Medicare

Current Taxes And Tax Reform Undermine Social Security & Medicare

Published by Anonymous (not verified) on Fri, 27/10/2017 - 2:00am in

Above Photo: (Photo: 401(K) 2012/Flickr) If You Want to Collect Social Security, Trump’s Tax Plan Is an Outrage You probably pay about four times more of your income to Social Security than millionaires, who want to cut their taxes and your benefits. How much did your paychecks total last year? You know the answer, of course. So does the Social Security Administration. The totals for every American’s paycheck income are sitting in Social Security’s computers. Once every year, Social Security does a serious data dump out of those computers to let us know just how much working Americans are actually making. The latest totals — covering 2016 — have just appeared. Most of us, the new numbers show, are simply not making all that much. In fact, nearly half of our nation’s employed — 49.3 percent — earned less than $30,000 in 2016. A good many of these Americans lived in poverty. In 2016, families of four that earned less than $24,339 ranked as officially poor. We don’t have an “official” figure for middle class status. But the Economic Policy Institute has calculated the costs of maintaining a no-frills middle class existence in various parts of the United States. In Houston, one of our nation’s cheaper major cities, a family of four needed $62,544 in 2016 to live a bare-bones middle class lifestyle. Nationally, according to the new Social Security payroll income numbers, over three-quarters of working Americans — 76.4 percent — took home less than $60,000 in 2016. Some Americans, on the other hand, took home a great deal more. The Social Security Administration counts 133,119 Americans who pocketed over $1 million in paycheck income last year. Now which of these two groups — the millionaires or the under-$60,000 crowd — do you think paid a greater share of its income in Social Security taxes? The millionaires could certainly afford to pay the bigger share. But they didn’t. Individuals who took home $1 million in 2016 had $16,265 deducted from their paychecks for Social Security and Medicare. Those deductions totaled a meager 1.6 percent of their paycheck income. Working Americans making $60,000 last year, by contrast, had 7.65 percent of their take-home deducted for Social Security and Medicare. In other words, Americans making $60,000 paid over four times more of their income for Social Security and Medicare than Americans who made $1 million. How could that be? Our tax code currently has a ceiling on earnings subject to the Social Security tax. That ceiling this year rests at $127,200. All paycheck income up to that level faces a 6.2 percent tax for Social Security and a 1.45 percent tax for Medicare. Income above that ceiling faces no Social Security tax at all. Until the Obama years, income above the earnings ceiling faced no payroll tax for Medicare either. But President Obama succeeded in getting that changed. Individual income over $200,000 now faces an additional 0.9 percent Medicare tax. If all income over $200,000 faced a Social Security tax as well, we’d have enough new revenue to significantly improve Social Security benefits. The Trump administration is moving in the opposite direction. Earlier this year, the White House tried and failed to get the Obama Medicare tax on the rich repealed. Now the administration is pushing a tax “reform” that totally ignores the unfairness of the current Social Security payroll tax and instead hands America’s wealthiest a stunningly generous assortment of tax giveaways. If this Trump tax plan passes, Americans making $60,000 will still be paying over four times more of their income in payroll taxes than Americans who make $1 million. And America’s millionaire-packed top 1 percent will get 80 percent of the new Trump tax cuts, the Tax Policy Center calculates. The Trump tax plan, in other words, makes the U.S. tax code even more millionaire-friendly than the current code. The White House calls that “reform.” The rest of us ought to call it an outrage.

My Sister Served in the Army. The Biggest Threat to Her Survival is Congress.

Published by Anonymous (not verified) on Fri, 15/09/2017 - 4:00am in

This post originally appeared at Talk Poverty.


RELATED: Democracy & Government


Mary Mayhew, commissioner of Maine's Dept. of Health & Human Services (left) and Gov. Paul LePage answer questions during a news conference to announce changes to the MaineCare system in Augusta, Maine, on Dec. 6, 2011. (Photo by Joe Phelan/Portland Press Herald via Getty Images)

The War on Medicaid Is Moving to the States

BY Greg Kaufmann | September 5, 2017

My older sister, Lynn, was always getting into trouble when we were kids. I was the goody two-shoes in the family, but if I did ever get myself in trouble, she’d get in even more trouble to help me out. She was a good sister in that way — always looking out for me. When I was little, I didn’t like to sleep by myself during thunderstorms, and she’d let me crawl into bed with her because she knew I was afraid.

