I read a news story this week that sent me on a nostalgic trip down memory lane. This past Monday, July 30th was the 47th anniversary of Medicare. To celebrate it, the Raging Grannies, as they're known, gathered outside the county office building in Rochester, New York to protest rumored cuts to their Medicare coverage.
They praised Medicare in song as "the best deal we have in the country," and even called for expanding it Medicare into universal health care for everyone.
It seems the Republican Speaker of the House, John Boehner, was coming up from Washington to raise funds for Republican congressional candidate Maggie Brooks. The Raging Grannies wanted to make certain Ms. Brooks didn't sign on to the GOP budget which includes cuts to Medicare.
For myself, the Raging Grannies channeled a familiar voice -- the Texas twang of my boss back in 1965, Lyndon Baines Johnson.
I was a White House assistant at the time and had been working with the President and others on the team trying to get Medicare through Congress. Even with overwhelming Democratic majorities in the House and Senate, it was one tough fight. Others had tried before us.
In his 1948 State of the Union message, President Harry Truman said:
"This great Nation cannot afford to allow its citizens to suffer needlessly from the lack of proper medical care. Our ultimate aim must be a comprehensive insurance system to protect all our people equally against insecurity and ill health."
But every time Harry Truman proposed legislation to do just that, Congress refused to budge. In the 1960s, John F. Kennedy took up the cause:
"Our working men and women, instead of being forced to ask for help from public charity, once they are old and ill, should start contributing now to their own retirement health program through the Social Security System..."
But his proposal failed in the Senate by just two votes.
On the other side, actor Ronald Reagan, still in private life, had signed on as the American Medical Association's hired spokesman in their campaign against Medicare. Doctors' wives organized thousands of small meetings in homes around the country, where guests listened to a phonograph record of Reagan deploring the evils of "socialized medicine":
"Behind it will come other Federal programs that will invade every area of freedom as we have known it in this country [...] until one day, as Norman Thomas said [...] you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free."
But now, it was Lyndon Johnson's turn. Tragically thrust into the White House by Kennedy's assassination, LBJ, the son of Franklin Roosevelt's New Deal and Harry Truman's Fair Deal, vowed to finish what they had started. He pushed us relentlessly to get it done. Here he is talking to his Vice President, Hubert Humphrey, in early March of 1965:
"They are bogged down. The House had nothing this week, all ---damn week. Now that's where you and Moyers and Larry O'Brien have got to find something for them. And the Senate had nothing [...] so we just wasted three weeks [...] Now we are here in the first week in March, and we have just got to get these things passed [...] I want that program carried. And I'll put every Cabinet officer behind you. I'll put every banker behind you. I'll put every organization we got behind you [...] I'll put the labor unions behind you."
About all he had left was the White House kitchen sink, and pretty soon he threw that behind us, too.
Later that March he called me to talk about a retroactive increase in Social Security payments that we were supporting. I had argued for it as a stimulus to the economy. LBJ said okay, but reminded me that social security and Medicare were about a lot more than economics:
"My inclination would be [...] that it ought to be retroactive as far back as you can get it [...] because none of them ever get enough. That they are entitled to it. 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. I never did it because I thought it was going to be good for the economy of Austin. I always did it because I thought she was entitled to it. And I think that's a much better reason and a much better cause and I think it can be defended on a hell of a lot better basis [...] We do know that it affects the economy [...] But that's not the basis to go to the Hill, or the justification. We've just got to say that by God you can't treat grandma this way. She's entitled to it and we promised it to her."
LBJ kept that promise. He pushed and drove and cajoled and traded, until Congress finally said yes. And so it was that 47 years ago, we traveled to Independence, Missouri, the hometown of Harry Truman, and there with the former president at his side, LBJ signed Medicare into law. Turning to Truman, whom he called "the real daddy of Medicare, " Johnson signed him up as its first beneficiary. Harry Truman was 81.
All this was high drama, touched with history, sentimentality, politics, and compromise. A whole lot of compromise. The bill wasn't all LBJ wanted. It was, in fact, deeply flawed. There were too few cost controls, as some principled conservatives warned, who were then rudely ignored. Co-pays and deductibles remain a problem. And we didn't anticipate the impact of new technology, or the impact of a burgeoning population.
In fact, even as he signed the bill we still weren't sure what all was in it. As LBJ himself once told me, never watch hogs slaughtered before breakfast and never, never, never show young children how legislation gets enacted.
But Lyndon Johnson had warned: "We will face a new challenge and that will be what to do within our economy to adjust ourselves to a life span and a work span for the average man or woman of 100 years."
That longevity, and the cost, are what we must now reckon with. As the historian Robert Dallek has written, Medicare and Medicaid, the similar program for the very poor, "...did not solve the problem of care at reasonable cost for all Americans", but "the benefits to the elderly and the indigent...are indisputable."
And there's no going back, current efforts notwithstanding. A new study in the journal Health Affairs finds that Medicare beneficiaries age 65 and older are more satisfied with their health insurance, have better access to care, and are less likely to have problems paying medical bills than working-age adults who get insurance through employers or purchase coverage on their own.
So sing on, Raging Grannies, sing on. The surest way to save so popular and efficient a health care system is to make it available to everyone.
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