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Medicare plan would start generational war

    After reading your Aug. 19 coverage of the back and forth between the Obama and Romney campaigns on Medicare, I am left to wonder: If the Romney-Ryan plan for Medicare is so benign, why the constant assurances from them that those of us over 55 should avert our eyes from the plan since it will not apply to us?
    This approach, in combination with the overwhelming support of Republicans in Congress for a much different system, causes one to suspect that their plan is not so harmless. Republicans frequently charge that the president is encouraging class warfare. This is a curious accusation from a group that (1) appears to have exerted enough influence in Washington to have already won the class war, and (2), is openly encouraging those of us over 55 to enlist in a generational war against our children.
    The plan would have us reserve traditional Medicare for ourselves, while we bequeath an inferior, more costly plan to our children. The Republicans would have us be as greedy as many of them are. Are we really that selfi sh? Are the children of the “Greatest Generation” poised to be remembered as the greediest generation?
    This country needs an honest, mature debate about the future of Medicare. But the starting point for this conversation should not be the Republican default position that we rush to a voucher system that enriches private insurance companies. Medicare is so valued that many Americans look with great anticipation to the time when they are eligible.
    Why not begin the debate on the future of Medicare with the goal of keeping what we have, and exploring what it will take to leave our children something we can be proud of — a plan as highly regarded as what was left to us by those who came before.

    RICH LEON
    Glenville

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Social Security History
     
Appendix A: Chronology of Significant Events Leading to Enactment of Medicare

1883 German national compulsory health insurance program enacted.

1902 First U.S. workmen's compensation law enacted (later declared unconstitutional).

1906 American Association for Labor Legislation (AALL) founded (disbanded in 1942).

1908 Workmen's compensation system established for Federal employees.

1911 British National Health Insurance program enacted.

1912 Social insurance, including health insurance, endorsed in platform of Progressive Party and espoused by its candidate, Theodore Roosevelt.

December. Social Insurance Committee created by the AALL.

1913 AALL Social Insurance Committee report favors State-run compulsory health insurance.

June. AALL sponsors First National Conference on Social Insurance, in Chicago.

1915 November. A "standard" health insurance bill is published for State consideration, by AALL.

1916 Congressional hearings on health insurance.

December. American Medical Association (AMA) Social Insurance Committee, headed by Dr. Alexander Lambert, recommends compulsory, State-run health insurance..

1917 June. AMA House of Delegates passes resolution stating principles to be followed in Government health insurance plans.

October. War Risk Insurance Act.

1918 First Federal grants to States for public health services.

November. California voters defeat a referendum to permit establishment of a State health insurance plan.

1919 April. New York State Assembly defeats a health insurance bill previously approved by the State Senate.

1920 AMA House of Delegates reverses position, declaring itself in opposition to Government health insurance.

1921 Sheppard-Towner act, providing Federal subsidies for State-run child and maternal health programs, enacted.

1927 Committee on the Costs of Medical Care established by several foundations to make comprehensive study of medical economics.

1929 Precursor of Blue Cross established at Baylor University.

June. Sheppard-Towner act is allowed to expire.

1932 American Federation of Labor (AFL) endorses social insurance.

October. Committee on the Costs of Medical Care final report endorses group practice and voluntary health insurance.

1933 Private hospital insurance approved by American Hospital Association (AHA), leading to establishment of Blue Cross. Federal Emergency Relief Administration (FERA) provides emergency medical care to the needy.

1934 June 29. Committee on Economic Security created by President Roosevelt.

1935 January 17. Report of the Committee on Economic Security sent to Congress without health insurance recommendations, but spelling out principles and promising further efforts to evolve a plan.

February. AMA House of Delegates meets for "emergency" session.

June. Health report of Committee on Economic Security, "Risks to Economic Security Arising Out of Illness," filed but not published.

July 15. First Government health insurance bill introduced in Congress, the "Epstein bill" (S. 3253) sponsored by Senator Capper.