Now, in some ways, I’m her big sister. I do my best to take care of her.

Lynn — a 62-year-old army veteran — cannot walk. Her dementia makes it impossible for her to remember to take her medicine. Her forgetfulness has life-or-death implications, since she has diabetes, high blood pressure and high cholesterol. As a result, Lynn has been in a nursing home for the past four years. Medicaid pays the bills for that — just like it does for most people who need nursing home care — and I’m terrified of what would happen without it.

She’s not trying to take more than her fair share of the pie.

Lynn joined the army right out of high school. When she was in boot camp, she had a traumatic head injury during basic training. The military doctors held her for observation, diagnosed her with a concussion and then released her. She served her time as a private, then was honorably discharged and got married.

A few years later, she was struck by a car. She was at a crosswalk, and the car in front of her stopped to let her cross. But the car behind it was impatient, so it swerved around the first car, plowing into the crosswalk and hitting my sister. That left her with her another traumatic head injury, as well as the beginning of hip problems that will plague her for the rest of her life.


RELATED: For the Record


An elderly woman shows her gratitude to President Lyndon B. Johnson for his signing of the Medicare health care bill in July 1965. (Photo by © CORBIS/Corbis via Getty Images)

LBJ Launches Medicare: ‘You Can’t Treat Grandma This Way’

BY Bill Moyers | July 30, 2017

Over time the hip problems worsened, until she finally had a hip replacement in her mid-50s. She was able to walk without pain for a while, but she then contracted a MRSA infection in her new hip joint. That can happen with artificial joints — it’s rare, but once you have the infection it’s hard to remove. Lynn’s infection spread quickly, and it almost killed her. Doctors tried to treat her with some very powerful drugs at first, which made her thoughts so fuzzy that she said her brain was buzzing.

Eventually, doctors had to remove her hip bone to control the MRSA. Medicaid paid for this surgery, too — otherwise, we wouldn’t have been able to afford it.

Just four years ago, Lynn was working multiple jobs to put her daughter through college: in the cafeteria at her daughter’s school, at Walmart and at a deli. Now Lynn can no longer walk, or work. The doctors say the drugs impaired her brain and made her dementia onset much more quickly.

But this isn’t a sob story. I don’t want you to feel bad for her, or take pity on her. Lynn is still the same person I’ve always known, full of life and warmth. She can break the tension in a moment better than anyone I know. I still remember a moment a few years ago, when she was recovering from her first hip surgery. She flew into Washington, DC, to visit us, and we were trying to get her out of baggage claim and into the elevator in her wheelchair. The doors started to close, and nobody wanted to hold them — she was far away, and she was moving so slowly. But she shouted, “I’m coming as fast as I can!” across the airport. They actually held the door for her. In the elevator, she chatted with them amicably, asking how their Christmas was going. Strangers were smiling and talking to her — that’s a rare sight in DC.

Lynn would be lost without Medicaid. She served her country and worked hard to provide for her family. She’s not trying to take more than her fair share of the pie. She’s just somebody who needs care — and she didn’t expect to need the care that she needs as young as she is.

When our elected representatives decide to cut Medicaid — whether through repeated attempts to repeal the Affordable Care Act or a budget that cuts $3.6 trillion from services such as Medicare and Medicaid — they should think about what this means to people like me and my family. They should think about Lynn, and the millions of other veterans who have turned to Medicaid.

The post My Sister Served in the Army. The Biggest Threat to Her Survival is Congress. appeared first on BillMoyers.com.

Counterpunch: Bernie Sanders Outlines His Plans for ‘Medicare for All’

Today’s Counterpunch has a piece by the radical, progressive Democratic politician, Bernie Sanders, reblogged from the New York Times. In it, Sanders discusses the outrageous scandal that 28 million Americans have no medical coverage, despite the fact that their country spends more on healthcare than almost any other nation. He points out that this is because the insurance-based healthcare system is designed not to give Americans access to decent healthcare, but to enrich the companies’ executives and shareholders. He describes how many Americans cannot afford healthcare, and are forced to cut down on the drugs they need, simply because they cannot pay for them. He argues that the experience of Canada, and the Medicare programme brought fifty years ago, both show that single-payer healthcare is cheap, popular and effective.

