LBJ's success

We’ll just skip right to the good part on this one, because the rest of this gets pretty complicated. After a solid decade of the American Medical Association opposing government sponsored health care, the Social Security Act of 1965 was passed in July under the leadership of President Lyndon Baines Johnson.

Johnson gets all the credit for creating both Medicare and Medicaid, but just as his “Great Society” was a direct descendent of President John F. Kennedy’s “New Frontier” agenda, Johnson’s Medicare bill was the child of the Medical Health Bill for the Aged that had been a part of Kennedy’s campaign platform in 1960.

To back things up one step further, and introduce another key player, that campaign promise was based on the inadequacy of a the one piece of health care coverage the AMA had supported—the Kerr-Mills bill. Wilbur Mills, the author of the bill, was the chair of the House Ways and Means Committee, a key position because all health care legislation had to make it through his conservative-dominated committee, blocking bills from making it to the Democrat-dominated full session.

The Kerr-Mills bill expanded medical vendor payments under state-run programs, but didn’t do enough—few people were able to access the expanded coverage.

After Kennedy was elected, the first iteration of the bill which would eventually become Medicare came into being. It was called the King-Anderson bill, but the Democrats decided to wait until after the 1962 mid-term elections before attempting it. (They had lost a number of seats in the 1960 elections.)

When Kennedy decided to move forward with King-Anderson in 1962, he found his way blocked by Mills and the other conservatives on the Ways and Means Committee. It was thought that the bill could pass if it made the floor in a regular session, but because tax legislation can only be introduced in the House of Representatives, there was no practical way of getting the bill out of committee.
To get around the stubborn Mills and his committee, King-Anderson was introduced to the Senate as an amendment to an existing tax bill. This proved to be a tactical error. Because it undermined the traditional power of the committee, dodging the Ways and Means Committee alienated five senators who had previously supported the King-Anderson legislation, and the amendment was defeated 52-48 in a July 1962 Senate vote.

Unfortunately, the question of Kennedy’s continuing to pursue health care reform was answered permanently on November 22, 1963 by Lee Harvey Oswald.

Johnson did not pursue the controversial topic of health care reform until after winning a landslide victory in the 1964 presidential election. But when he did, he found his efforts stymied, just as Kennedy’s had been, by the Ways and Means Committee, and Wilbur Mills.

Mills was, however, feeling the public support for the concept of government funded health benefits, and drafted a bill which combined King-Anderson with several competing ideas. His compromise, which would create both Medicare and Medicaid, eventually became law only after 513 differences were ironed out in the conference between House and Senate.