The History of Medicare

ESSENTIAL DILEMMA

Medicare 1966: President Lyndon Johnson’s “American way” or Ronald Reagan’s “advance wave of socialism”?

Introduction

The Social Security health insurance plan, which President Kennedy worked so hard to enact, is the American way. It is practical. It is sensible. It is fair. It is just.
—Lyndon B. Johnson, 1964 (DeWitt, 2003)

Don’t ever argue with me [about health]. I’ll go a hundred million or billion on health or education. I don’t argue about that any more than I argue about Lady Bird [Mrs. Johnson] buying flour. You got to have flour and coffee in your house. Education and health. I’ll spend the goddamn money. I may cut back some tanks. But not on health.
—Lyndon B. Johnson, 1965 (New York Times, 2009)

Having given our pensioners their medical care in kind, why not food baskets, why not public housing accommodations, why not vacation resorts, why not a ration of cigarettes for those who smoke and of beer for those who drink?
—Barry Goldwater, 1964 (Nichols, 2011, p. 16)

In 1966, with the active leadership and support of President Lyndon B. Johnson, Congress passed Medicare, a program of government-sponsored health insurance for those age 65 or older (and, starting in 1972, the disabled). Versions of federally sponsored healthcare insurance had been unsuccessfully put before Congress three times under President Truman and three additional efforts were made while John F. Kennedy was president. President Johnson presented Medicare as part of his larger set of Great Society initiatives—initiatives that demanded an end to poverty and racial injustice as “just the beginning.” 

Although a 1965 Gallup poll showed that 63% of Americans supported the idea of Medicare (Twight, 1997), the American Medical Association (with then–private citizen Ronald Reagan as one of its spokespersons) opposed it. Medicare’s bi-partisan passage in the House and Senate may have reflected an unwillingness on the part of Republicans to oppose a popular bill that they knew would pass without them (Beam, 2009).

Was Medicare, a program that had previously been rejected six times by Congress, “the American way”? Was it the expression of a core American value, an agreed-upon commitment by society to help the elderly live above the line of poverty when they could no longer work? Or, did the government reach beyond its responsibility for the lives of individual Americans by providing a publicly run health insurance program?

There continues to be a range of opinion on this question, and the discussion has intensified as the future of the Medicare program is undermined by what continues to be an exponential rise in the cost of medical care.

This lesson examines the origins of Medicare and asks students to address this essential dilemma by:

  • Analyzing data and early documents associated with the program
  • Reading statements both for and against the program
  • Analyzing how those who supported and opposed Medicare in the early and mid-1960s would have responded to the question posed by the essential dilemma
  • Identifying what more they would need to know in order to answer the question for themselves

The lesson is followed by an optional extension activity that asks students to discuss contemporary political cartoons on the Medicare controversy in light of their historical understandings.

Learning Objectives

Understand:

  • Medicare was the fulfillment of what Truman, Kennedy, and Johnson believed to be the promise of Social Security.
  • Disagreement over Medicare legislation was contentious, with the American Medical Association calling the plan “socialized medicine.”
  • Positions on the 1965 Medicare legislation often corresponded to views on the role government should play in the lives of individual Americans.
     

Be Able To:

  • Ask good questions and make inferences.
  • Support positions with evidence.
  • Formulate a position or course of action on an issue.
  • Recognize, explain, and analyze causes and consequences.

Process

Day 1 of 2

Entry

Ask students to look at the graph “Poverty Rates by Age: 1959 to 2014” (Resource 1). Help students understand how to read the graph, but otherwise, provide minimal introduction. If necessary, prompt students by asking them what they see and if they notice, in particular, any great changes in the poverty rate during those years. Direct students’ attention to the line for people 65 years and older and ask them what they find interesting or perplexing. Make a note of their observations on the board. If some students think they know what caused the shift that took place in the late 1960s when poverty rates for the elderly decreased, let them explain. If not, tell students the decrease in those poverty rates is correlated with the implementation of a program called Medicare, the topic of the lesson.
 

LESSON STRATEGIES AND ACTIVITIES

Understanding Medicare

Without much explanation, show students “Your Social Security,” a 1968 poster intended to inform senior citizens about the Medicare program that had been added to Social Security in 1965 (Resource 2). Ask students to find as much information as they can from the resource, including who the intended audience is. Tell them to “read” the picture and the text.