He states that he intends to introduce a bill for Medicare for All into Congress next Wednesday, and outlines how he envisages an initial four year transition period from the current American system. He also makes it plain that there will be concerted opposition to his proposal.

His piece begins

This is a pivotal moment in American history. Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right? Or do we maintain a system that is enormously expensive, wasteful and bureaucratic, and is designed to maximize profits for big insurance companies, the pharmaceutical industry, Wall Street and medical equipment suppliers?

We remain the only major country on earth that allows chief executives and stockholders in the health care industry to get incredibly rich, while tens of millions of people suffer because they can’t get the health care they need. This is not what the United States should be about.

All over this country, I have heard from Americans who have shared heartbreaking stories about our dysfunctional system. Doctors have told me about patients who died because they put off their medical visits until it was too late. These were people who had no insurance or could not afford out-of-pocket costs imposed by their insurance plans.

I have heard from older people who have been forced to split their pills in half because they couldn’t pay the outrageously high price of prescription drugs. Oncologists have told me about cancer patients who have been unable to acquire lifesaving treatments because they could not afford them. This should not be happening in the world’s wealthiest country.

Americans should not hesitate about going to the doctor because they do not have enough money. They should not worry that a hospital stay will bankrupt them or leave them deeply in debt. They should be able to go to the doctor they want, not just one in a particular network. They should not have to spend huge amounts of time filling out complicated forms and arguing with insurance companies as to whether or not they have the coverage they expected.

Even though 28 million Americans remain uninsured and even more are underinsured, we spend far more per capita on health care than any other industrialized nation. In 2015, the United States spent almost $10,000 per person for health care; the Canadians, Germans, French and British spent less than half of that, while guaranteeing health care to everyone. Further, these countries have higher life expectancy rates and lower infant mortality rates than we do.

Please go to the Counterpunch site and read the whole article. It’s at:
https://www.counterpunch.org/2017/09/14/why-we-need-medicare-for-all/

The state and state-funded healthcare systems of the European countries have contributed immensely to their people’s health and wellbeing, ever since Bismarck introduced it in Germany in 1875 in an attempt to steal working class votes away from the socialist SDP.

And it’s driving the Reaganites and Thatcherites of the corporate sector up the wall, because it denies them so much of the juicy profits that comes from the insurance-driven sector. That’s why the Tories over here have been privatizing the NHS piecemeal by stealth ever since the days of Maggie Thatcher. It’s why the corporate bosses of the big healthcare firms, like the fraudster Unum, came over here at the beginning of New Labour’s tenure in office to lobby Blair to privatize the NHS.

And it’s part of the reason the Blairites, Tories and Lib Dems, and their paymasters in big business and lackeys in the media, including the Beeb, fear and hate Jeremy Corbyn, as the Republicans and the corporatist Democrats around Hillary Clinton despise Bernie Sanders in the US.

Any civilized country has to demand proper medicine for its people, regardless of the demands of the corporatists to keep it the expensive privilege of the affluent. So, go Bernie! And may Corbyn also win in his fight to renationalize the NHS.

Why Down Under Comes Out on Top in Health Care

Published by Anonymous (not verified) on Wed, 09/08/2017 - 3:21am in

When I arrived in New York as a young journalist from Sydney, Australia in 2003, not even the dazzle of the big city could conceal the extent of my surprise over three conditions of American society.

One, the racism that still played out; a dark underbelly of a nation painted on the resigned faces on the 4 subway as I traveled home to Crown Heights every day. Two, the air of individualism you could smell on the streets. Yes, there were the Wall Street financiers, but it was everywhere — in the delis, on the bikes of restaurant delivery boys peddling furiously into the night. It seemed to whisper, “Hey girl, you might make it if you try hard enough, but you’re on your own now, good luck!”

There’s good reason why American politicians are gushing over health care down under. Bernie Sanders was back at it again on the Senate floor last week, and even Donald Trump has praised Australia’s health care system this year. Here’s why.

— Christine Kearney

And then finally, there was the American health system. If the first two issues were steeped in American history, health care seemed different. To the outsider, it was nearly unfathomable why the most prosperous nation on earth had not fixed a decades-old problem, that was only becoming a costlier and increasing burden as each year passed.

