universal health care

One Nation, In Sickness and in Health

Published by Anonymous (not verified) on Fri, 20/10/2017 - 4:14am in

A couple of things observed after successful surgery and a week in the hospital:

  • For reasons seemingly unrelated to your operation, you will find bits of surgical tape attached to odd parts of your body for days after your return home.
  • While confined to your hospital bed, you will hear and say the words “urine” and “urinate” more than you have in your entire previous life.
  • Most important, time and again you will be amazed and comforted by the dedication, competence and patience of virtually every doctor, nurse, nursing assistant, physical therapist and cleaner you meet — especially the nurses and nursing assistants, who clearly are in charge of the joint.

Which is why it’s so infuriating to compare the true public service of these men and women to the man who is supposed to be our public-servant-in-chief — he who insists on trying to torpedo Obamacare and on running our country and government into the ground by fomenting policies fueled not by duty or patriotism but by incompetence, ego and petty vindictiveness.


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Fourth–-year medical student Kellie Lim checks one of her patients during rounds at the UCLA Medical Center pediatrics ward. (Photo by Mark Boster/Los Angeles Times via Getty Images)

Is Health Care Doomed?

BY Bill Moyers | March 4, 2017

It’s a given that our health care system, one-sixth of our nation’s economy, is a nightmare. And that despite my encomiums of praise for the medical profession stated above, there also are stinkers out there quick to abuse the system and make a big fast buck, especially in the pharmaceutical and health insurance industries.

Yet while Obamacare is a deeply flawed program — ultimately, single-payer is the way we must go or face economic and social ruin — it still has been a step in the right direction (“the end of the beginning of the reform we need,” in the words of advocate Wendell Potter), and could in some ways be patched until we yield to the obvious and make universal health care a right for every one of us.

But no. Dear Leader, frustrated by the Republican congressional majority’s repeated inability to repeal and replace Obamacare, decided to take matters into his own hands and issue executive orders that make a mockery of medicine’s guiding principle: First, do no harm. And all to take revenge on his predecessor, whose name he believes must be expunged and thrown down the memory hole.


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A July 2017 protest against the Republican health care bill in Milwaukee, Wisconsin. (Joe Brusky/Flickr cc 2.0)

Doctors Are Warming Up to Single-Payer Health Care

BY Rachel Bluth | August 22, 2017

One executive order allowed cheaper policies but fewer protections and benefits. The other cut subsidies to health insurers that help cover the costs of medical insurance for low income individuals and families, resulting in projected premium increases of up to 25 percent by 2020 and, according to the Congressional Budget Office, costing the government $194 billion over the next 10 years. Genius.

As Sarah Kliff at Vox observed, “This is a policy that helps nobody and hurts millions.”

But at his Monday Cabinet meeting, Trump brayed, “Obamacare is finished. It’s dead. It’s gone. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore.”

Yet like so much of Trump’s bragging, it wasn’t so. Or so we thought. Democratic Sen. Patty Murray and Republican Sen. Lamar Alexander came forward with a bipartisan compromise that restores the subsidies for a couple of years but also yields to conservatives and gives states more leeway in regulating health plans. Trump seemed to say he supported it. And then he didn’t. What’s more, many conservatives, especially in the House, are opposed. So… more mayhem.

All of this is reflective of what commentator Andrew Sullivan calls “nihilist, mindless reactionism.” The president, Sullivan writes, is “a reactionary fantasist, whose policies stir the emotions but are stalled in the headwinds of reality. He can’t abolish Obamacare because huge majorities prefer it to any Republican alternative, so he is sabotaging it.”

On the campaign trail, Trump bragged how he would immediately “terminate” Obamacare and replace it with something “really, really great that works.” But if for some reason you don’t know by now, he’s all radio talk show bombast and no substance. To fix our health care system requires hard work, study and a solid determination to create something that serves the collective need and protects each of us at our most vulnerable. There’s no evidence of that hard work happening in the White House or on Capitol Hill.

As I’m recovering from my time under the knife, I’ve been reading Keeping On Keeping On, the latest volume of diaries and other ephemera from the English playwright and essayist Alan Bennett. Now in his 80s, one of his bête noires is conservative attacks on Britain’s National Health Service.