[Students might report that Medicare is a federal government program (small print in the lower right corner); the intended audience is probably people over the age of 65; Medicare might have been a relatively new program when this document was created, because the information is very basic (and because it is connected to an older program people would already know about, Social Security); based on the photograph, Medicare might be a program that is hospital based; also based on the photograph, middle class people are eligible to receive Medicare benefits.]

Ask students what they know about Medicare. Correct any misconceptions, and use the information in the introduction to this lesson, and from “Overview of Medicare” and “Social Security and Medicare Timeline” included with this packet (and available online), to give students a brief introduction to the program and its history. Both the Overview and the Timeline can be used as handouts, but consider holding these back. The history of the program and details of its intent will emerge from the documents used in the lesson.

Ask students to read the excerpt of President Johnson’s remarks on the Medicare bill (Resource 3). As students read, they should underline phrases or terms with which they are unfamiliar. Use the following questions to guide the rest of the discussion:

  • Why might the older population need health insurance, such as Medicare?
    [Student answers will include that many older people are no longer able to earn a living, either because they can no longer perform a physically demanding job, because employers won’t hire them, or because of poor health and disability.]
     
  • How is the Medicare program going to be funded?
    [Students should understand from Johnson’s speech that the workers and their employers are to fund the program through additional contributions to their Social Security payroll plan.]
     
  • According to President Johnson, what will be the benefits of the program?
    [Johnson details that the insurance will pay for hospitalization and home health care and, beginning in 1967, 100 days of care in a nursing home. He refers to a separate plan to cover doctor fees. Johnson says the significance of this is that families will no longer be financially “crushed” by the uncovered medical expenses faced by older Americans.]
     
  • What role is the government playing in providing Medicare?
    [Medicare is providing elderly and disabled people with insurance coverage for hospitalization, prescription drugs, and care by physicians and other healthcare providers. The government funds Medicare with general revenues, payroll taxes, and premiums paid by beneficiaries of the program.]
     
  • Why would President Johnson refer to this program as “the American way.” 
    [Students might note that Johnson used that phrase to promote the program, probably countering claims that Medicare was socialized medicine. Older Americans were not usually covered by health insurance, and often were unable to afford good care, so Johnson believed the program was fair and just—and American.]

Confirm that students understand Medicare was introduced as an extension of Social Security, the government-sponsored pension plan passed in 1935, and that it offers coverage for hospital bills and doctor fees. Poll students about whether, based on what they know so far, they think this role is a proper one for the federal government to play. Explain that they will be reading points of view that might influence them to change their mind, so these ideas are a point of reference they can return to.
 

Day 2 of 2

The American Way

Tell students “the American way” is a term that can be used in many, many ways. For example, winning at all costs and playing fair have both been called the American way. Ask students to take 5 minutes and write down what they think of when they think of “the American way.” This could be framed as, “What do people mean by the American way?” or “What does the American way mean to you?”

Ask for examples to clarify responses like freedom, opportunity, justice, and equality. Collect responses on the board and ask students what they notice about the statements. Do any of them belong together because they say the same or similar things? Are any of them the opposite of each other?

[Student responses to this task, as well as their observations about the results, may vary widely. Students might notice that many of the responses use the word “freedom,” but not always in the same way. Some of the statements might emphasize material goals, “the American dream.”]

Ask students if they find anything missing from the collection, and tell them that they will have a chance to come back to this collection at the end of the lesson after looking at how the American way was defined during the Medicare debate in the early 1960s.
 

The Role of Government vs. The Responsibility of the Individual

Tell students that, just as they have multiple visions of the American way, so do political leaders. It is the American way to advocate for particular public policy options on the basis of their expression of essential American values; however, interpretations of those values vary widely. Although there are many ways in which American values find their way into political and public policy debate, this lesson focuses on an issue that was essential to the discussion of Medicare: the role of government vs. the responsibility of the individual.

For some policy advocates, essential American values are about the limits of government and freedom from its restrictions. They support policies that emphasize the protection of individual political and economic rights. Advocates who disagree might view American values as being less about individual autonomy and freedom from restriction than about collective responsibility. They support policies that emphasize the role government can and should play in assuring the political inclusion and economic well-being of all Americans.
 

Medicare and the American Way

The purpose of this activity is to associate two sets of frequently invoked American values—two different conceptions of the American way—with different views on the proposed Medicare legislation. After completing the association, students should be asked what else they would need to know to be sure that the matching was accurate. Presumably they will say that, among other things, they would need a larger sample of writings.