We had all heard about it. Horror stories spread back home of Australians who had forgotten to take out travel insurance in the US only to end up with six-figure hospital bills. But it was different when right before my eyes — back then some 45 million people carrying the burden of being uninsured. (Little did I know I would soon join them.)

Despite coverage of 2003’s Medicare Prescription Drug, Improvement and Modernization Act, when I quizzed American journalists why there were not more stories, why there didn’t seem any sense of urgency to overall change, I would often be met with a small shrug, and resignation that all those stories had been done before. Change had failed. It wasn’t a scoop.

If that was the sense among some journalists, I still wondered why the public wasn’t more restless. I had to conclude many everyday Americans were simply clueless about how other countries worked.

But now, they’re beginning to know. A couple weeks ago, Americans heard Bernie Sanders gush how Australia’s universal health care is wildly more efficient and effective than America’s. Sanders told the Senate floor: “Not only does Australia guarantee universal health care, spend less on health care per capita, and pay less than we do for many health services, they have better health outcomes.”

Sanders was capitalizing on Donald Trump admitting back in May to a visiting Australian Prime Minister Malcolm Turnbull, “you have better health care than we do.” Yet analysts say the now defeated “skinny repeal” of Obamacare Trump backed would have made the US system less like Australia’s, not more. And Democrats have rightly pointed out the Australian system includes a publicly funded Medicare system far more comprehensive than America’s that covers all ages.

This isn’t refutable. Study after study ranks America way down and Australia among the best overall health care in developed nations. Just two weeks ago, a new study by a team of American researchers found the United States spends far more on health care than other high-income countries, with spending levels rising continuously over the past three decades.

A recent study by the Commonwealth Fund think tank compared the quality of health care systems of 11 high income countries based on 72 indicators, ranking Australia’s mixed public-private system among the top three overall, along with the UK and The Netherlands. It also ranked highest on Administrative Efficiency and Health Care Outcomes.

Despite the praise, Australia’s health care system still depends on a mixed market structure (like the US), using both public and private sectors to provide funds to deliver health care. And it’s not without its failings, including sliding down the world rankings on equity, with people in rural and poorer areas less able to access quality health care, and in general out-of-pocket costs for everyone continuing to increase.

The federal government funds Medicare, a universal public health insurance program providing free or subsidized access to care for Australian citizens…Private health insurance (PHI) is readily available and offers more choice of providers, faster access for nonemergency services, and rebates for selected services.

— The Commonwealth Fund

But that is little consolation for the US, which ranked last overall, last in access, equity and health care outcomes, and next to last in administrative efficiency, as reported by patients and providers. Only in care process did it perform better, ranking fifth.

The authors concluded: “Despite spending nearly twice as much as several other countries, the country’s performance is lacklustre.”

That America’s health care system overspends isn’t exactly news to Americans.

But the tendency to reject change isn’t just politics, say analysts, it’s also human nature, whether in Australia or America.


RELATED: Money & Politics


A small group of activists rally against the GOP health care plan outside of the Metropolitan Republican Club, in New York City on July 5, 2017.. Republicans in the Senate will resume work on the bill next week when Congress returns to Washington after a holiday recess. (Photo by Drew Angerer/Getty Images)

The Battles Ahead: Meet the Biggest Opponents of Single-Payer

BY Michael Corcoran | July 7, 2017

“There’s the human tendency to get used to the benefits you have, or the system you have,” says Australian-American relations expert, Associate Professor Brendon O’Connor of the Sydney-based think tank The US Studies Centre.

Another underlying reason Americans might have difficulty changing their thinking on health care could be buried in the second of my initial observations in New York — the overall effects of such a free-market leader, he noted. Not least the view that Australians see health care as a right, while in America’s that’s still debatable.

O’Conner believes that is why in America “you have some of the world’s best health care, and you also have some of the biggest gaps in coverage.”

“It goes to a little bit to the heart of America as a more free-market, laissez faire, more capitalist society,” he said. “The idea of a government providing a one-stop shop for health care like the United Kingdom, or even like ours, I would argue is an anathema to American values and traditions.”

Still, while for now a Republican-controlled Congress is hardly going to push for an increase in the government’s role, O’Conner believes “something is sort of changing” and any new president and new Congress might give hope to more universal health care.

“People realize it’s a very expensive system, it doesn’t cover as many people or [offer] benefits like other systems in the western word, so a little bit of comparative analysis rightly leads American politicians and a lot of policymakers to think, ‘Hang on, this system isn’t all its cracked up to be and it’s got a lot of faults.’”