“The word patient means a sufferer,” Bennett writes, “and when someone comes to the doctor they are coming not because they want to buy something but because they want help. Structure and restructure the Health Service how you will doctors are not shopkeepers, patients are not customers and medicine is not a product.”

A hospital stay has a way of making you focus and realize things about yourself and the structures that keep us alive and well. Proper medical care for all should be a boon to our society, a miracle of public policy that sustains and protects. Mindless cant and empty braggadocio are not policy. They’re a disease that threatens the health of the nation. And Mr. Trump, you’re the Typhoid Mary spreading the contagion.

The post One Nation, In Sickness and in Health appeared first on BillMoyers.com.

Now That Skinny Repeal Is Squashed, What’s Next for Health Care?

Published by Anonymous (not verified) on Wed, 02/08/2017 - 6:31am in

This Q&A is part of Sarah Jaffe’s series Interviews for Resistance, in which she speaks with organizers, troublemakers and thinkers who are doing the hard work of fighting back against America’s corporate and political powers.

Today we bring you a conversation with Mari Cordes of Vermont, a registered nurse, union leader, candidate for local office, stalwart of the single-payer campaign and founding board member of Rights and Democracy. This interview has been edited for length and clarity.

 

 

Sarah Jaffe: You were in Washington, DC, on Thursday when the vote went down on health care reform, right?

Mari Cordes: I have been here since Thursday. I am running for the Vermont House of Representatives again in 2018 and I am here for the Progressive Change Campaign Committee’s national candidate training. I was selected as one of 300 candidates to attend this amazing training, which coincided with more actions by the amazing Center for Popular Democracy and Housing Works in the Senate offices, in the Capitol, and at senators’ offices. I was part of the protest and the rally outside of the Capitol building the night the vote came down.

SJ: Tell us a little bit about what that was like, while you were waiting to hear about the vote.

MC: It was an amazing experience to hear, once again, many stories of how everyone not only would have been impacted by the repeal of the Affordable Care Act, but by the reality that our elected leaders intentionally were [basically] attacking the American people.

As my friend Sampson and I were heading toward the rally that night at the Capitol, we passed near an outdoor movie theater and it turns out they were playing Star Wars. It was the perfect setting to hear that bombastic, symphonic music, because all of this still feels so unreal, so surreal, that this actually is happening in the United States.

Representatives from the Center for Popular Democracy, Housing Works and Rights and Democracy thank Sens. Collins, Murkowski and McCain. (Photo courtesy of Jennifer Flynn Walker)

Representatives from the Center for Popular Democracy, Housing Works and Rights and Democracy thank Sens. Collins, Murkowski and McCain. (Photo courtesy of Jennifer Flynn Walker)

We heard so many incredible and painful and heartbreaking stories about friends, people that we know, people that we don’t know that would have died and/or families that would have lost their homes and/or gone bankrupt, all in the name of an obsession with an ideology, an obsession with a hatred that a black man was president of the United States and was successful in creating policy that was definitely not perfect, but did help millions of people. It was very powerful to be in that circle, that communion of sorts, and hold a vigil for our country, whatever the outcome [was] going to be.

In that moment, there was the moment of “We are going to lose” and that feeling of hopelessness and despair. Then, a pause and a quiet moment and Ben Wikler [the Washington Director of MoveOn.org] delivered it beautifully. He became really somber. I thought it meant that we had lost, but it created this silent space for us to hear the statement that the vote was “No.” I don’t think I have ever experienced anything so powerful in my life. It was incredible.

SJ: That vote was “No,” but you are not stopping. We are talking on Saturday evening and you are about to head to another rally for health care. Tell us about that and tell us about why the fight is still going on.

MC: We got to bed at 4:30 that morning. We did rest a little bit, but with the awareness that the American people are still under attack on many fronts, not just health care, but the freedom and liberation of many individuals in this country is at risk. So, we can’t stop. In fact, there is no better time to increase the pressure and increase our activism than after a win like this, because especially those who were at risk of losing so much and especially those who have been working so hard in this fight, we have that lived experience of collective power of movement building, the organizing work. We cannot stop. We have to take this momentum and move forward.

SJ: You went to DC a few times. You were involved in a lot of organizing, even though Vermont, obviously, didn’t have a senator that was going to vote “Yes” on this thing. But, what are some of the important lessons that you learned from the seven months of fighting to try to stave off cuts to health care?

