Happy  birthday and thank you to Medicare and Medicaid for 60 years of addressing the health care needs of the elderly, the disabled and the poor. 

For the most part, the terms “Medicare” and its companion “Medicaid” are tossed about between proponents and opponents of federal health care spending. The debate is fueled in part by the cost of the programs—approximately one-third of the total annual federal budget. What does the nation get for the dollars spent?

One must begin with an understanding of the history of  attempts to insure the health of vulnerable citizens. 

In the early 20th century, a broad coalition that included the Socialist Party, the Progressive Party and even the American Medical Association (AMA) for a time supported the idea of national health insurance. 

Politics shifted in the country after the Russian Revolution in 1917, and support in Congress fizzled until the Depression years.

Bernie Sanders is far from being the first to propose a program of national health insurance. Passage of the Social Security Act of 1935 rekindled interest. Then the surgeon general proposed national health insurance as a provision of the Act in 1937. The onset of war in Europe shut down its progress in Congress.

In 1949, the Truman administration tried again. Despite its popularity (59 percent) among wage earners, those who would finance the program through the Social Security payroll tax, the AMA led a campaign—joined by the insurance industry—characterizing national health insurance as a crawl toward “socialized medicine,” and Congress once again rejected the proposal. 

The AMA was not done, however. Through its lobbying efforts and false claims of the negative impact of old age health insurance on medical practice, the AMA and pharmaceutical corporations succeeded in shutting down the effort by driving 80 percent of its supporters from Congress.

Renewed interest in national health insurance rose from the ashes of the McCarthy period of the 1950s, when pressure from organized labor and the efforts of activists in the National Council of Senior Citizens in 1961 prompted the Kennedy administration to announce its support of health insurance for the elderly linked to Social Security. Future President Ronald Reagan was recruited by the AMA to speak against the proposal and counter the vocal support of the proposal coming from advocates within the labor movement, like Walter Reuther.

Lyndon Johnson capitalized on his 1964 landslide electoral victory by presenting a proposal to Congress for health care reform, by providing health care insurance for the elderly over 65 and health care for the poor through expansion of the Social Security Act.

Johnson, who was an effective Senate majority leader before becoming Kennedy’s VP, enlisted the equally powerful chairman of the House Ways and Means Committee, Wilber Mills, to organize the proposed legislation. 

Mills suggested that the legislation have three parts—one covering the costs of hospital care for those over 65 years old, another voluntary program to cover doctors’ visits, and a third for a means-tested program for the poor. The first two parts comprise what we now know as Medicare parts A and B. The third part, known as Medicaid—insurance for the poor—is defined by a calculated assessment of a person’s financial assets.

In March 1965, both programs were passed by Congress as the 18th and 19th amendments to the Social Security Act. (Mills demonstrated that even a politician later compromised by alcoholism and a sex scandal can do good; search on Tidal Basin and Fanny Foxe.)

There is little doubt that each program has expanded access to care for the target populations, particularly those living in poverty. Longevity, infant and maternal mortality and other public health measures have also improved as a result of this legislation. The addition of Medicare Part D (drug benefit) and Part C (so-called Medicare Advantage) have been added with the goal of making the program more comprehensive and affordable. Because these additions are newer, less is known about their cost-value calculation. Consequently, they have become new bones to pick in the ongoing debate of how to provide the best health care for the buck.

The United States remains an outlier among countries with highly developed economies. We Americans have been resistant to establishing universal free health care. Our two-tiered system provides one program for the poor and another for the more fortunate. The line between the needs of the poor and the needs of the rest of us is artificial and at best temporary. Most of us, poor or financially secure, who require long-term institutional care will need Medicaid to pay for it.

“Without health, there is no happiness. An attention to health, then, should take the place of every other object.”—Thomas Jefferson

So let’s offer wishes for robust health to Medicare and Medicaid for another 60 years of protecting and supporting the health of Americans.