- - Wednesday, July 29, 2015


Diehard defenders of President Obama’s continuing, wretched rollout of the Affordable Care Act may be quick to point out that other government programs, most notably Medicare, also had rocky starts. But the historical record doesn’t support such nonsense.

Medicare was signed into law on July 30, 1965, as a voluntary upgrade to Social Security. In 1965, as now, most Americans had no choice in signing up to pay taxes for Social Security when they became employed. Not so with Medicare, which was comprised of two parts: (A) hospital coverage, covered by part of one’s working-years’ contributions to Social Security and free after age 65 and (B) out-of-hospital expenses, such as physicians, for which a monthly premium during retirement had to be paid. Even if a 65-year-old wanted part A and not part B, he still had to sign up.

Because it was voluntary to individuals over the age of 65, Medicare was not attractive to some, even part A. Older Americans at the time viewed hospitals as a place where the elderly went to die; indeed, home care by families, with occasional doctor visits, was often the preferred choice. And about half of all seniors already had health insurance. Then there was the stark fact that life expectancy in 1965 was just 66.8 years for men, 73.7 for women. Some hospitals and physicians were wary as well, worried about not only their amount of income from the program but the time that it would take to process payments.

Most important, in his speech after signing the law, President Lyndon B. Johnson was absolutely truthful — no hyperbole or misstatements — in explaining Medicare’s premiums and benefits:

“During your working years, the people of America — you — will contribute through the social security program a small amount each payday for hospital insurance protection. For example, the average worker in 1966 will contribute about $1.50 per month. The employer will contribute a similar amount. And this will provide the funds to pay up to 90 days of hospital care for each illness, plus diagnostic care, and up to 100 home health visits after you are 65. And beginning in 1967, you will also be covered for up to 100 days of care in a skilled nursing home after a period of hospital care.

“And under a separate plan, when you are 65 — that the Congress originated itself, in its own good judgment — you may be covered for medical and surgical fees whether you are in or out of the hospital. You will pay $3 per month after you are 65 and your Government will contribute an equal amount.”

Unlike Obamacare, which had more than three years to get its act together, Medicare had just 11 months to unfurl by July 1, 1966. A taskmaster, Mr. Johnson wanted results quickly. An excellent administrator, 50-year-old Arthur Emil Hess, was appointed as director of the Bureau of Health Insurance of the Social Security Administration. And not only were there numerous details to be worked out (for example, the original law didn’t spell out how hospitals and doctors would be paid), but getting enrollees was first and foremost.

Some 250 million pamphlets were distributed well before the deadline for enrolling (March 31, 1966, later extended to May 31, 1966). President Johnson not only kept track of enrollment, but, on March 6, 1966, promoted National Medicare Enrollment Month, barking its importance on every public occasion. “Since I signed the historic Medicare Act last summer,” said Mr. Johnson, “we have made more extensive preparation to launch this program than for any other peaceful undertaking.”

By June 25, 1966 — a week before launch day — 6,204 of 7,200 eligible hospitals had been certified as acceptable for Medicare benefits. And the executive director of the Federation of American Hospitals, I. Leon Goodman, assuaged members by noting that “the paper work being required by the Medicare Act is not any greater than that required by Blue Cross.”

The drive for enrollees was not only swift but successful, totaling 19.5 million or 9.7 percent of the total population during the first year. Mr. Johnson was ecstatic: “In the past year, through a mass program, we have tried to reach virtually every American over 65 years of age with news about medical care. We have not reached every one of them. But more than 90 percent of them … have signed up for elective medical benefits.”

Thomas V. DiBacco is professor emeritus at American University

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