MC: I think the most important lesson is to never give up. In a fight like this, never give up. I have been very active working in Vermont towards a universal publicly funded health care system that gets rid of the highly profitable insurance companies and creates a real system. We have had our successes, like when Act 48 in Vermont passed, and we have lost in Vermont when Gov. Shumlin pulled the plug on that. We are still working hard in Vermont to move towards a universal publicly funded system. I would say that is the most important thing. We have to keep going. It is OK to rest for a little bit and take care of each other and ourselves, but we have to keep moving forward.

SJ: I want to go back to the situation in Vermont in a minute, but was there a particular moment or a particular tactic around Trumpcare that you thought was particularly successful? Some moment that maybe you saw somebody’s mind change?

MC: I think there were many moments that were successful, but they were most powerful because each action, each arrest — I was in the first group of people of 150 or more and 40 of us were arrested; I was in the second group, I don’t remember how many were in there, but 80 of us were arrested. Then, the third time, I was a legal support for ADAPT. Hundreds were arrested, I believe, in that action.

I think it was a cumulative effect, in addition to all of the actions and emails and calls from people across the country that created enough pressure on senators. All of these actions, and the media that they generated, including all of the social media, I could see on my own personal social media sites people getting engaged that might not have gotten engaged before and taking actions. It is a cumulative thing. That is the thing about collective power and movement building — it is generative. It is obvious now that people are rising up and that more people realize that organizing does work.

SJ: As you said, you are a nurse, you have been a union leader, and you have been working on health care for your entire adult life. Why is this such a powerful issue to get people organized around?

MC: Health care is a very powerful issue to get people organized around because it impacts every single person personally, often in potentially devastating ways. As I mentioned earlier, many people that I have met though doing these actions and then all the patients that I work with every day, I hear, I see how critically important having access to health care is for them and their families.

I work in a busy cardiology unit at the University of Vermont Medical Center and every day I am at work, when I have three or four patients, I look at each one of them and wonder: “What if they didn’t have access to health care, if they didn’t have insurance? If they couldn’t get health care when they needed it, would they be alive right now?” The huge majority of the time, the answer is “No.”

Then, it is personal for me, too. I have health issues, like most of us do. I would say, more than anything, it is such a huge area of injustice in our country and the fact that in 2017 we are having to fight to stay alive is ludicrous beyond ludicrous.

Mari Cordes and her Rights and Democracy colleagues leave for their delegation to DC. (Photo courtesy of Rights and Democracy)Mari Cordes and her Rights and Democracy colleagues leave for their delegation to DC. (Photo courtesy of Rights and Democracy)

SJ: You were involved in a fight to end insurance discrimination against transgender people. Of course, this week while the health care fight was going on, Trump came out and said he was going to ban trans people from the military because their health care was too expensive. I wonder if you could talk a little bit about that particular fight that you were in and what we can learn from that.

MC: My friends and I were just at the rally at the White House today around Trump tweeting military policy changes. I was involved in some major change work in Vermont, in co-leading a coalition of organizations and people, including physicians that provide medical care for transgender individuals. The organizations we worked with have been working on transgender justice issues for a long time. Vermont, at the time, I think it was 2011 or 2012, did have a law that said it was illegal for health insurance companies not to provide insurance for transgender individuals, but that was a pretty broad statement and, of course, what the health insurance companies did was refuse to cover medically necessary care for transgender people.

I became aware of that when an amazing nurse friend who is also transgender came to me and told me that he needed to have surgery and it was not covered by our hospital insurance. The University of Vermont Medical Center self-insures, so they get to decide what their policy looks like. This person and I and the other leaders of these organizations worked together on a campaign that eventually led the commissioner of the Department of Financial Regulation, which oversees insured companies in Vermont, to issue a clarifying bulletin that made Vermont, at the time, the fourth state in the nation to have such clear language that denying medically necessary care for transgender individuals was against the law.

SJ: I am wondering if there is something about this happening in the midst of the health care fight, your experience on both these issues, that you think we can learn from going forward, as Trump is clearly going to keep doubling down on attacking marginalized groups, especially as he is losing?

MC: More than anything. Because of all the attacks against marginalized groups, more than ever we need to be unified. I do see that happening. I do see people in organizations working toward being as unified as possible. I believe it is the only way that we are not only going to survive, but thrive.

