The Secret History of Medicare

The overwhelming conventional wisdom about health care reform is that if reform is defeated in 2009, it’ll stay defeated for a good long time. Proponents won’t just be able to regroup twelve months later, make their case again, wage another election, and bring it back up in the next congress. I don’t particularly question that wisdom, but it is worth noting that this “get it right the first time” approach to legislative change is at odds with the way past major health reforms got done. Here, via David Leonhardt, is how we got Medicare:

— In 1960, as a Senator and Presidential candidate, John F Kennedy backs a Medicare legislative proposal that falls four votes short in the Senate.

— In 1962, now-President Kennedy backs Medicare in a State of the Union address and a 20,000 mass rally in Madison Square Garden simulcast on three television networks; the bills falls short by two votes.

— The bill is reintroduced in 1963 after the midterms and dies again.


— In 1964, Lyndon Johnson was able to ride the sympathy wave to pass the Civil Rights Act, but Medicare still couldn’t pass.

— In 1965, Medicare finally passes following a landslide election.

This is just totally different from the “win an election, try at reform, and if you fail give up for 20 years” model that Bill Clinton pursued and that people generally seem to feel applies in the Obama era. Instead, the fight went on-and-off for five years across three different elections and a presidential assassination. The idea was that reformers had a proposal that they thought was a good idea and that they thought was a popular idea; when they lost they didn’t blame themselves for having failed to persuade the opposition to stop opposing reform, they blamed the opposition and tried to win the next election.

Of course this doesn’t work if you get crushed in the midterm elections.