Remarks with President Truman at the Signing in Independence of the Medicare Bill

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Remarks with President Truman at the Signing in Independence of the Medicare Bill

Speech

By: Lyndon B. Johnson

Date: July 30, 1965

Source: Lyndon Baines Johnson Presidential Library. "Remarks with President Truman at the Signing in Independence of the Medicare Bill." <http://www. lbjlib.utexas.edu/johnson/archives.hom/speeches.hom/650730.asp> (accessed June 18, 2006).

About the Author: Lyndon Baines Johnson (1908–1973) began his tenure as President of the United States on November 23, 1963, when he assumed the presidency upon the assassination of President John F. Kennedy. Johnson remained president until January 1969. The enactment of the Medicare provisions in 1965 was a part of a broader legislative program hailed by Johnson as a part of his vision for America he called "the Great Society."

INTRODUCTION

The passage into law of President Lyndon Johnson's cherished Medicare bill on July 30,1965 was the culmination of a political and legislative struggle that began in earnest during the Roosevelt Administration with the passage of the Social Security Act in 1935.

Johnson's speech, replete with references to former Presidents Harry Truman and Franklin Roosevelt, pays tribute to the history leading to the Medicare enactment, a legislative program that provided state-supported health insurance for all American citizens sixty-five years of age or older. The Social Security Act represented the first legislation in the United States to constitute a safety net for a disadvantaged segment of society, and the notion of a similar comprehensive scheme of medical insurance or other assisted health coverage was advanced by Roosevelt at various times in his presidency. In 1943, Roosevelt used the now famous expression "cradle to grave health coverage" to describe his ambitions for an extension of his Social Security structure.

State-sponsored health coverage was attacked during Roosevelt's presidency as a form of socialism that had no place in America. Entrenched and conservative interests such as the American Medical Association were firmly opposed to any form of centralized government health care. When Truman assumed the American presidency in 1945, he also sought a form of universal health coverage and throughout his administration various pitched battles were waged in both Congress and in the forum of public opinion over the issue.

When Johnson assumed the presidency after the Kennedy assassination in November 1963, he and his advisers determined that the government would embark upon a legislative program that was known as the "Great Society." The cornerstones of the Great Society agenda included the passage of both the Civil Rights Act of 1964 and Medicare as an extension of the existing Social Security legislation in 1965.

The passage of the Medicare legislation through both the Congress and the Senate required a concerted effort by the Democratic Party lawmakers to win over more liberal-minded elements of the Republican Party in both Houses, coupled with an intense effort by Johnson to secure the support of the American Medical Association membership. Without the support of the medical profession, it is unlikely that Medicare could have been enacted.

At Independence, Missouri at the Johnson speech, former President Truman became the first American to be enrolled in the Medicare program, a symbolic linkage between the efforts of the Democratic Party since the time of Roosevelt to those of Johnson to secure the establishment of the Medicare provisions.

PRIMARY SOURCE

PRESIDENT TRUMAN: Thank you very much. I am glad you like the President. I like him too. He is one of the finest men I ever ran across.

Mr. President, Mrs. Johnson, distinguished guests: You have done me a great honor in coming here today, and you have made me a very, very happy man. This is an important hour for the Nation, for those of our citizens who have completed their tour of duty and have moved to the sidelines. These are the days that we are trying to celebrate for them. These people are our prideful responsibility and they are entitled, among other benefits, to the best medical protection available.

Not one of these, our citizens, should ever be abandoned to the indignity of charity. Charity is indignity when you have to have it. But we don't want these people to have anything to do with charity and we don't want them to have any idea of hopeless despair.

Mr. President, I am glad to have lived this long and to witness today the signing of the Medicare bill which puts this Nation right where it needs to be, to be right. Your inspired leadership and a responsive forward-looking Congress have made it historically possible for this day to come about.

Thank all of you most highly for coming here. It is an honor I haven't had for, well, quite awhile, I'll say that to you, but here it is: Ladies and gentlemen, the President of the United States.