August 14. Social Security Act signed into law; health insurance excluded.

August 15. President Roosevelt announces formation of Interdepartmental Committee to Coordinate Health and Welfare Activities.

First National Health Survey begun.

1937 Technical Committee on Medical Care established under Interdepartmental Committee.

1938 February. Report of the Technical Committee on Medical Care, A National Health Program, published.

July 18-20. National Health Conference convened in Washington, D.C., under sponsorship of Interdepartmental Committee.

1939 February 28. Senator Robert F. Wagner introduces "National Health Bill" (S. 1620) incorporating recommendations of National Health Conference.

AMA establishes "National Physicians' Commit-tee for the Extension of Medical Service" to fight Wagner bill.

April 29-July 13. Hearings on Wagner bill; proposal dies in committee.

1942 Representative Thomas Eliot introduces a precursor of National Health Insurance (H.R. 7534).

November. Beveridge Report advocates a comprehensive social welfare system for Britain.

1943 January. President Roosevelt, in his state of the Union message, calls for social insurance "from the cradle to the grave."

March. Emergency Maternity and Infancy Care program (EMIC) enacted by Congress to provide health benefits for dependents of low-ranking servicemen.

June 3. Original Wagner-Murray-Dingell bill, providing for comprehensive health insurance under social security (S. 1161 and H.R. 2861) introduced. Congress takes no action on proposal.

1944 January 11. President Roosevelt outlines in his state of the Union message an "economic bill of rights," including "the right to adequate medical care and the opportunity to achieve and enjoy good health."

January 19. The Social Security Board, in its eighth annual report to Congress, specifically calls for compulsory National Health Insurance as part of the social security system.

1945 January 6. President Roosevelt in his state of the Union message again makes reference to the right to "good medical care" but again no specific recommendations are made.

The California legislature defeats Governor Warren's State compulsory health insurance proposal.

November 19. President Truman sends health message to Congress. Revised Wagner-Murray-Dingell bill (S. 1606 and H.R. 4'730) providing for National Health Insurance immediately introduced.

1946 May 3. Taft-Smith-Ball bill (S. 2143), authorizing grants to States for me.dical care to the poor, introduced as an alternative to administration bill; no action taken on either bill.

Committee for the Nation's Health organized to promote Wagner-Murray-Dingell bill.

Hill-Burton Hospital Survey and Construction Act passed.

1947 May 19. President Trurnm, in another special health message to Congress, again requests a National Health Program. S. 1320 introduced by Senators Wagner and Murray; Senator Taft's bill also reintroduced (S. 545).

May-July. Hearings on various health proposals. No action taken.

1948 May l-4. National Health Assembly is convened in Washington under sponsorship of the Federal Security Agency.

AMA launches a "National Education Campaign against National Health Insurance proposals.

1949 April 22. President Truman, in another special message, calls again for National Health Insurance. Hearings held on the issue, but no action taken.

May 31. Flanders-Ives bill (S. 1910 and H.R. 4918-4924), providing for Federal subsidies to private insurance companies, introduced.

1950 August 13. National Conference on Aging is convened by Federal Security Agency.

August 28. Social Security Act amendments of 1950 include grants to States for "vendor payments" in behalf of welfare recipients.

1952 February 26. Federal Security Administrator Oscar Ewing publicly proposes enactment of health insurance for social security beneficiaries.

April. Social Security Administration annual report (1951) recommends health insurance for beneficiaries.

April 10. Senators Murray and Humphrey, and Representatives Dingell and Celler, introduce bills (S. 3007, H.R. 7484-5) embodying the beneficiaries idea. No congressional action taken.

December. President's Commission on the Health Needs of the Nation endorses such a program.

1954 January. President Eisenhower proposes "re-insurance" measure, embodied in H.R. 8356 and S. 3114. Hearings in both houses.

July 13. H.R. 8356 recommitted by House, ending action on proposal.