In the meantime, while America’s health care system remains broken, it still plays an important role in Australian politics.

“The American model is presented as bit of monster, politically, in campaigns,” said O’Conner. “It’s one of those good examples of America being a kind of dystopia or disfunction that Australians want to avoid. It’s been a pretty regular trope of the Labor Party to say, ‘Look, we don’t want to go to that American model.’”

The post Why Down Under Comes Out on Top in Health Care appeared first on BillMoyers.com.

Bill Moyers on NPR’s ‘Fresh Air’ Talking About Medicare, Passed 52 Years Ago This Week

Published by Anonymous (not verified) on Fri, 04/08/2017 - 11:21pm in

Bill Moyers with President Lyndon Johnson.

Earlier this week, Bill Moyers penned an essay recalling the long legislative road that faced Medicare in the intervening years between President Franklin D. Roosevelt’s New Deal and President Lyndon Johnson’s Great Society. At the time of the bill’s passage, in 1965, Bill worked in Johnson’s White House as a special assistant to the president, and was witness to Johnson as he “coaxed, cajoled, badgered, buttonholed and maneuvered Congress into enacting Medicare for the aging and Medicaid to help low-income people.”

He tells Fresh Air host Terry Gross:

Lyndon Johnson was a genius in knowing everyone’s price… What all of this shows is that it takes a president who is informed, and engaged and active in the legislative process respecting the differences between the branches. But it takes someone who knows what is going on, cares about the details of the bill and is willing to sit one-on-one —

I can see right now Lyndon Johnson having individual and collective members of Congress to have coffee in the morning, lunch at noon, a drink at 6 o’clock, even dinner sometimes. And then I can see him meeting with the head of the Chamber of Commerce, the head of the AFL-CIO, very important for the passage of Medicare, they brought their 14 million members to back it. That’s how he worked it.

Listen to the entire interview, which aired on Fresh Air on Aug. 3, 2017.

The post Bill Moyers on NPR’s ‘Fresh Air’ Talking About Medicare, Passed 52 Years Ago This Week appeared first on BillMoyers.com.

LBJ Launches Medicare: ‘You Can’t Treat Grandma This Way’

Published by Anonymous (not verified) on Mon, 31/07/2017 - 12:53am in

Watching the craziness in the Senate this week, as Mitch McConnell and the GOP’s zealots drove their clown car into a brick wall and yet another effort to take away health care coverage from millions crashed and burned, I thought back to a different turn of events.

It was 52 years ago this Sunday — July 30, 1965. Two American presidents celebrated the birth of Medicare, the most significant advance toward national health insurance in America’s history.   

I was a White House assistant at the time, working for President Lyndon B. Johnson as he coaxed, cajoled, badgered, buttonholed and maneuvered Congress into enacting Medicare for the aging and Medicaid to help low-income people. For all the public displays over the years of his outsized personae and powers of persuasion, this time he had kept a low profile, working behind the scenes as his legislative team and career health care experts practically lived on Capitol Hill, negotiating with members of Congress and their staffs.

From the White House, LBJ worked the phones; invited senators and representatives singly and collectively in for coffee, drinks or dinner; listened attentively in private to opponents and proponents from interests as varied as business, labor, medicine and religion; and kept in his head a running tally of the fluctuating vote count.
 
As it had been for decades, it was a tough fight down to the wire. A look back is instructive, not only to show how long it can take to move a legislative dream to reality but also to illustrate how a president with a grasp of history and knowledge of how government works is crucial to making success possible.

In 1935, when President Franklin Roosevelt first tried and failed to get health insurance included as part of Social Security, I was 1 year old and my family was broke. The Great Depression had ended my father’s tenant farming. He took a job for a dollar a day as a laborer on the construction of a highway in southeast Oklahoma.

Earlier, my mother had lost twin girls — one at birth, the other some months later — because the nearest doctor was too far away to arrive in time to help. My parents moved into town. To pay the doctor who delivered me, my father lugged large stones by hand to the site the physician had bought to build his first office. It’s still there.

At about this time in Washington, Republicans, conservative Democrats and the American Medical Association (AMA) were winning their fight to sink President Roosevelt’s proposal for health insurance. Congress was intimidated, and in August 1935 FDR gave up, signing the Social Security Act without health coverage.   

