# Medicare and Medicaid at 50

**Channel:** KFF
**Source:** https://www.youtube.com/watch?v=f9NUCvrrRz4
**Transcript page:** https://www.withtranscript.ai/video/f9NUCvrrRz4

## Chapters

- 0:04 — Origins of National Health Insurance
- 2:59 — Medicare and Medicaid Become Law
- 7:52 — Implementation, Integration, and Expansion
- 11:30 — Modern Reforms and Lasting Impact

## Transcript

**[0:04]:** there was a Time in America when the government had almost no role in providing Health Care the sick and needy especially the elderly Bartered borrowed or begged to see a doctor or they went without the principal problem was medical care costs not that people couldn't get good care but it was that they could not afford it the elderly even without the depression were quite dependent on their sons and daughters and their sons and daughters were out of jobs during the Depression in 1930 life expectancy for white Americans was 61 for African-Americans just 48 interest in national health insurance insurance for every American came and went in Washington the debate became more serious in 1945 when Harry Truman became the first president to send a proposal to Congress Harry Truman was very much troubled during World War II when he found that there was no health care and as a result young men were coming into

**[1:10]:** the army with with with lack in terms of their health simply because there was no way of providing it Truman's effort failed but the seed was planted in 1960 Congress enacted the Kerr Mills bill it provided federal grants to States for medically Indigent seniors and it passed with the support of Southern conservatives they thought it would help elderly people in the South well what happened was that three years later in 1963 uh only 32 states had adopted it but of those States five industrial States I mean New York California Michigan Massachusetts and Pennsylvania got 90% of the dollars and Mills was Furious the Congress has for Mills is Chairman Wilber Mills of Arkansas whose house Ways and Means Committee was the gatekeeper to Boulder legislation events converg to make that possible paying their hospitalization Americans wanted to honor John Kennedy by enacting programs the slain president had supported in the 64 elections Democrats seized control

**[2:21]:** of Congress by a 2 to1 margin over Republicans and the needs of the elderly were escalating we had just completed the 1963 survey of the agent and what we had and what we showed very clearly was that only half the agent had coverage for health and most of it was very very poor coverage members of the Congress enter lynon Johnson determined to drive through a health insurance program for everyone 65 and over there was no plan

**[2:59]:** yet to include younger poor Americans our older people are likely to be hospitalized three times as often as younger people but their income is less than half that of people under 65 when I came to the White House the push was on that uh times are wasting what what have you done about this what have you done about that and Lyon Johnson was always racing Against Time the debate over Medicare engaged the most powerful players of the time the labor movement and the American Medical Association for the AFL CIO Medicare would be a step towards something much bigger when the am and other opponents said this is just the camel's nose Under the Tent yes it was perceived that way by proponents as well that once you could establish a really good program that was successfully working for all people over 65 then it might show that you could have a national program of health

**[4:09]:** insurance for all the ama's Dr Edward Annis crisscrossed America warning doctors of the Socialist yoke Medicare bureaucrats would place around their necks they' make the decision they decide who gets in who gets out what they get what they don't and finally interfering in the practice medicine and I predicted it will change bring about a different system of medicine for all Americans The Dilemma that ama had was the problem was real that that was the Fatal flaw in their opposition that the problem was real and generalized whether the solution was the best solution you know you could debate for Wilbur Mills Medicare was a way to make good on the limited success of ker Mills but he went even further the administration's bill was straightforward coverage of hospital bills to encourage support from Republicans Mills added the voluntary participation of doctors we were sort of all uh taken aback when the chairman said well everybody thinks

**[5:17]:** doctors are going to be in Medicare so we're going to put them in there we all what like this we said we don't know how the hell we going to pay the doctors for their Mills kept going to at the AMA which did support help for 10 million Americans on welfare he added a third element to the package Medicaid it would be financed the way ker Mills had been Medicaid had virtually flown under the radar and Mills was the pilot Bob ball and another Administration official Wilber Cohen witnessed the chairman make his move and one afternoon in this Committee in uh in private session but Wilbur and I were there Mill said well why don't we do this like he just thought of it well uh Wilbur and I were more or less openmouth Medicare and Medicaid were enacted July 30th 1965 the old and the poorest Americans would have health insurance congressman John Dingle

**[6:23]:** sat in the chair when house votes were cast a testament to his father who was a congressman fought for national health insurance inside of me there was a sense of quiet Elation and happiness that we had done something important most people don't don't know the story um a lot of people um think that you know this was always there or getting it was easy to honor the early footwork of President Truman Johnson staged the Medicare and Medicaid signing ceremony in Truman's hometown of Independence Missouri we wanted you to know and we wanted the entire world to know that we haven't forgotten I appreciate that who is the real daddy of Medicare for those in charge of implementing Medicare the hard part was just beginning the Social Security Administration needed to enroll 19 million elderly Americans in a matter of months in a time before supercomputers the Social Security district offices were kept open into the

**[7:33]:** evenings for people who were still at work uh the forest service even had Rangers looking for Hermits in the woods every agency of government was helping I don't know whether this has ever been be repeated