Divide students into groups of no more than three or four students. Distribute “Excerpts For and Against Medicare” (Resource 4) among the groups. Give half the groups the readings from Set A and half of them the readings from Set B. (This activity would also be interesting if each group is given one reading from Set A and one reading from Set B.)

Distribute a copy of a schematic created for the purpose of this lesson: “The American Way: Two Lists” (Resource 5). Ask students to read their selections from Resource 4 twice and, on the second reading, compare what each of their writers is saying with the two sets of American way values in Resource 5. After choosing the set that most closely matches the views of each author, students are to pick the two or three values each author would say are most important, and underline evidence in their paragraphs to support their selection.

Ask groups to report on the results of their close reading. While each group reports, write some of the most important values on the board. At the close of the reports, tell students what they have already gathered—that Johnson and Udall supported Medicare whereas Reagan and Goldwater opposed it— and ask them what they notice about how the different American way values do or do not reflect those different positions on the legislation.
 

Resource 4, Excerpts, Set A includes:

Congressman Morris Udall: A 1965 statement by Morris Udall, a congressman from Arizona, explaining that he supports the Medicare bill because he has determined it is supported by a majority of his constituents.

President Lyndon Johnson: The partial transcript of a March 25, 1965, conversation between President Johnson and his press secretary, Bill Moyers. In the conversation, Johnson is explaining why he favors a retroactive payment to Social Security recipients and how he would present the request to Congress. (He rejects the idea that it should be presented as a stimulus to the economy.) Even though this excerpt quotes President Johnson on the specific subject of Social Security, it reflects the sense of obligation he feels towards the elderly—a sentiment he transfers to his work on Medicare.
 

Resource 4, Excerpts, Set B includes:

Ronald Reagan: A statement by Ronald Reagan from a recording of remarks made in 1961 in which he warns that Medicare will lead to socialism. Ronald Reagan was governor of California from 1967 to 1975 and President of the United States from 1981 to 1989, but these remarks were made when he was still a citizen and actor.

Senator Barry Goldwater: An excerpt from a 1964 campaign speech and an excerpt from “The Conscience of a Conservative,” a 1960 warning against the power of the federal government. Barry Goldwater was a U.S. senator from Arizona from 1953 to 1965, and from 1969 to 1987. He ran for president against Lyndon Johnson in 1964.
 

Resource 5 includes:

Two sets of American way values, a schematic that was created for the purpose of this lesson. Set A is usually associated with those who hold politically conservative views and who would have, in this case, opposed the Medicare legislation. Set B is usually associated with those who hold politically liberal views and who would have, in this case, supported the Medicare legislation.

Conclusion

After the “matching” discussion, bring the lesson to a close by asking students one or more of the following questions:

  • What more would you need to know (or perhaps already know) to put the views of Johnson, Udall, Goldwater, and Reagan in a historical context?
    [Students might associate talk of socialism with the strain of the cold war, or trace President Johnson’s populist views to growing up poor himself. Build on this discussion in ways that connect with what else students are studying or will be studying.]
     
  • Do these sets of American way values relate to the way in which politicians discuss current public policy issues?
    [Consider asking students whether the value sets are useful ways of differentiating points of view, or if they become irreconcilable positions that make it hard to debate a proposal on its own merits. Use examples from current policy debates to ground this discussion in specifics, or consider referring students back to the readings, including the last paragraph in the Goldwater reading. Be prepared to reference some current public policy debates. Ideally, bring in relevant newspaper headlines.]
     
  • Look back at the American way values you generated at the beginning of the lesson and consider whether you want to revise them based on new ideas you have gotten from the perspectives introduced by Senators Udall and Goldwater or Presidents Reagan and Johnson, or from classroom discussion. What more would you need to know to decide which of these values are closest to your own point of view?
    [Lead students to consider evaluating the actual outcomes of different policy positions.]

 

ADDITIONAL STANDARDS

Common Core State Standards (CCSS) Initiative
CCSS.ELA-Literacy.CCRA.R.6. Assess how point of view or purpose shapes the content and style of a text.
CCSS.ELA-Literacy.RH.11-12.6. Evaluate authors’ differing points of view on the same historical event or issue by assessing the authors’ claims, reasoning, and evidence.
CCSS.ELA-Literacy.RH.11-12.7. Integrate and evaluate multiple sources of information presented in diverse formats and media (e.g., visually, quantitatively, as well as in words) in order to address a question or solve a problem

The College, Career, and Civic Life (C3) Framework for Social Studies State Standards
D2.His.12.9-12. Use questions generated about multiple historical sources to pursue further inquiry and investigate additional sources.
D2.His.16.9-12. Integrate evidence from multiple relevant historical sources and interpretations into a reasoned argument about the past.

