[EDITORIAL NOTE: Pulitzer Prize-winning journalist Saul Friedman writes the bi-monthly Reflections column for Time Goes By in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation. He also publishes a weekly column, Gray Matters, on aging for Newsday.
I’m old enough to remember how it was before Medicare. My mother-in-law was in declining health and my wife and I were seeing to her care. On one visit to her family doctor, a golfer whom we called Buzzie, he told us, “Boy, if she only had the money we could give her the treatment she should have.” We left him for a nice, non-Jewish doctor I had met on the police beat.
Yet honestly, even as a journalist in Texas, I was too young, callow and full of myself to follow the Medicare battles in the Congress or appreciate its importance when it became law in July 1965. Since then, I have used thousands of dollars of Medicare’s money. I’ve written endlessly about Medicare in my day job, and I consider myself an expert.
But only recently have I been reminded how Lyndon Johnson prodded conservative lawmakers to give millions of older, disabled and poorer citizens the nation’s first universal national health care insurance, Medicare and Medicaid.
Now, Johnson’s victory could and should serve as a lesson for Barack Obama if, as he has promised, he intends to strengthen Medicare and eventually provide universal health coverage for the rest of America. If he doesn’t pay attention to this past, his efforts may meet the fate of the Clintons’ health care proposal in 1993.
The model for Obama and his White House is contained in a fine, straightforward essay appropriately entitled, The Lessons of Success – Revisiting the Medicare Story, in the November 27, New England Journal of Medicine. The authors, David Blumenthal, an MD (an unpaid Obama adviser) and James Morone, note that
“…this was the only time in our country’s history when the federal government extended health care coverage to a vast new swath of the American public.”
Partisans may claim that George Bush’s Part D drug coverage in 2003 was also a huge and expensive expansion of Medicare, but that bill was passed by a Republican Congress in the middle of the night along party lines, and further privatized Medicare, taking government out of the program.
If anything, it weakened traditional Medicare. One of Obama’s early challenges will be to roll back the 12 years of Republican efforts, like Medicare Advantage, that sought to nibble Medicare to death. (I’ll be writing more about this issue in coming months).
Following John Kennedy’s murder and the overwhelming defeat of Barry Goldwater in 1964, Johnson had huge Democratic majorities in the Congress. Still, he faced the problems of the percolating Vietnam War and the civil rights struggles. And conservative Southern Democrats who were hostile to government programs ran many of the key committees. But as the NEJM essay points out, Johnson masterfully won the support of Ways and Means Chairman Wilbur Mills, by letting him take credit for the legislation. Indeed Mills surprised Johnson by adding what became Medicaid to the bill to cover the poor.
At the time, LBJ and his Great Society programs enjoyed great popular support, but that faded quickly. Thus one of NEJM lessons for President Obama: Act quickly, decisively, with a deep personal commitment to health care reform and an understanding of what you want in the legislation.
“Bill Clinton waited for nine months to introduce his Health Security Act in 1993, which allowed the opposition to mobilize and defeat him.”
In addition, says the essay, Obama needs to keep his health care proposal relatively simple and easy for the public to understand. Clinton’s attempt to assuage all the special interests - doctors, the insurance industry and the drug makers - ended up satisfying no one and confusing members of Congress.
Even now, Obama’s proposals are complicated and rely on the insurance industry for coverage, for he has rejected the single-payer idea and Medicare for all.
Finally, Johnson decided early on in his battle for Medicare to worry about cost later, much later. As the essay concludes,
“Major expansions of health care coverage rarely fit the budget.”But the passage of Medicare was one of his great rewards, Johnson, said as he signed the bill sitting next to another great champion of national health insurance, Harry Truman. That’s company waiting for Obama to join.
[At The Elder Storytelling Place today, Florence Millo recalls how she learned about intricacies of Quilting - sewing and social.]