**[7:52]:** again in one week alone during the campaign a million people enrolled President Johnson had another concern a potential boycott by doctors he called AMA leaders to the White House ostensibly to talk about supporting the Vietnam War but when they went in front of the press the subject changed Johnson says call in the press the Press comes in and the first question is about Medicare the dog's going to sign up under Medicare and Johnson says these men they're sending Physicians over to Vietnam to die for this country of course they're going to support the lore of the land sign up for Medicare turns to the AMA President says doctor and the says yes of course we will and that was the end of it the doctors were in but would hospitals do the same would the nation's 1,000 segregated hospitals begin treating blacks and whites equally a requirement to participate in Medicare was a very uh

**[8:53]:** worrisome period to think that you may have hundreds of hospitals that would not be available to patients didn't work out that way because the president was so adamant about his position uh that we would not give ground on that issue and it made all the difference I mean it totally transformed Medical Care in the United States in the first week just seven calls of complaint came into a government hotline the process of integration had begun at a time when about four out of 10 African-Americans lived in poverty the combination of Medical Care Medicaid and civil rights legislation changed the health care landscape forever for black Americans and for all Americans not just for those who were 65 and above Americans especially the neediest Americans who never had Medical Care were now getting it there were a lot of uh elderly people and lowincome people in the case of the Medicaid Program who were clearly in

**[9:57]:** many instances receiving services for the first time and uh many of whom had not had the surgical procedure they'd been delaying or not had access to other kinds of care so that you could tell that this uh program was making a difference in people's lives before long the programs were costing more than anyone expected some congressmen complained Medicaid was becoming a blank check for the welfare system despite early concerns about potential Rising costs both programs steadily grew in in 1972 Medicare took on a new population the permanently disabled under age 65 there was a strong desire to cover the disabled under the Medicare program but the costs were huge of doing that so the decision they made was to cover the disabled but only after they had been disabled for two years that dramatically cut the cost of adding the disabled because it was kind of a darwinian cost cutting reduction a half of the

**[10:58]:** disabled died before they reached the 2-year period in the mid 80s concern about the growing number of Americans lacking health insurance coverage led to an expansion of Medicaid for low-income pregnant women and poor children in 1997 even more children gain coverage with the passage of Chip the children's health insurance program it's been an enormous benefit for these kids to have a healthy start to have a real chance to live out their lives and realize their potential

**[11:30]:** as human beings for Medicare the next big change providing a long awaited prescription drug benefit came through in 2003 when President George W bush and the Republican L Congress succeeded where politicians before had failed Part D took effect in 2006 now that the plan is in place 39 million have signed up for it drug costs are less than anticipated even more significant changes were ahead for Medicare and Medicaid with passage of the Affordable Care Act in 2010 we are done among other changes the ACA completed Medicaid's Evolution from a welfare style program to a modern era health insurance program broadening it as a base of coverage for the lowincome population including millions of previously uninsured adults even though it hasn't lost the political image the connection on the operational level in most of the country to welfare has been broken and is a practical matter to a large extent and it's much more a health

**[12:36]:** care program and is closer to a universal healthcare program every state is modernizing enrollment procedures under ACA requirements with the hope there will be seamless coordination across public and private insurance options and Medicaid is implementing more costeffective and patient- centered models of health care including for long-term care which only Medicaid covers some of our most important results-driven partners are actually state governments which are taking creative and Innovative steps when it comes to improving the quality and achieving smarter spending of Medicaid dollars the ACA has had a significant impact on Medicare as well by lowering out-of-pocket costs for people with high drug expenses improving coverage of preventive services and setting in motion new models of care the overall goal is clear it's Better Health at a lower cost so we need to do a better job of measuring what we want healthc care to really produce the ACA helps slow medicare's rate of spending growth in

**[13:38]:** recent years which in turn helped to strengthen the program's Financial Outlook but with the Aging of baby boomers the first of whom enrolled in Medicare in 2011 concerns about the future remain ultimately we do have to take on the financing issue uh we can take advantage of the uh slow growth period in spending we're in now to try to understand that but don't we can't fool ourselves it's ahead of us and it's going to be a challenge despite the challenges to sustain the programs no one disagrees that Medicare and Medicaid have improved the lives of millions that these programs helped create a Health Care system that might not otherwise exist if there wasn't a Medicaid I can't conceive of there being a nursing home industry sure you'd have the high-end assisted living facilities for the wealthy but you decimate the rest of the long-term care uh Children's Hospitals I believe it's uh like 40% of

**[14:39]:** their revenue coming from the Medicaid Program key institutions in every major city in America being in terrible shape a lot of care was given that would never have been given if it hadn't been for Medicare particularly quality of life activities for example cataracts hip replacements it's important not just for the elderly what it has done is to relieve the burden on the children of the elderly who whatever wasse be most likely to have had to pay for this in 1965 at the creation President Johnson spoke about a nation that is not indifferent to despair John Dingle who presided over the house vote all those years ago believes that promise has been kept and this was an attempt to seeing to it that we address serious problem you best judge a society by the way it treats its young it's old the sick the unfortunate those who have the least for the Kaiser Family Foundation this

**[15:54]:** is Jackie J