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Originally conceived as a foundation of universal healthcare coverage, the debate over Medicare's place in American medical care is still going, fifty years after its enactment.
When President Lyndon Johnson signed Medicare into law on July 30, 1965, he declared, "No longer will older Americans be denied the healing miracle of modern medicine" (Johnson, 1965). On that promise, and much more, Medicare has delivered (Oberlander and Marmor, 2015). Over the past fifty years, Medicare has provided tens of millions of older Americans with a crucial measure of financial security and access to medical care. Moreover, since 1972, Medicare has provided coverage to persons with permanent disabilities and endstage renal disease.
Medicare is a program that almost all American families come to rely on. At the same time, so too has the medical industry come to rely on Medicare. As the single largest purchaser of medical services in the United States, Medicare is an important source of income for hospitals, physicians, home health agencies, and other medical care providers. Changes made in Medicare policy reverberate through American medical care. Medicare spending currently comprises about 20 percent of all national healthcare expenditures and 14 percent of the federal budget, giving the program a central role in debates over deficits and healthcare spending (Kaiser Family Foundation, 2014).
American healthcare is today unimaginable without Medicare. But why did the United States create a separate health insurance program for seniors? How did the political legacies of Medicare's enactment shape its subsequent development? And how have Medicare politics changed over time?
Medicare's Origins
Medicare's story begins with the failed campaign for national health insurance during the first half of the twentieth century (Oberlander, 2013). In 1915, reformers introduced a model health insurance bill to submit to state legislatures, but it failed to gain traction. After fading during the 1920s, health reform returned as an issue during the New Deal (Starr, 1982). The 1935 Social Security bill initially contained a single line authorizing the study of health insurance, prompting vigorous protests from the American Medical Association (AMA), which believed government health insurance threatened the organizational, financial, and clinical autonomy of physicians. President Franklin Delano Roosevelt, fearing the controversy would jeopardize Social Security's enactment, refrained from pushing health insurance and ordered the...