Medicare at 50: a long political struggle
Medicare came into being 50 years ago. In the context of the long history of struggles to obtain national health insurance in the USA, this was a momentous act.
Organized efforts to attain national health insurance in the USA began in the early 20th century, first by the Socialist Party, and soon after, by the Progressive Party and the American Association for Labor Legislation. At first, the American Medical Association (AMA) supported the idea of national health insurance, but then reversed its position. The Journal of the American Medical Association (JAMA) presented national health insurance as a “revolutionary” and “Bolshevik” menace to the public health, undermining traditional American values of individualism and self-reliance.
Despite such claims, national health insurance became an increasingly insistent policy demand. Few politicians wanted to provoke the ire of the AMA or face the opposition of the insurance industry, the pharmaceutical industry, and an array of conservative political forces that declared that any proposal for “socialized medicine” was probably inspired by Communism. With no politically viable alternative, private sector health insurance grew steadily, especially as unions insisted on including health benefits in bargaining agreements. Health insurance thus became tied to employment; retirees, the unemployed, and the underemployed were largely left out.
At that time, older Americans had low incomes and no health insurance. The elderly were much more likely than younger people to suffer from chronic diseases, they needed more medical care, and their hospital stays were longer and more frequent. Insurance companies, therefore, considered them a “bad risk”, and were not particularly interested in providing for their needs. Proponents of health insurance began to focus on the idea of a programme specifically for older Americans. Health insurance proposals were brought before the Congress, and received some initially tepid, but steadily growing, support.
When a new President, John F Kennedy, was elected in 1960, advocates of national health insurance gained renewed hope and saw new possibilities. Kennedy soon announced his support for a health insurance plan for older people, linked to social security. Organized labor rallied around the cause through a National Council of Senior Citizens. Older people, in particular, were galvanized. They marched and rallied, wrote letters, and carried signs—asking for, and demanding, the right to health care. The AMA recruited then-movie star Ronald Reagan to record a speech about Medicare, proclaiming it the beginning of the end of freedom in the USA.
When Kennedy was assassinated in November, 1963, and Vice-President Lyndon Johnson became President, he lost no time in declaring his commitment to expand access to medical care. In a message to Congress, he called for a range of new health programmes—citing Thomas Jefferson, “Without health there is no happiness. An attention to health, then, should take the place of every other object.”
In 1965, the US Congress passed the Medicare Act and Johnson arranged to sign it into law in the presence of the former President Truman, honouring Truman’s earlier efforts to establish national health insurance. Johnson handed the first two Medicare registration cards to Mr and Mrs Truman. The former President, then aged 81 years, described it as a “profound personal experience.”
Today, some 54 million Americans rely on Medicare for their health and economic security. National health insurance continues to be extremely controversial, as is evident by the bitter battles over the Affordable Care Act, passed in March, 2010 under President Barack Obama. The long political struggle that brought Medicare into being continues today.
National Library of Medicine, Bethesda, MD 20894, USA
Signing the US Medicare Act: a long political struggle.
Lancet. 2015 Jul 25