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As Erin outlined yesterday, we’re tackling the Great Society this week by looking at its key achievements in their historical context. In light of the upcoming vote on the American Health Care Act this week, I wanted to focus on the creation of Medicaid and Medicare, two programs that were key components of President Lyndon Johnson’s vision of a Great Society. As part of his Great Society, Johnson wanted to guarantee that “every citizen will be able, in his productive years when he is earning, to insure himself against the ravages of illness in his old age.” Opponents of Medicare and Medicaid, on the other hand, believed that such programs opened the way for socialism, undermined the free market, and denied Americans the right to choose their medical care.

In July 1965, President Johnson signed the Social Security Amendments of 1965 into law, creating Medicare and Medicaid. Put simply, Medicare provides health insurance to Americans aged 65 and older who have paid into it throughout their lives via payroll taxes. It also includes provisions for Americans with disabilities and other medical conditions. Medicaid is a program designed to help the poor, disabled, and other Americans in need of assistance to acquire health insurance.

President Johnson justified the creation of Medicare and Medicaid as fulfilling the obligation of the American government to its people. He believed that no American should have to lose their life savings because of the cost of health care. Johnson stressed the great material abundance of the United States should mean that every citizen had access to health care regardless of their ability to pay. After signing the law, Johnson explained that

No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts.

And no longer will this Nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this progressive country.

But there is another tradition that we share today. It calls upon us never to be indifferent toward despair. It commands us never to turn away from helplessness. It directs us never to ignore or to spurn those who suffer untended in a land that is bursting with abundance.

Conservatives had long opposed the creation of a national health insurance system. They believed that it was not the role of the government to interfere in the health insurance industry. Such government regulation reeked of socialism and government control over business and free enterprise. Alongside members of Congress, the American Medical Association, led the attack on Medicare and Medicaid. They had fought against any form of national health insurance dating back to the 1930s. In 1961, the AMA hired Ronald Reagan to record an album detailing why Americans should reject any form of nationalized health care. Reagan claimed that

It’s very easy to disguise a medical program as a humanitarian project, most people are a little reluctant to oppose anything that suggests medical care for people who possibly can’t afford it….

Now in our country under our free-enterprise system we have seen medicine reach the greatest heights that it has in any country in the world. Today, the relationship between patient and doctor in this country is something to be envied any place. The privacy, the care that is given to a person, the right to chose a doctor, the right to go from one doctor to the other.

But let’s also look from the other side. The freedom the doctor uses. A doctor would be reluctant to say this. Well, like you, I am only a patient, so I can say it in his behalf. The doctor begins to lose freedoms, it’s like telling a lie. One leads to another. First you decide the doctor can have so many patients. They are equally divided among the various doctors by the government, but then the doctors are equally divided geographically, so a doctor decides he wants to practice in one town and the government has to say to him he can’t live in that town, they already have enough doctors. You have to go some place else. And from here it is only a short step to dictating where he will go…

From here it’s a short step to all the rest of socialism, to determining his pay and pretty soon your son won’t decide when he’s in school where he will go or what he will do for a living. He will wait for the government to tell him where he will go to work and what he will do.”

The debates over Medicare and Medicaid came down to a question of what was the proper role of government. Should the government make sure all Americans had health insurance or should it not interfere? As you follow the fate of the American Health Care Act this week, keep these arguments in mind and see what parallels they have with today.

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