Medicare at 50

“And then I read that this bill will sap the individual self-reliance of Americans,” President Kennedy said. “I can’t imagine anything worse, or anything better, to sap someone’s self-reliance, than to be sick, alone, broke—or to have saved for a lifetime and put it out in a week, two weeks, a month, two months.”

Kennedy was speaking to a massive crowd in Madison Square Garden, his remarks carried live on television and by closed circuit to similar rallies around the nation. His topic on that May 20, 1962, was his bill to provide medical care for senior citizens. It was one of his most effective speeches, not least because he seemed at one point to drop his guard with a reference to his father’s recent stroke.

“I visited twice, yesterday and today, in the hospital—where doctors labored for a long time—to visit my father. It isn’t easy. It isn’t easy.” Kennedy seemed to choke up. It was a startling public moment from a president noted for his cool, unemotional tone, and the crowd made up mostly of seniors responded with supportive applause. The president then fell back on his wit to lighten the moment—“He can pay his bills, but otherwise I would be. And I am not as well off as he is.”

Two days later, from an empty Madison Square Garden, the U.S. watched two American Medical Association leaders give a competing television presentation denouncing medical care for the aged as socialism.

“If our government wants to move now toward welfare state medicine, then let them tell us so honestly,” said Dr. Edward Annis. “Why sneak it in piece by piece on the backs of old people first? The [Democratic] crowd intends to take us all the way down the road to a new system of medicine for everybody—and don’t mistake it. England’s nationalized medical program is the kind of thing they have in mind for us eventually.”

The AMA was often called the most powerful lobby group in D.C. It used tactics later emulated by the National Rifle Association, such as burying Congress in mail every time medical care for seniors showed signs of life. Two months after the JFK/AMA faceoff on television, Kennedy’s bill—already heavily watered down—was defeated 52-48. Twenty-one Democrats voted with the AMA. Five Republicans voted for Kennedy’s bill. Nevada Sens. Howard Cannon and Alan Bible voted for the bill. In Nevada, one of the leading opponents was physician Wesley Hall.

It was the fourth presidency in which Medicare had gone down under the AMA onslaught. But the end was coming, and Kennedy’s 1963 murder fueled both sentiment for the bill and for the 1964 election landslide for Democrats that made Medicare’s enactment finally possible. In 1964 the Senate approved it 57 to 13. By then the U.S. was the last developed nation to create such a program.

What happened next would surprise anyone born thereafter who watched the Affordable Care Act being enacted by Congress in 2009.

Although the 30-year battle over Medicare was long and hard fought, it was not a party line vote. Once Medicare was law, the GOP did not, for years afterward, tie approval of other, unrelated programs to it. Republicans didn’t try to shut down the government to get their way. The AMA made a point of telling doctors they didn’t have to serve Medicare patients, but it was just a gesture by then, and few doctors did refuse. No one tried to kill Medicare by defunding it. No one tried to delay the law taking effect.

Rather, nearly everyone accepted the outcome, and life for most patients and doctors resumed with few changes. The AMA turned its attention to stopping a national health care plan.

Nevada’s Dr. Wesley Hall, meanwhile, was moving up the AMA’s ladder. By 1966, he chaired its board of trustees and said the group would try to hold down the size of Medicare.

“It’s the law of the land, and we’ll live with it, but we want to do our best to keep it from expanding by lowering ages of eligible persons and extending coverage before it gets off the ground,” he said.

He went on, “One of the last vestiges of free American enterprise is the practice of medicine. Our country is based on pioneer spirit and competition, but these government programs destroy initiative.”

He was right about the initiative of private enterprise. The disdain for Medicare the AMA had fostered among its members found an outlet. Within a few years, Medicare fraud was becoming a problem. Then in 1972, the Bureau of Labor Statistics released a survey indicating doctors had raised their prices an average of 21 percent just before Medicare took effect. It also indicated that in the late 1960s and early ’70s, doctors’ fees went up 39.7 percent while the Consumer Price Index for all goods and services rose 25.1 percent. And that same year, the National Association of Blue Shield Plans said that in 1971 it had refused to pay some physician charges, what it called “reductions, sometimes voluntary on the part of physicians, resulting from the use of screens on usual customary and reasonable charges.” Others called these “overcharges.” The disallowed amounts came to 4 percent of all charges.

Wesley Hall became national president of the AMA in 1971 in time to deal with all this bad publicity. He said costs to physicians for staff, offices, equipment and lab services increased 10 to 15 percent during each of the years surveyed by Labor Statistics.

There were occasional disputes between doctors and Medicare over treatment that even prompted some physicians to talk about unionizing. “I don’t want some bureaucrat telling me that I can’t keep a patient in the hospital for one more day when I think it necessary,” Las Vegas physician John Holmes told United Press International. Holmes was president of a union of doctors affiliated with the AFL-CIO.

AMA president Hall said he was OK with a doctor being a union member “as long as he takes care of his patients.”

Eventually, things settled down and normality overtook the once-controversial program. Some people even seemed to lose track of the fact that it is a government program. During the 2009 fight over the Democratic health care plan, to the amusement of many, signs were printed reading “KEEP GOVERNMENT OUT OF MY MEDICARE/ YOU DAMN SOCIALISTS.”

A generation of physicians grew up knowing no health care system without Medicare. They routinely urge their patients to enroll in it.

Medicare worked its way so deeply into the texture of U.S. culture that Republicans were usually careful to couch arguments for “reform” in language that supported the program itself, sometimes even criticizing Democrats for not doing enough to protect it. In 1995, when U.S. Rep. Barbara Vucanovich of Nevada gave the Republican response to a radio speech by President Clinton marking Medicare’s 30th anniversary, she said the program needed to be protected from the Democratic president taking its solvency for granted. “There aren’t too many birthday celebrations left for Medicare unless we act now. While President Clinton and many Democrats in Washington are content to celebrate … by reminiscing about its past, Republicans are securing Medicare’s future.”

Clinton said GOP leaders were pushing legislation that would drive up health costs under Medicare in order to finance tax cuts on upper income brackets.

By then 33 million elderly and 4 million disabled citizens were covered by Medicare. And Vucanovich was right that Democrats like to celebrate it. When Medicare turned 50 on July 30, U.S. Sen. Harry Reid issued a statement: “Before Medicare was the law, only about half of seniors had health insurance. Only some of those had coverage for regular doctors visits.”

But they’re not the only ones celebrating. In North Las Vegas last week, retirees marked the 50th anniversary of Medicare by calling on the district office of U.S. Rep. Cresent Hardy, who they accuse of not being supportive of Medicare.

That’s a reflection of the fact that, after achieving the status of a national fixture, today the wind is shifting again. Whether Medicare should survive is back on the table, put there by Republican leaders like Paul Ryan.

On July 22 during a discussion of Medicare in the first presidential primary state of New Hampshire (percent of resident senior citizens: 15.5), Republican presidential candidate Jeb Bush said, “And I think we need to be vigilant about this and persuade people that our—when your volunteers go door to door, and they talk to people, people understand this. They know, and I think a lot of people recognize that we need to make sure we fulfill the commitment to people that have already received the benefits, that are receiving the benefits, but that we need to figure out a way to phase out this program for others and move to a new system that allows them to have something—because they’re not going to have anything.”