Eight years later, in the midst of World War II, he once again called for social insurance “that will extend from the cradle to the grave.” And again, his proposal went nowhere.

On FDR’s death, Harry Truman became president. In his 1948 Message to Congress on the State of the Union, he said:  

This great nation cannot afford to allow its citizens to suffer needlessly from the lack of proper medical care. Our ultimate aim must be a comprehensive insurance system to protect all our people equally against insecurity and ill health.

 

Congress still refused to budge. Running for election in his own right that year, and way behind in the polls, Truman won an upset victory after demanding that health care insurance and civil rights be included in the Democratic Party platform. That same year, congressman Lyndon Johnson of Texas, whose home district was Democratic and liberal in a state turning increasingly Republican and conservative, was running for election to the US Senate. He opposed Truman’s health care plan as socialistic and was elected.  

In 1952, Republicans won control of Congress for the first time since 1932 and hardened their stand against a national health care program. War hero Dwight Eisenhower won the presidency for the Republicans. He, too, opposed the plan that had been shelved by Congress before Truman left office.

Ike only was willing to support subsidizing private insurers to cover certain low-income groups and no more. With the continuing opposition of the nation’s doctors — amplified through their political lobby, the AMA, as well as the US Chamber of Commerce — the notion of Medicare appeared finished once and for all.    

Yet when he yielded the presidency to Eisenhower, Truman lamented his failure but was prophetic when he said: “[It] has only delayed and cannot stop the adoption of an indispensable health insurance plan.”

He was right. The battle heated up. In 1957, the AFL-CIO brought its 14 million members to the fight. The American Hospital Association, which bore the brunt of the problems older people encountered as they aged, signed on, too.

Public opinion was swinging in favor of national health insurance. When John F. Kennedy and Lyndon Johnson were nominated as the Democratic ticket in 1960, they made health care for Social Security retirees a major plank in the platform and endorsed a bill in the Senate that in time would become Medicare.

Though he was Kennedy’s running mate, Johnson was still the powerful Senate majority leader, that body’s top Democrat, and responsible for steering its legislative agenda. After a long day on the campaign road, or in the Senate, we would get to his home late and he would stay up until after midnight, making phone calls to one or another member of Congress urging passage of the Medicare bill.

Despite his efforts, it failed by four votes. LBJ had studied the polls and knew public opinion was building for national health insurance; he feared this defeat might cost Democrats the election. It didn’t, although the margin of victory was incredibly slim. As soon as they were inaugurated, now President Kennedy and Vice President Johnson championed yet another effort known as the Medical Care for the Aged bill. Still adamantly opposed by the Republicans and the AMA, it also failed — this time by two votes.

In early 1963, the bill was reintroduced in Congress, only to fail again. Some observers again pronounced it once and forever toast. But in November of that year, an assassin killed John Kennedy, tragically catapulting Lyndon Johnson into the White House. Just days later, in a dramatic speech to Congress and the nation, he slowly and deliberately drawled: “Let us continue!” With that challenge, LBJ set out to enact Kennedy’s legislative agenda — with a good chance, he thought, of passing the Medicare bill.

As before, the opposition fought back with everything they had, which now included the AMA’s new pitchman, Ronald Reagan. Not yet a candidate for public office, the actor was hired to warn the country against letting government get between doctors and their patients. He made a popular recording played at thousands of small meetings around the country in which attendees heard his pitch warning of “socialized medicine” and predicting “behind [Medicare] will come other federal programs that will invade every area of freedom as we have known it in this country.” Just think if he’d had Twitter.

Our strategy that year came to naught, producing in the early fall a stalemate. The Senate actually did pass a national health care bill for the elderly (despite the opposition of the Republican nominee for president, Barry Goldwater of Arizona, who interrupted his campaign and returned to Washington to vote no). But the powerful and conservative Democratic chairman of the House Ways and Means Committee, Wilbur Mills, would not agree to a medical care provision of any kind. A conference meeting to work out differences between the House and Senate ended in deadlock.

Johnson gritted his teeth and returned to the campaign, winning a four-year term in his own right.

Elections matter — surely no one doubts that fact anymore — and the ’64 election mattered dramatically. Not only did it deliver LBJ a landslide victory, but it brought Democrats their biggest majorities in the House and Senate since FDR. “If we can’t get Medicare through now,” the president told me after the election, “we don’t deserve what we just won.”

