Here's the last of our posts this week on health reform history...Then we'll turn our attention back to health reform's future...
Medicare, the government health insurance system that covers all America's senior citizens and many of its disabled, and Medicaid, a federal-state partnership providing insurance to the poor, are two of the great legacies of the Great Society era of the mid-1960's. Medicare and Medicaid cover tens of millions of people and remain giants of the current American social contract. Like the State Children's Health Insurance Program of the mid 1990s, Medicare and Medicaid emerged after a comprehensive reform initiative had failed earlier.
In the 1940s, Congress and President Truman made various attempts to institute national health insurance. A 1947 bill with Republican support (including that of Congressman Richard Nixon) would provide government subsidies for a private nonprofit insurance system with premiums scaled to individual's incomes. (If you include private for-profit insurance companies in the mix, it sounds quite a bit like current coverage proposals.) In 1950, Congress did finally pass, and Truman signed, legislation to provide federal matching grants to state payments for medical care for the poor. This became the forerunner to Medicaid.
During the 1950s, expanding health coverate to all temporarily faded as a pressing political concern, reflecting both the enormous expansion of employer-sponsored insurance and the conservatism of the time. But by the late 1950s, pressure grew to expand Social Security to include relief from medical bills for the aged. Because the elderly have the highest medical costs of any group, many seniors were unable to purchase insurance; medical bills were a leading cause of poverty among the elderly. In 1960, outgoing President Eisenhower did sign into law Kerr-Mills, the forerunner to Medicare. That gave grants to states for health care for the aged poor. But it didn't work very well; by 1963, only 28 states were participating.
Though the massive Democratic sweep of 1964 gave President Johnson huge majorities in Congress. Medicare and Medicaid emerged from a compromise between the majority and the Republican minority in Congress.