50 years later, how Medicare changed America

Innovation Hub

Few programs have had so much impact on lives of ordinary Americans as Medicare. But what seems like a mundane program has actually been controversial during much of its 50-year history. And the law that was signed on July 30, 1965, wasn't even close to the original dream:

Nearly 20 years before Medicare was signed into law, President Harry Truman passionately sought out a new sort of health insurance — universal care for all Americans, paid for by tax dollars.

But new ideas sometimes fail to launch. And this idea, in particular, was disliked by the most powerful medical group in the country, the American Medical Association.

“[Advocates] couldn’t overcome the propaganda launched by the AMA and business groups that this would be socialistic — just as the Cold War was heating up,” explains Jennifer Klein, a professor of history at Yale.

In fact, Klein says that Medicare was born out of all kinds of compromises. Universal health care advocates decided to just focus on one sliver of the population: older Americans. Even that effort took work — and some rebranding. The words used to describe this group shifted, and older people became known as "senior citizens," rather than the aged or the elderly.

“By 1962, the public support had really risen for what they called: ‘universal, public health insurance for the elderly, with dignity.’ They really recognized what they had done for the nation with their lives," adds Klein.

When Lyndon Johnson was swept into office on a rising liberal tide in 1964, Medicare became doable, with its impacts felt well beyond the medical world. Before it passed, hospitals in the South were still largely segregated. Medicare forced their integration.

But Klein notes that Medicare was different from Civil Rights legislation, or welfare for the poor:

“I think what’s really important to point out, is it would not be a poverty program. Rather, it was aimed at being a universal program as a right of citizens. It was a universal, federally operated, government health insurance plan; all beneficiaries would participate in the same program, with the same benefits, premiums — and eligibility is automatic. So that’s really why it has such widespread popular support. Because it’s seen as a program for everybody.”

Medicare was a creation that may not have fully pleased anyone. Certainly not the people who opposed the government getting involved in healthcare at all. But also not the people who want the government to take over healthcare, because Medicare is built on our private insurance system.

50 years ago marked the beginning of a grand experiment. A concept that was reiterated, repackaged and rebranded. Because even presidents can have trouble bringing ideas to market.

A version of this story first aired as an interview on PRI's Innovation Hub.

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