National Center for History in the Schools’ Historical Thinking Standards
1.F. Chronological Thinking. Reconstruct patterns of historical succession and duration in which historical developments have unfolded, and apply them to explain historical continuity and change.
2.H. Historical Comprehension. Utilize visual and mathematical data presented in graphs, including charts, tables, pie and bar graphs, flow charts, Venn diagrams, and other graphic organizers to clarify, illustrate, or elaborate upon information presented in the historical narrative.
5.B. Historical Issues. Marshal evidence of antecedent circumstances and current factors contributing to contemporary problems and alternative courses of action.

NCSS’s National Curriculum Standards for Social Studies
2. Time, Continuity, and Change. Social studies programs should include experiences that provide for the study of the past and its legacy.
6. Power, Authority, and Governance. Social studies programs should include experiences that provide for the study of how people create, interact with, and change structures of power, authority, and governance.
 

REFERENCES CITED

Beam, C. (2009, July 7). Med school: What the 1965 Medicare debate can teach us about health care reform. Slate. Retrieved from http://www.slate.com/articles/news_and_politics/prescriptions/2009/07/med_school.html

Cardow, C. (2011, August 3). Threats. Cagle Cartoons. Retrieved from http://www.politicalcartoons.com/cartoon/76827563-85b2-4edd-ad11-63201937c851.html

DeNavas-Walt, C., & Proctor, B. D. (2015). Income and poverty in the United States: 2014. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-252.pdf

DeWitt, L. (2003, May). The Medicare program as a capstone to the Great Society-Recent revelations in the LBJ White House tapes. Retrieved from http://www.larrydewitt.org/Essays/MedicareDaddy.htm

Duncan, G. (1935, March). Ol’ rockin’ chair. Life, 102(2600).

Goldwater, B. (2004). The 2004 essay: The conscience of a conservative. Heritage Foundation. Retrieved from http://www.heritage.org/about/speeches/president-essays

Liberty Voice. (2009, September 8). Ronald Reagan’s 1961 coffeecup speech. Retrieved from http://www.thelibertyvoice.com/ronald-reagans-1961-coffeecup-speech

Lyndon Baines Johnson Library and Museum. (2007, June 6). President Lyndon B. Johnson’s remarks with President Truman at the signing in Independence of the Medicare bill, July 30, 1965. Retrieved from http://www.lbjlib.utexas.edu/johnson/archives.hom/speeches.hom/650730.asp

New York Times. (2009, September 19). Don’t let dead cats stand on your porch: A tutorial from Lyndon B. Johnson. Retrieved from http://www.nytimes.com/2009/09/20/weekinreview/20word.html

Nichols, J. (2011). The “S” word: A short history of an American tradition . . . socialism. New York: Verso Press.

Sheneman, D. (2011). Medicare warning labels. Tribune Media Services. Retrieved from http://theweek.com/section/cartoon/51/214190/congress

Social Security Administration. (1968). Your Social Security [poster]. Retrieved from https://www.socialsecurity.gov/history/pics/near65s.gif

Twight, C. (1997). Medicare’s origin: The economics and politics of dependency. Cato Journal, 16(3). Retrieved from http://object.cato.org/sites/cato.org/files/serials/files/cato-journal/1997/1/cj16n3-3.pdf

Udall, M. K. (1965, March 31). Medicare v. Eldercare—a big issue finally resolved. Retrieved from http://www.library.arizona.edu/exhibits/udall/congrept/89th/650331.htm

Extension Activity

  1. Play students an excerpt from an August 26, 2009, interview with James Monroe, co-author of The Heart of Power: Health and Politics in the Oval Office (http://www.npr.org/templates/story/story. php?storyId=112234240). In the interview the author discusses a 1962 taped telephone conversation between President Johnson and Senator Ted Kennedy in which Johnson cautions against letting the costs of a health bill get projected too far into the future because they would scare people. Ask students if they believe Johnson was justified in concealing the future costs of Medicare in order to get the program passed.
     
  2. Use materials from the EconEdLink lesson “Medicare and the National Debt” to consider both the impact Medicare legislation has had on the health and well-being of the nation’s elderly and the challenges presented by the program’s cost.
     
  3. Use any of the three cartoons in Resource 6 to identify how the current debate about Medicare is framed. A Discussion Guide for Teachers is included in the resource.