So as soon as he and Vice President Hubert Humphrey were inaugurated in January 1965, we started over. You can get a glimpse of the intensity of LBJ’s drive from a conversation I had with him around that time. With others, I had urged that the new bill include a provision for a retroactive increase in Social Security payments as an economic stimulus. He called me to say okay, but wanted me to understand it wasn’t because of the economy:

…My inclination would be … that it ought to retroactive as far back as you can get… because none [of the elderly] ever get enough. They are entitled to it. That’s an obligation of ours. It’s just like your mother writing you and saying she wants $20, and I’d always sent mine a $100 when she did. I never did it because I thought it was going to be good for the economy of Austin. I always did it because I thought she was entitled to it. And I think that’s a much better reason and a much better cause and I think it can be defended on a hell of a better basis…. We do know that it affects the economy… it helps us in that respect. But that’s not the basis to go to the Hill, or the justification. We’ve just got to say that, by God, you can’t treat grandma this way. She’s entitled and we promised it to her.

 

He understood the legislative process like no one I ever met. “Nothing given, nothing gotten — that’s the rule!” he told us in an Oval Office meeting on how to break yet another Capitol Hill deadlock. He sent his senior legislative aide to play sweet with a still-recalcitrant Wilbur Mills and warned, “I’ll tell you this, Wilbur Mills will take your pants off unless you’ve got something that he’s got to trade for.” When Mills still wouldn’t budge, the president let loose a string of invectives that would have made even Anthony Scaramucci blush. The next day he was courting Mills again, as if nothing had happened.

As the cherry blossoms bloomed that spring of ‘65, the president thought Congress was moving too slowly. The civil rights movement was under siege in the South, violence was continuing against blacks and we were working around the clock to pass legislation  to end discrimination. Even so, he wouldn’t let us slow down on Medicare — or other pending priorities. When he thought we were lagging, he took us to the woodshed, as you can see in a telephone conversation with Vice President Humphrey and me:

They [the House and Senate] are bogged down. The House had nothing this week — all goddamn week. You and Moyers and Larry O’Brien [his chief congressional expert] have got to get something for them. And the Senate had nothing… So we just wasted three weeks… Now we are here in the first week in March [1965], and we have just got to get these things passed… You’ve got to look each week and say, what is the Senate doing in committee this week and when will they be through, what is the House doing… You’ve got to be running into these guys [members of Congress] in the halls, and going over and having a drink with them in the evenings… I’ll put every Cabinet officer behind you, I’ll put every banker behind you, I’ll put every organization that I can deliver behind you… I’ll put the labor unions behind you.

A few days later, breakthrough. LBJ’s now-gentler courting of Wilbur Mills paid off, and the House Ways and Means chairman pieced together a bill from several options championed by different interests. He got it past the committee’s conservative coalition with a straight party vote, 17-8.   

Remembering our defeat the previous fall, our team fretted over how to make the final sale to the full House and Senate. The president had some more advice for us. As he told Larry O’Brien, the White House chief legislative honcho: Give bragging rights to anyone who voted on the final version of both Medicare — and the big education bill also in the pipeline:     

[Tell them] that every guy that votes for Medicare and education, his grandchildren will say my grandpa was in the Congress that enacted these two… So it makes ‘em proud. And they can go back home and say I was one of the 54 [who voted yes], or my daddy was one of the 54… so all his children and grandchildren are bragging about being one of the 54.

 

Medicare passed the House by a vote of 313-115. But in the Senate, liberal Democrats added $800 million to its cost, outraging conservatives (and vexing LBJ, who knew such overreach would give opponents more fuel to attack).  

Back the bill went to a conference committee between the House and Senate. Then to the House floor again, where it survived more than 500 amendments before passing on July 27 by majority vote, 307-116. One day later the Senate passed it, 70-24. All that was needed now was the president’s signature and Medicare and Medicaid would become the nation’s first public health insurance programs.  

