Today in 1966: Medicare takes effect

July 1, 2011

Today in Legal History45 years ago today, the federal Medicare program went into effect.

The program was the culmination of national health insurance efforts that started during the Great Depression.

It was one of Franklin Roosevelt’s goals to institute a national health insurance program as part of his New Deal, since healthcare costs were rapidly rising and access to medical care was greatly limited by income.

The plans, though, were shelved in favor of advancing Roosevelt’s Social Security program, since Roosevelt believed that simultaneously pushing his healthcare plans may interfere with the passing of Social Security.

Because of strong opposition, from both the American Medical Association who believed Roosevelt’s “socialized medicine” would strip doctors of their autonomy, and from southern Democrats who believed that further government expansions could interfere with segregation, Roosevelt’s proposals floundered.

However, the ideal was passed to two future presidents: Harry Truman and Lyndon B. Johnson.

Truman, Roosevelt’s Vice President, continued Roosevelt’s call for a national medical program.

The political landscape was not favorable to Truman, and the proposals, again, failed to gain any traction, and with the election of Republican President Dwight D. Eisenhower, they were dead in the water for eight years.

The plans saw new life with the election of John F. Kennedy, but at this point they had been pared down as an expansion of Social Security, that is, a program funded by payroll taxes covering those 65 years of age or older.

Again, though, because of the political climate, these plans failed.

When Johnson assumed the presidency in 1963, he brought Roosevelt’s ideals with him.

When Roosevelt was president, Johnson was a representative in the House and a strong ally of Roosevelt’s.

Johnson’s belief in a national health program stemmed from his fierce rural populism, as released audio tapes of Johnson’s conversations detail.

Specifically, he believed that his elders were “entitled” to health benefits, and to no end, at that.

“That’s an obligation of ours. It’s just like your mother writing you and saying she wants $20, and I’d always sent mine a $100 when she did.”

The same opposition that Roosevelt faced from southern Democrats and the AMA persisted and plagued advancement of Johnson’s Medicare plans.

The AMA actually deployed strong lobbying efforts, including enlisting Ronald Reagan as the spokesman for their campaign against Medicare in 1963.

The AMA deployed physician’s wives to communities across the country to hold informal meetings designed to organize opposition to Medicare.

The main event of the meetings was the playing of a recorded message of Reagan stirringly detailing how Medicare was the first step towards a socialist America.

The opposition was short-lived, since Johnson’s 1964 landslide election victory bestowed on him a strong mandate.

The Social Security Act of 1965, to which both Medicare and Medicaid were attached, was signed into law at the Harry S. Truman Presidential Library in Independence, Missouri, with Truman present.

When the program was implemented on July 1, 1966, over 19 million individuals had enrolled.

Today, more than 40 million seniors are enrolled.

The necessity of program is not debated in mainstream politics.

Rather, attempts to diminish or eliminate the program (or perceptions of such attempts) can be politically deadly.

Whether any other major federal health care programs come to be as treasured as Medicare may not be readily apparent; we may have to wait another 40 years to find out.