1956 June 7. Military "medicare" program enacted, providing Government health insurance protection for Armed Forces dependents.

July 5. Insurance pooling proposal introduced (S. 4172). No action taken.

1957 AFL-CIO Executive Council decides to press for Government health insurance.

August 27. Original Forand bill, to provide health insurance for social security beneficiaries, (H.R. 9467) introduced just prior to adjournment.

December. AMA. House of Delegates resolves to defeat bill.

1958 June. Hearings on health issue in Ways and Means Committee result in committee request for more study by the Department of Health, Education, and Welfare.

1959 February 18 . Forand bill (H .R . 4700) reintroduced.

1960 March 14. Ways and Means Committee begins extended sessions on amendments to the Social Security Act.

March 31. Ways and Means Committee votes on Forand bill in executive session; bill defeated 17-8.

April. Senate Subcommittee on Problems of the Aged and Aging holds hearings, primarily on health needs of the elderly.

May 4. HEW Secretary Flemming presents administration proposal for a Federal-State pro-gram of protection against the cost of long-term and expensive illness for low-income elderly.

June 3. Ways and Means Committee's second vote on Forand bill; defeated again 17-8. Vote on stripped-down bill, providing hospital benefits only, also defeated, 16-9.

June 13. After more than 3 months of deliberation, Ways and Means Committee reports Social Security amendments (H.R. 12580), including a new program of Federal grants to the States for medical services to the "medically indigent" elderly.

June 29. The 1960 Annual Conference of Governors calls for congressional enactment of medical insurance for the elderly under social security.

August 23. After rejecting a Kennedy-Anderson amendment embodying the health insurance approach, as well as a Javits amendment embodying the administration plan, the Senate approves a modified version of H.R. 12580, known as the Kerr-Mills bill.

September 13. Kerr-Mills bill signed into law.

1961 January. White House Conference on Aging is convened in Washington, sponsored by the Department of Health, Education, and Welfare.

January 10. Presidential task force on Health and Social Security for the American People recommends health insurance for the elderly under social security.

February 10. President Kennedy sends special message to Congress on health.

February 13. Representatirve King and Senator Anderson introduce an administration hospital insurance bill (S. 909 and H.R. 4222).

July. American Medical Political Action Committee (AMPAC) established by the AMA.

July. National Council of Senior Citizens for Health Care Through Social Security established to promote King-Anderson bill.

July-August. Ways and Means Committee conducts hearings on Medicare bill (King-Anderson). No further action taken.

1962 May 20. President Kennedy addresses the Nation on the Medicare issue in a speech televised from Madison Square Garden.

May 22. AMA's Dr. Edward Annis gives televised reply.

July 17. Anderson-Javits amendment, a compromise Medicare measure attached to a welfare bill (H.R. 10606), tabled by Senate (52-4.

1963 February 21. President Kennedy sends special message to Congress on problems of the aged. Slightly revised King-Anderson bill (H.R. 3920 and S. 880) reintroduced the same day.


November. Hearings in Ways and Means Committee on King-Anderson bill interrupted by assassination of President Kennedy.

1964 January. Ways and Means Committee completes hearings.

February 10. President Johnson sends special message, "Health of the Nation," to Congress, advocating Medicare.

June 24. Ways and Means Committee executive session decides to postpone action on Medicare.

July 7. Ways and Means Committee reports Social Security amendments (H.R. 11865) which include a cash benefit increase but no health care proposal.

July 24. H.R. 11865 passed by the House.

August 6. Senate Committee on Finance begins hearings on H.R. 11865.

August 20. H.R. 11865 reported by the Finance Committee without the addition of a health insurance provision.

September 2. Medicare measure passes Senate (49-44) as a floor amendment to H.R. 11865.

October 2. House-Senate Conference Committee deadlocks, being unable to resolve differences, between Senate and House versions of H.R. 11865.

