Making Harry Truman's Dream Come True

by Mark K. Updegrove
Hardcover: 400 pages
Publisher: Crown (March 13, 2012)
Price: $27.00 + tax and shipping
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[excerpt] At the top of Johnson’s legislative agenda in 1965 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 sixty-five had no medical insurance, and a third of the aged lived in poverty, unable to afford proper medical care; Johnson believed it was high time to do something about it. Shortly after his November election win, he told 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 demanding that America’s senior citizens “be spared the darkness of sickness without hope.”

Franklin Roosevelt 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 sixty-five and older, but it was blocked by an intractable Ways and Means Committee. 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,” an ambiguous characterization that nonetheless made it intrinsically un-American. Conservatives also cast a wary eye. Actor Ronald Reagan, a darling 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.”

But sixteen years after Truman’s efforts were derailed by an unwilling Congress, Johnson believed “the times had caught up with the idea,” though it didn’t hurt that his electoral mandate and increased majorities in the House and Senate gave him the tools. The AMA would prove to be as big and powerful an obstacle as it had in earlier years, but unlike Truman, Johnson would find some leeway with the House Ways and Means Committee.

Along with most members of the committee, its Democratic chairman, Arkansas congressman Wilbur Mills, had been a fierce opponent of Medicare when Kennedy proposed it, professing it to be fiscally irresponsible. He felt no differently in 1965. Principle, however, would give way to pragmatism; Johnson, he knew, could find the votes to bring Medicare to fruition. Shortly after Johnson’s 1964 election victory, in which Johnson improbably added Arkansas to his win column, Mills stated publicly that he was willing to “work something out” on Medicare and would work closely with Cohen to help shape the bill to ensure its passage and effectiveness.

Telephone conversation with LBJ, Wilbur Mills, U.S. representative, Arkansas 1939–77, and Wilbur Cohen, March 23, 1965, 4:54 p.m.

LBJ: When are you going to take it up?
Wilbur 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 line as Johnson continues the conversation with Cohen.]
LBJ: Now, remember this. Nine out of ten 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.
Wilbur 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.
Cohen: Yeah.
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 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.

The plan Mills came up with was described by Cohen as a “three-layer cake.” In addition to including the administration’s original bill to provide hospital care for the elderly as part of Social Security, Mill’s legislation would include Medicaid, a supplemental medical welfare program to offer federal matching funds to states for the indigent, and an opt-in federally subsidized insurance program for doctors’ bills. Much to Cohen’s surprise, Mills had approved a $500 million government subsidy for the latter program after Cohen persuaded him that it would eliminate 80 percent of the doctors’ bills if the patient paid the first $50.

When Cohen asked the President what he thought of the $500 million subsidy, Johnson responded by telling him not to worry about the $500 million before relating a Hill Country yarn:

LBJ: I told [Wilbur] about the test that had been given to a man in Texas who wanted to become a railroad switchman. One of the questions he was asked was: “What would you do if a train from the east was coming at sixty miles an hour, and a train from the west was coming at sixty miles an hour on the same track, and they were just a mile apart, headed for each other?”

The prospective switchman replied: “I’d run get my brother.” “Now why,” he was asked, “would you get your brother?” “Because,” the fellow answered, “my brother has never seen a train wreck before.” I told Wilbur I thought I would run and get my brother if the Ways and Means Committee reported out this extended Medicare bill he had described to me. I approved the proposal at once.

Suddenly, Mills, “the villain of [Medicare],” in Johnson’s words, was “now a hero to old folks” as Medicare sailed through the House and was approved by the Senate on July 9.

But another villain would rear its head: the AMA threatened a national boycott of Medicare, holding out the possibility that as many as 95 percent of American doctors would follow suit. Johnson, who had sent Cohen away with instructions to “watch out for trains,” would shrewdly railroad the AMA into compliance in a meeting at the Ranch with eleven of its officers on July 11. After reminding the group that John Byrnes, the ranking Republican member of the House Ways and Means Committee and former opponent of Medicare, had urged that “all do their utmost to make the program work as well as possible,” Johnson switched gears, asking that the AMA support a program of rotating doctors in and out of Vietnam to serve the civilian population.

When they agreed to the latter, Johnson ordered an impromptu press conference, in which he praised the AMA for its commitment to the Vietnamese. When asked inevitably about whether the AMA would support Medicare, Johnson declared, “These men are going to get doctors to go to Vietnam where they may be killed. Medicare is the law of the land. Of course, they’ll support the law of the land.” He then turned to the AMA president, “You tell him.” Put firmly on the spot, he replied, “Of course, we will. We are law abiding citizens, and we have every intention of obeying the new law.” Within a matter of weeks, the AMA would formally endorse Medicare, with 95 percent of doctors not resisting it but following suit.

On July 30, 1965, Johnson traveled to the Harry S. Truman Library and Museum in Independence, Missouri, where the eighty-one-year-old Truman, lean and bent with age, his wife, Bess, in tow, watched Johnson sign Medicare into law. Proclaiming the thirty-third President the “real daddy” of Medicare, Johnson awarded President and Mrs. Truman the first two Medicare cards, numbers one and two. “He had started it all, so many years before,” Johnson wrote of Truman later. “I wanted him to know that America remembered.”

Jack Valenti: [Johnson] said, “I’m going to make Harry Truman’s dream come true. Old folks are not going to be barred from a doctor’s office or a hospital because they don’t have any money for medical attention. They are never again going to have to be sick and hurt and cry alone. It’s a god- damned crime,” he said, “and we’re never going to have that happen again in this country. When this bill is passed, I’m going to Independence, and I’m going to sign it in Harry Truman’s presence.” He did exactly that.

John Gardner: Medicare made an enormous difference in the lives of older Americans. It has had its problems, as every great social program inevitably must have. But it stands as a towering achievement. That’s not really debatable. You’ll encounter, occasionally, financially secure people who scorn Medicare—and Social Security, too—and cry for the good old days when each family looked after its own aging members. I’m . . . old enough to remember those good old days. So was Lyndon Johnson. In that time old age and poverty were firmly linked, and a good many old folks went “over the hill to the poorhouse.” That was the phrase of the day, “over the hill to the poorhouse.” . . . Don’t talk to me about the good old days.