THE PRESIDENT: President and Mrs. Truman, Secretary Celebrezze, Senator Mansfield, Senator Symington, Senator Long, Governor Hearnes, Senator Anderson and Congressman King of the Anderson-King team, CongressmanMills and Senator Long of the Mills-Long team, our beloved Vice President who worked in the vineyard many years to see this day come to pass, and all of my dear friends in the Congress—both Democrats and Republicans:

The people of the United States love and voted for Harry Truman, not because he gave them hell—but because he gave them hope. I believe today that all America shares my joy that he is present now when the hope that he offered becomes a reality for millions of our fellow citizens.

I am so proud that this has come to pass in the Johnson administration. But it was really Harry Truman of Missouri who planted the seeds of compassion and duty which have today flowered into care for the sick, and serenity for the fearful.

Many men can make many proposals. Many men can draft many laws. But few have the piercing and humane eye which can see beyond the words to the people that they touch. Few can see past the speeches and the political battles to the doctor over there that is tending the infirm, and to the hospital that is receiving those in anguish, or feel in their heart painful wrath at the injustice which denies the miracle of healing to the old and to the poor. And fewer still have the courage to stake reputation, and position, and the effort of a lifetime upon such a cause when there are so few that share it.

But it is just such men who illuminate the life and the history of a nation. And so, President Harry Truman, it is in tribute not to you, but to the America that you represent, that we have come here to pay our love and our respects to you today. For a country can be known by the quality of the men it honors. By praising you, and by carrying forward your dreams, we really reaffirm the greatness of America.

It was a generation ago that Harry Truman said, and I quote him: "Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection."

Well, today, Mr. President, and my fellow Americans, we are taking such action—20 years later. And we are doing that under the great leadership of men like John McCormack, our Speaker; Carl Albert, our majority leader; our very able and beloved majority leader of the Senate, Mike Mansfield; and distinguished Members of the Ways and Means and Finance Committees of the House and Senate—of both parties, Democratic and Republican.

Because the need for this action is plain; and it is so clear indeed that we marvel not simply at the passage of this bill, but what we marvel at is that it took so many years to pass it. And I am so glad that Aime Forand is here to see it finally passed and signed—one of the first authors.

There are more than 18 million Americans over the age of 65. Most of them have low incomes. Most of them are threatened by illness and medical expenses that they cannot afford. And through this new law, Mr. President, 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.

This insurance will help pay for care in hospitals, in skilled nursing homes, or in the home. And under a separate plan it will help meet the fees of the doctors. Now here is how the plan will affect you. 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. The benefits under the law are as varied and broad as the marvelous modern medicine itself. If it has a few defects—such as the method of payment of certain specialists-then I am confident those can be quickly remedied and I hope they will be.

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.

And this bill, Mr. President, is even broader than that. It will increase social security benefits for all of our older Americans. It will improve a wide range of health and medical services for Americans of all ages.

In 1935 when the man that both of us loved so much, Franklin Delano Roosevelt, signed the Social Security Act, he said it was, and I quote him, "a cornerstone in a structure which is being built but it is by no means complete." Well, perhaps no single act in the entire administration of the beloved Franklin D. Roosevelt really did more to win him the illustrious place in history that he has as did the laying of that cornerstone. And I am so happy that his oldest son Jimmy could be here to share with us the joy that is ours today. And those who share this day will also be remembered for making the most important addition to that structure, and you are making it in this bill, the most important addition that has been made in three decades.

History shapes men, but it is a necessary faith of leadership that men can help shape history. There are many who led us to this historic day. Not out of courtesy or deference, but from the gratitude and remembrance which is our country's debt, if I may be pardoned for taking a moment, I want to call a part of the honor roll: it is the able leadership in both Houses of the Congress.

Congressman Celler, Chairman of the Judiciary Committee, introduced the hospital insurance in 1952. Aime Forand from Rhode Island, then Congressman, introduced it in the House. Senator Clinton Anderson from New Mexico fought for Medicare through the years in the Senate. Congressman Cecil King of California carried on the battle in the House. The legislative genius of the Chairman of the Ways and Means Committee, Congressman Wilbur Mills, and the effective and able work of Senator Russell Long, together transformed this desire into victory.

And those devoted public servants, former Secretary, Senator Ribicoff; present Secretary, Tony Celebrezze; Under Secretary Wilbur Cohen; the Democratic whip of the House, Hale Boggs on the Ways and Means Committee; and really the White House's best legislator, Larry O'Brien, gave not just endless days and months and, yes, years of patience—but they gave their hearts— to passing this bill.