1965 January. King-Anderson bill reintroduced (H.R. 1 and S. 1).

March 23. Ways and Means Committee approves a Medicare measure, substituting the "Mills bill" (H.R. 6675) for the King-Anderson bill.

April 8. Mills bill passed by House, 313-115.

April 28-June 24. Senate Finance Committee holds extensive hearings and executive sessions.

July 9. Senate passes bill, 68-21.

July 14-21. House-Senate Conference Committee convenes to reconcile differences between Senate and House versions of H.R. 6675.

July 27-28. Conference committee report is passed by House and Senate, respectively.

July 30. Medicare (as part of the Social Security Amendments of 1965) signed into law by President Johnson.

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Social Security History
     
Chapter 5: Who Makes Social Welfare Policy?

IN THE 8 years between the introduction of the original Forand bill in 1957 and final passage of Medicare, some 80 revisions, compromises, and alternatives had been drafted. Congressional committees conducted no fewer than eight sets of public hearings on the issue, and the published testimony from those exercises fills an entire bookshelf. The Ways and Means Committee gave more of its time to Medicare during this period than to any other subject. Likewise, the Congressional Record is laced with innumerable speeches and "insertions" on Medicare. The pre-vote floor debates alone would fill more than a volume.

Between 1957 and 1965, at least a dozen books and literally hundreds of television, radio, magazine, and newspaper features were devoted to various aspects of the issue. The opposing sides together probably made several thousand stump speeches and distributed millions of pamphlets. Though neither side admits to having added up its costs, total lobbying expenditures exceeded several million dollars.

Quite probably, the cost of the debate to the Federal Government also amounted to several million dollars--for the salaries of the legislators, departmental officials, numerous staff assistants, technicians, secretaries, and others who devoted all or part of their time to this issue. Such a reckoning would also have to include research expenses, paper and printing costs, telephone calls, and a host of miscellaneous items. Democracy is expensive--but it is a time-tested way of resolving conflicts.

In American society, as in most others, a delicate balance always exists between conflict and consenus. Without a relatively high degree of agreement on fundamentals, no orderly social and political life is possible. On the other hand, our diverse interests and ways of pursuing happiness-- as individuals and as organizations--frequently come into conflict with one another. Some theorists argue that such conflicts are a manifestation of human nature. Others take the position that such conflicts are simply a product of our culture, or, in the view of the Marxists, our economic system. But whatever the cause, conflict (as well as consensus) has been a major theme of American history.

Conflict was an important and highly visible aspect of the Medicare debate. Yet the contending parties also displayed a high degree of consensus. Both sides agreed to "play by the rules of the game" and accepted the decisions of the legislative process as binding. This is often taken for granted in our society, but it is no small achievement. Beyond that, the heated debate obscured the fact that there was substantial agreement on certain fundamental points. Neither side argued that the aged had no right to decent medical care ; ever since the 1930's, medical care had been accepted as one of the basic necessities of life which, as a last resort, society itself must provide. And if the aged were unable to pay for their medical care, it was the responsibility of society somehow to finance it.

The argument, then, centered on two issues: (1) Whether or not the aged, or a substantial number of them, did in fact need help with their medical bills; and (2) if they did, what mechanism should be employed to cope with the problem. As the debate progressed, the first point came to be accepted as true, although there continued to be differences over the seriousness of the problem. At the end the unresolved conflict was over means. Three basic alternative approaches were considered--either separately or in combination: (1) some form of Government subsidies for private insurance carriers as in the Flemming and Javits proposals, the Bow bill, and, finally, the AMA's Eldercare; (2) direct Government, payments for medical services to low-income elderly through State welfare agencies as in the "vendor payments" and, later, Kerr-Mills programs ; and (3) health insurance financed and administered through social security.

Each of these alternatives, along with their various administrative and technical features, had important social, economic, and political implications that influenced the preferences of the opposing sides. And, in the end, the issue could only be resolved through the political process. It was finally resolved in favor of social security (Medicare) supplemented by an expanded Kerr-Mills program of direct payments for health services to the elderly and other poor (Medicaid).

