reform and repair these two programs. The AAFP, through our advocacy efforts, has made significant improvements to care delivery, quality, and payment in both Medicare and Medicaid. Yet, we have so many lingering concerns and recommendations on what should be done to improve the programs for the millions of people who rely upon them. Normally, I would provide a series of resources for you to support the issue outlined in the blog, but this week I am leaving you with a quote from Johnson’s 1965 speech. I hope it reinforces why the voice of the concerned and compassionate physician is so important to our national debates and demonstrates all that can be achieved when we focus on doing the right thing for those in need.
“Few can see past the speeches and the political battles to the doctor over there that is tending the infirm, and to the hospital that is receiving those in anguish, or feel in their heart painful wrath at the injustice which denies the miracle of healing to the old and to the poor. And fewer still have the courage to stake reputation, and position, and the effort of a lifetime upon such a cause when there are so few that share it.”