Let us also remember those who sadly cannot share this time for triumph. For it is their triumph too. It is the victory of great Members of Congress that are not with us, like John Dingell, Sr., and Robert Wagner, late a Member of the Senate, and James Murray of Montana.

And there is also John Fitzgerald Kennedy, who fought in the Senate and took his case to the people, and never yielded in pursuit, but was not spared to see the final concourse of the forces that he had helped to loose.

But it all started really with the man from Independence. And so, as it is fitting that we should, we have come back here to his home to complete what he began. President Harry Truman, as any President must, made many decisions of great moment; although he always made them frankly and with a courage and a clarity that few men have ever shared. The immense and the intricate questions of freedom and survival were caught up many times in the web of Harry Truman's judgment. And this is in the tradition of leadership.

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. I said to Senator Smathers, the whip of the Democrats in the Senate, who worked with us in the Finance Committee on this legislation—I said, the highest traditions of the medical profession are really directed to the ends that we are trying to serve. And it was only yesterday, at the request of some of my friends, I met with the leaders of the American Medical Association to seek their assistance in advancing the cause of one of the greatest professions of all—the medical profession—in helping us to maintain and to improve the health of all Americans.

And this is not just our tradition—or the tradition of the Democratic Party—or even the tradition of the Nation. It is as old as the day it was first commanded: "Thou shalt open thine hand wide unto thy brother, to thy poor, to thy needy, in thy land."

And just think, Mr. President, because of this document—and the long years of struggle which so many have put into creating it—in this town, and a thousand other towns like it, there are men and women in pain who will now find ease. There are those, alone in suffering who will now hear the sound of some approaching footsteps coming to help.

There are those fearing the terrible darkness of despairing poverty—despite their long years of labor and expectation—who will now look up to see the light of hope and realization. There just can be no satisfaction, nor any act of leadership, that gives greater satisfaction than this.

And perhaps you alone, President Truman, perhaps you alone can fully know just how grateful I am for this day.

SIGNIFICANCE

The escalation of American involvement in the Vietnam War is the most prominent aspect of the presidency of Lyndon Johnson, one that has been most often recalled by both the American public and academic commentators in the relatively short span of history since Johnson left office in early 1969. It is noteworthy that both the Medicare provisions enacted by the Johnson administration in 1965 and the Civil Rights Act of 1964 have each endured. Both laws have become a part of the fabric of American society in the period since their passage.

At the time of the creation of Medicare, Johnson noted that there were eighteen million Americans over the age of sixty-five who would be protected from the potential devastation of large medical costs. It is noteworthy that Medicare is now applicable to over thirty-five million of these senior citizens, or twelve percent of the American population, coupled with a further six million persons under age sixty-five to whom Medicare has been extended since the 1965 enactment. These persons include the seriously disabled and persons who suffer from terminal afflictions, such as Lou Gehrig's disease.

The trends in American population growth as confirmed by current census data suggest that by the year 2050, an estimated twenty-one percent of the population will be sixty-five years of age or older. The growth in this demographic since the 1965 passage of Medicare has bedeviled American administrators of Medicare, who have expressed concerns that the plan may run out of money to fund itself by 2010, if its current resourcing by way of payroll tax and similar revenues is the only funding mechanism.

In the period since 1965, American state governments have enacted supporting legislative schemes that serve the entire population in terms of the provision of medical insurance for the most disadvantaged aspects of society. Medicaid is the name of the state health schemes, with a primary focus on the provision of hospital care for the poor.

The American federal government has been resistant to the "cradle to grave" sentiments first expressed by Roosevelt in 1943 as a government objective in health care. The limitation of Medicare to American senior citizens has rendered the United States something of an anomaly among the Western countries to which it is allied both culturally and politically. Nations such as Australia, Great Britain, and Canada have each had comprehensive universal health care schemes in place for over forty years.

The state of American health care is a frequent source of national political debate. On one side of the health care issue are those who point to the accumulating American national deficit as the key reason why the United States cannot afford a national system of health coverage. On the other side of the issue are those who point to the individual consequences of inadequate medical coverage; the argument is summarized by the assertion that a significant number of American families are one paycheck away from bankruptcy should one of their members sustain a catastrophic illness or injury.