Who, then, makes social welfare policy decisions?

After President Johnson had finished his brief prefatory speech that day in 1965 when he was in Independence, Mo., to sign Medicare into law, he took a seat at a large table, next to former President Truman. Beside him in several racks were nearly 100 of the old-fashioned nibbed pens, which he was about to use to transform the Mills bill into Public Law 89-97. As photographers and news cameramen recorded the scene, the President began to construct his signature, using each of the pens in turn to stroke a fraction of his name and then ceremoniously giving the pen as a memento to one of the assembled notables.

The President's gesture, a tradition at bill-signing ceremonies since Franklin Roosevelt's day, was more than an act of flattery to his guests. It symbolized the theme of the President's prefatory remarks. The final victory of Medicare, he had said, was not attributable to the efforts of any one man. It mas attributable to the joint efforts of many--to at least a score of Congressmen and Senators (some of whom had died before seeing the fruit of their work), to dozens of departmental officials and technicians, to congressional staff people, to the leaders and staffs of the many interest groups and organizations which supported the measure, to newspaper and magazine editors who had endorsed it, to philanthropists, courageous physicians, committed intellectuals, dedicated pamphleteers, and self-effacing political organizers. All of these people and more contributed their ideas, their money, their labor, and their influence to the cause.

But perhaps the most important contributors were the four Presidents of the United States who had made health insurance under social security one of their goals. As the only official who owes his mandate to the entire American electorate, a President uniquely embodies the will of the people. He, more than anyone else, is obligated to speak and act for the Nation as a whole.

Thus, while the answer to the question may not conform to any theoretical blueprint of democracy, it does conform to the spirit of democracy.


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History
The Medicare and Medicaid programs were signed into law on July 30, 1965. President LBJ is pictured at the signing ceremony in Independence, Missouri at the Truman Library. Former President Truman is seated beside him. LBJ held the ceremony there to honor President Truman's leadership on health insurance, which he first proposed in 1945. You can read LBJ's speech at the signing ceremony and listen to his taped conversations relating to CMS programs. Key speeches and press conference excerpts from other President's are also available. See the links in the Downloads section below.

The most significant legislative change to Medicare--called the Medicare Modernization Act or MMA--was signed into law by another President from Texas, George W. Bush, on December 8, 2003. This historic legislation adds an outpatient prescription drug benefit to Medicare and makes many other important changes. You can read his speech at the signing ceremony and see pictures of the event at the White House web site. See the links in the Downloads and Related Links Outside CMS sections below.

Oral histories of former Secretaries, Administrators, Members of Congress and other important players in the history of CMS programs are available as well as more oral histories and other CMS related-materials on the SSA web page. See the links in the Downloads and Related Links Outside CMS sections below.

Since 1965, a number of changes have been made to CMS programs. A more detailed listing of those changes is at CMS milestones. Moreover, the agencies charged with implementing the programs have changed as well. See agency history for more information about Medicare's early days in Social Security, Medicaid's early days in the Social and Rehabilitative Services Administration, and why they were joined together into one agency in 1977. Learn why CMS headquarters is located in Baltimore County, Maryland and how it was almost moved to the City of Baltimore. See the links in the Downloads and Related Links Outside CMS sections below.

Downloads
Agency Administrators' Tenure [PDF, 87KB]
CMS History Project Presidents' Speeches Table of Contents [PDF, 1MB]
Key Milestones in CMS Programs [ZIP, 1MB]
Oral History Biographies and Interviews   [ZIP, 5MB]
President Bush Signs Medicare Legislation [PDF, 1MB]
President Milestones [PDF, 1MB]
Why is CMS in Baltimore? [PDF, 1MB]
35th Anniversary Speeches  [PDF, 1MB]
40th Anniversary Photos and Transcript [ZIP, 85KB]
CMS History Quiz [PDF, 106KB]
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