SJ: Let’s go back to the single-payer struggle in Vermont. Vermont was the first state to vote for a universal publicly funded health care system but had trouble getting it implemented. I wonder if you could tell people a little bit about that process, the organizing that got the bill passed, and then the efforts to move forward with it.

MC: We began around 2008 — “we” meaning the Vermont Workers Center — started the Healthcare Is a Human Right Campaign, which was an amazing grass-roots mobilization and education project all across the state of Vermont that got thousands of people involved in not only the education of people in the community about how our health care system, or lack of it, is broken and what we can do to fix it.

We did things like holding peoples’ forums across the state where the people led the forums with legislators present. It was a chance for people to ask legislators questions, but also ask them the main question: Do you and will you actively work to support universal health care, publicly funded? The Workers Center organized annual rallies. I think before the Women’s March, it was one of the Healthcare Is a Human Right rallies on May Day that was the largest rally in Vermont’s history. Eventually, working with other organizations like Vermont for Single Payer Now [part of Dr. Deb Richter’s Physicians for a National Health Program], working with other organizations across the state led to us winning by putting pressure on legislators and supporting those who were doing the policy and taking the political risks. We did win Act 48, which has embedded in it the five universal human rights principles.

I was appointed as a commissioner to two, at the time, of Gov. Shumlin’s workgroups: the Consumer Workgroup for Health care to try to move toward this new system and another commission. We did a fair amount of good work there, but in retrospect it seemed like a farce. What was really being planned was not happening in those groups with members of the public and health care professionals. It was happening at the governor’s office. That meant that eventually Gov. Shumlin and some of the legislators decided that they didn’t have the political capital to pull this off, so they pulled the plug on it.

SJ: Where are things now? You have a different governor now. So, what are things like on the ground in Vermont, working on health care on the state level?

MC: We are organizing. Always organizing. Actively … the main organizations that are working toward a universal publicly funded health care system are now working together to figure out what that looks like going forward. We are back on the ground organizing in communities, setting up town halls, talking with legislators.

The one possible step that actually was in the state house as a bill last year is universal primary care, which would do just what it says: provide access to health care for everyone in Vermont as primary care. Primary care is often one of the obstacles that people face when they are sick or have something going on and they can’t afford it. They can’t access it. So, they don’t go and then, they get sicker and end up in the emergency department with a worse condition. A patient that I remember … had a simple infection [and] waited too long, and it turned into a devastating full-system infection that killed him. It was something pretty simple that could have been fixed had he been able to access primary care. That is what we are working on now.

SJ: You mentioned at the beginning that you are running for office. Tell us what your platform is. I presume that universal health care will be part of it.

MC: Yes, it is and it was. I ran in 2016. My main platform items are working toward an economy that works for us all. That includes having a health care system and working toward progressive tax reform that [e]nsures corporations and the wealthy pay their fair share, further developing and safeguarding the public services that are the foundation of strong communities. Also, that Vermont must lead on climate change. I am also a board member of 350Vermont.

And quality education — we have had some major changes in how school governance is run in Vermont with the passage of Act 46, which is very controversial and in many ways, took the local direct engagement away from small towns. The intent, or the stated intent of Act 46, one of them, is to help reduce property tax burdens. I am not sure how effective that is going to be. There are some one-time savings that we will see, but the real issue is that the biggest line item in a school district’s budget is health insurance for educators and staff. So until we get control over that, it is still going to be a major issue.

Then, I will continue to work very hard in organizing and also as a representative [of] my district to develop a health care system that is financed and administered publicly with strong and transparent government regulations and ample public engagement.

SJ: How can people keep up with you and your campaign and your health care organizing?

MC: A couple of different ways, they can go to www.maricordes.org. There are Facebook and Twitter links on my website. You can also find me on my personal Facebook page: Mari Cordes. I am working with Rights and Democracy a lot, so I would encourage people to follow Rights and Democracy Vermont and New Hampshire.

 
Interviews for Resistance is a project of Sarah Jaffe, with assistance from Laura Feuillebois and support from the Nation Institute. It is also available as a podcast on iTunes. Not to be reprinted without permission.

The post Now That Skinny Repeal Is Squashed, What’s Next for Health Care? 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

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