Lyndon B. Johnson & the Creation of MedicareJonathan Flug MD, MBA

Winthrop University HospitalMineola, NY

History of Pooled Insurance• Ancient Greek funeral societies

– Pooled resources to cover funeral costs• Idea of government supported healthcare also

goes back to ancient Greek city-states– Tax-supported public physicians

• Germany & Bismarck became the first modern nation to adopt an old-age social program in 1889– Chose an age of 70 for eligibility, later

lowered to 65

President Franklin Delano Roosevelt (President 1933-1945)

• 1934 – FDR considered including universal medical benefits to original Social Security Act– Highly unpopular and removed from final bill– The Act empowered the Social Security Board to

study “related” areas, and the board drafted a committee to explore government sponsored healthcare for all

President Franklin Delano Roosevelt (President 1933-1945)

• Healthcare legislation was then introduced in almost every congressional session after 1939.– First bill by Senators Wagner (D., N.Y.), Murray (D.,

Mont.), & Dingell (D., Mich.)– Early legislation attempted to incorporate

healthcare into social security– Legislative efforts went nowhere– Strong opposition from many groups, including

AMA and Republicans

President Harry Truman(President 1945-1953)

• After WWII, Truman fought strongly for universal government insurance

• 1945 – Submitted the first ever presidential message devoted exclusively to health care

• 1950 – Democrats suffered substantial losses in Congress. Proponents felt universal health coverage would never be realized– Proposals restructured earlier proposals to only

include elderly, Social Security recipients

President Dwight D. Eisenhower(President 1953-1961)

• As a Republican, he strongly opposed government health insurance

• Proposed bills for government healthcare for the elderly encountered strong opposition

• 1956 – Disability insurance added to Social Security – Considered an incremental advance

• 1960 – Congress passes Kerr-Mills Bill– Provided medical aid for the aged poor. Passed with the

hope it would act as a concession and thwart further governmental health insurance proposals.

President John F. Kennedy(President 1961-1963)

• Renewed presidential interest in government healthcare for the elderly

• 1962 – Supported the King-Anderson bill, which would have provided hospital coverage for seniors under Social Security– Blocked by Mills, a conservative Democrat in the

House Ways & Means Committee

President Lyndon B. Johnson(President 1963-1969)

• 1964 - Democratic President, Lyndon B. Johnson along with huge democratic majorities in the house and senate:– Believed healthcare to be integral to Great Society Program– At this time, only 55% of seniors had health insurance

• Mills changes his views, and supports Medicare– Historically given credit for passage of the bill– LBJ minimized his own role, leaving details and credit to

Congress to expedite passage as evidenced by recorded phone calls recently released by theWhite House

President Lyndon B. Johnson(President 1963-1969)

• H.R. 1 & S. 1 introduced as first bills in each House of the New Congress

• Those who initially opposed the bill switched focus to help create new, amended versions of it– Medicare Version – provided coverage of the aged, limited

hospitalization & nursing home insurance benefits– AMA Version – Eldercare. Government financing for physicians

services, surgical charges, drugs, nursing home costs, x-ray & lab services

– Congressman Byrnes’ Version – financing of doctors’ services and drugs. Voluntary participation.

President Lyndon B. Johnson(President 1963-1969)

• Final bill combined the proposals• New program would be an extension of Social

Security, adding 2 amendments– Title XVIII – Medicare – includes Part A & B

• Part A – Hospital coverage for the elderly• Part B – Supplementary medical insurance

– Title XIX – Medicaid• Provides for states to finance healthcare for

the poor with matching federal funds

President Lyndon B. Johnson(President 1963-1969)

• July 30, 1965 – Medicare Bill signed by President Johnson. Former President Harry Truman is the first Medicare enrollee.

To Read More On This Topic…• Centers for Medicare website

– Excellent history section with historic speeches, documents, and a Medicare quiz.

– https://www.cms.gov/History– https://www.cms.gov/History/Downloads/QUIZ08.pd

• Blumenthal, et al. The Lessons of Success – Revisiting the Medicare Story– An interesting article describing how a President should

approach healthcare reform

References1. “Social Security Act of 1965.” Wikipedia: The Free Encyclopedia. Wikimedia Foundation, Inc.

22 July 2004. Web. 1 Oct 2011. http://en.wikipedia.org/wiki/Social_Security_Act_of_19652. Dewiit L. The medicare program as a capstone to the great society – recent revelations in

the LBJ White House tapes. http://www.larrydewitt.net/Essays/MedicareDaddy.htm3. “Lyndon B. Johnson.” Wikipedia: The Free Encyclopedia. Wikimedia Foundation, Inc. 22 July

2004. Web. 1 Oct 2011. http://en.wikipedia.org/wiki/Lyndon_B._Johnson4. Blumenthal D, Morone J. The lessons of success – revisiting the medicare story. NEJM

2008;359:2384-2389.