And that’s how it came to pass that 52 years ago, on the morning of July 30, 1965. President Johnson loaded up two planeloads of dignitaries and headed toward Independence, Missouri, hometown of former President Harry Truman. He intended to sign the bill at the side of the man whose original proposal LBJ had dismissed as socialism. Now he revered Truman as “the real daddy of Medicare.” Here’s the actual moment Medicare became the law of the land:

President Lyndon Johnson flips through the pages of the Medicare bill for former President Harry Truman in Independence, Missouri on July 30, 1965. Johnson flew to Independence to sign the bill in front of Truman, the man who originally proposed the legislation almost two decades before. Behind Johnson and Truman are Mrs. Johnson (left), Vice President Hubert Humphrey and Mrs. Truman. (Photo by Bettmann Collection via Getty Images)

President Lyndon Johnson flips through the pages of the Medicare bill for former President Harry Truman in Independence, Missouri on July 30, 1965. Behind Johnson and Truman are Mrs. Johnson (left), Vice President Hubert Humphrey and Mrs. Truman. (Photo by Bettmann Collection via Getty Images)

 

After signing the bill, Lyndon Johnson turned to Harry Truman and signed him up as Medicare’s first beneficiary. It was high drama, touched with history, politics, sentimentality, showmanship and compromise.

The legislation was far from perfect. LBJ once told me never to watch hogs slaughtered before breakfast and never ever show young children how legislation gets enacted.

Too much secrecy surrounded the bill’s passage. Even as the president signed it into law, we weren’t sure of all that was in there. As some principled conservatives warned, there were too few cost controls. The experts feared copays and deductibles would become a burden.  

“Those can be fixed,” LBJ said, “once it sinks in that Medicare is here to stay.”

Meanwhile, as historian Robert Dallek has written, although Medicare and Medicaid did not solve the problem of care at reasonable cost for all Americans, “the benefits to the elderly and the indigent… are indisputable.”

Perhaps the biggest mistake was one of imagination — our failure to anticipate the advent of new and expensive technology to treat the sick or the demand on the system that would rise from a burgeoning population. That spring President Johnson had warned, “We will face a new challenge and that will be what to do within our economy to adjust ourselves to a life span and a work span for the average man or woman of 100 years.”

That, and the cost, we reckon with today.

Now that the eight-year effort of conservatives to repeal the Affordable Care Act (itself a flawed but significant extension of the effort to help more people get decent coverage) is stalled, the next steps are crucial. Going back to the status quo — a system driven by the profit motive and rationed health care based on income — is unthinkable. At the website Common Dreams, Dr. Carol Paris, president of Physicians for a National Health Program, writes:

“Clearly, the system is broken. Like a cracked pipe, money gushes into our health care system but steadily leaks out. Money is siphoned into the advertising budgets of insurance companies and the army of corporate bureaucrats working to deny claims. Even more dollars are soaked up by the pockets of insurance CEOs who have collectively earned $9.8 billion since the Affordable Care Act was passed in 2010. Nearly a third of our health care dollars go to something other than health care.”

Yes, our health system is broken, but broken systems can be fixed — not easily, but they can be fixed.  

Watching recent events, I thought of the long and arduous process I’ve just related, the many steps that brought Medicare into being, and how I was afforded a modest role in the supporting cast.

I came away from the experience with three lessons. First, whether health care is a right may be debatable, but it assuredly fulfills a basic human need — and without it, human beings without means will live and die suffering unduly.

Second, building that more perfect union which the founders of this republic defined as the mission of government has always been slow, hard, acrimonious, frustrating, tiring and elusive, because we as individuals are ourselves imperfect and because there are always among us those predators who regard democracy as an obstacle to their avarice.

Against such realities, the only way for democracy to succeed is for enough people to take up the cause where and when they can, as so many did for Medicare and are doing now for our eroding social covenant. That’s the third lesson I learned: It is harder to build something than to burn it down, but build we must.

 
Note: I am greatly indebted to Larry DeWitt, the historian of the US Social Security Administration, whose outstanding research and organizing talents have helped so many of us recollect with greater accuracy and context such experiences as I have recounted here. The author of numerous articles and essays — including “The Medicare Program as a Capstone to the Great Society — Recent Revelations in the LBJ White House Tapes,” on which  I have often relied — Mr. DeWitt also created http://www.socialsecurity.gov/history, one of the largest history-related web sites in the federal government. It’s a national treasure.  Check it out.

— Bill Moyers

The post LBJ Launches Medicare: ‘You Can’t Treat Grandma This Way’ appeared first on BillMoyers.com.

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