Mark K. Updegrove, Director of the LBJ Presidential Library,
examines President Lyndon Johnson’s battle to pass Medicare and how he succeeded where others had failed.
Just over a year before his election, Johnson had taken the presidency in the wake of the assassination of John F. Kennedy, using his prodigious legislative skills to pass bills that had eluded Kennedy, including the 1964 Civil Rights Act. Now, upon earning the job in his own right, Johnson urged Americans to join him “in the battle to build the Great Society,” which would rival FDR’s New Deal in its sheer audacity amounting to no less than a social revolution. Johnson’s plan included everything from voting rights and immigration reform to federal aid to education and the creation of endowments for the arts and humanities, all of which would see its way into law during the course of 1965.
But at the top of his agenda was Medicare, a federally funded insurance program to provide low-cost medical and hospital care for America’s elderly under Social Security. Half of the country’s population over age 65 had no medical insurance, and a third of the aged lived in poverty, unable to afford proper medical care. Johnson, as part of his aggressive “War on Poverty,” believed it was high time to do something about it.
Shortly after his November election win, Johnson told his Department of Health, Education, and Welfare’s assistant secretary, Wilbur Cohen, to make Medicare the administration’s “number one priority.” On January 4, Johnson put the issue front and center in his State of the Union message; three days later he pressed for passage of Medicare, issuing a statement to Congress proposing that “every person over 65 years of age be spared the darkness of sickness without hope.”
FDR was the first president to seriously consider a federal health insurance program. As Congress churned out New Deal legislation, Roosevelt advocated inclusion of a federal health insurance component in his Social Security Act of 1935, before dropping it to avoid jeopardizing the bill’s passage. Fourteen years later, Harry Truman sent the House a bill that would offer health insurance to those age 65 and older, but an intractable Ways and Means Committee blocked it. John F. Kennedy tried, too, sending a comparable bill to Capitol Hill in 1962, where it missed passage in the Senate by a few votes.
In each case, the American Medical Association (AMA) was the chief culprit in killing the legislation, spending millions to brand the concept as “socialized medicine.” Conservatives were also skeptical. Actor Ronald Reagan, a leader of the growing conservative movement and soon-to-be California gubernatorial candidate, warned that such a program would “invade every area of freedom in this country” and would, in years to come, have Americans waxing wistful to future generations about “what it was like in America when men were free.”
Still, Johnson believed “the times had caught up with the idea.” In a telephone call on March 23, Johnson urged Arkansas Congressman Wilbur Mills, Chairman of the powerful House Ways and Means Committee, and Wilbur Cohen to keep the bill on track. Their conversation is typical of the “Johnson Treatment” of unrelenting persuasion:
LBJ: When are you going to take it up?
Mills: I’ve got to go to the Rules Committee next week.
LBJ: You always get your rules pretty quickly though, don’t you?
Mills: Yeah, that’s right.
LBJ: . . . For God’s sake, let’s get it before Easter! . . . They make a poll every Easter. . .You know it. On what has Congress accomplished up till then. Then the rest of the year they use that record to write editorials about. So anything that we can grind through before Easter will be twice as important as after Easter.
(Mills gets off the telephone line)
LBJ: Now, remember this. Nine out of 10 things that I get in trouble on is because they lay around. And tell the Speaker and Wilbur [Mills] to please get a rule just the moment they can.
Cohen: They want to bring it up next week, Mr. President.
LBJ: Yeah, but you just tell them not to let it lay around. Do that! They want to but they might not. That gets the doctors organized. Then they get the others organized. And I damn near killed my education bill, letting it lay around.
LBJ: It stinks. It’s just like a dead cat on the door. When a committee reports it, you better either bury that cat or get it some life in it . . . [to Mills as he gets back on the line:] For God’s sakes! “Don’t let dead cats stand on your porch,” Mr. Rayburn used to say. They stunk and they stunk and they stunk. When you get one out of that committee, you call that son of a bitch up before [our opponents] can get their letters written.
Medicare passed both houses of Congress by July 9. Mills handled the legislation through Congress so skillfully he was, in Johnson’s words, “a hero to old folks.”
One of those “old folks” was the 33rd president Harry Truman. On July 30, Johnson traveled to the Harry S. Truman Library and Museum in Independence, Missouri, where the 81-year-old Truman, lean and bent with age, and his wife, Bess, watched Johnson sign Medicare into law. Proclaiming the 33 president the “real daddy” of Medicare, Johnson awarded President and Mrs. Truman the first two Medicare cards, numbers one and two respectively.
After the signing ceremony, Johnson spoke about the critical need for Medicare and its long-term impact. “There are those, alone in suffering who will now hear the sound of some approaching footsteps coming to help,” he said, with palpable satisfaction. “There are those fearing the terrible darkness of despairing poverty — despite their long years of labor and expectation — who will now look up to see the light of hope and realization. There just can be no satisfaction, nor any act of leadership, that gives greater satisfaction than this.”
For more information about the 50th Anniversary of Medicare and Medicaid, visit the LBJ Presidential Library. Follow the library on Facebook and Twitter.
Mark K. Updegrove is the director of the LBJ Presidential Library in Austin, Texas, where, in April 2014, he hosted the Civil Rights Summit which included addresses by President Barack Obama and former Presidents Jimmy Carter, Bill Clinton, and George W. Bush. He is the author of Indomitable Will: LBJ in the Presidency (2012), Baptism by Fire: Eight Presidents Who Took Office During Times of Crisis (2009), and Second Acts: Presidential Lives and Legacies After the White House (2006). His latest book Destiny of Democracy: The Civil Rights Summit at the LBJ Presidential Library was published in February. He has conducted exclusive interviews with five U. S. Presidents.