And those Republicans warned that expanding government in this way would inevitably lead us down the road to socialism, which would leave America in ruins.

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That situation is repeated today, but many things were different in 1965 as well. Democrats had huge majorities in Congress, propelled by Johnson’s 1964 landslide victory. They held a 295-to-140 advantage in the House and a 68-to-32 advantage in the Senate, margins that are unimaginable today. But they lacked what today’s Democrats enjoy: the living example of Medicare and Medicaid, and the popularity they now enjoy.

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The opposition was intense, especially from the American Medical Association, which worried that Medicare would turn doctors into slaves. The AMA got support from rising Republican star Ronald Reagan, who would be elected California governor in 1966.

“One of the traditional methods of imposing statism or socialism on a people has been by way of medicine,” he warned in a famous radio address. If Medicare were not stopped, Reagan said, “one of these days you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”

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But the bill passed, with the support of a few liberal Republicans (a species that has since gone extinct). When he signed it, Johnson echoed the same concerns people have now about security and cost:

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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.

Today there are 59 million people on Medicare and 73 million on Medicaid, combining to make up a full 40 percent of the American population. So guess what: We have the socialism Reagan warned about, just not for everyone.

Most disturbingly for Republicans who never abandoned their desire to scale back, privatize and otherwise undermine the programs, they remain incredibly popular. Everyone has long understood that about Medicare, in part because seniors are so vocal and organized.

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But it wasn’t until Republicans tried to repeal the Affordable Care Act in 2017 that they realized that Medicaid is just as popular among its recipients and the broader public, even if those recipients don’t have the same political influence. The fact that tens of millions of Americans would have been kicked off Medicaid drove much of the opposition and helped kill the push for repeal.

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Which brings us to today, when Medicare in particular exerts a symbolic influence over every aspect of the health reform debate. Democrats say they want “Medicare for all,” even if a variety of plans have been affixed with that moniker (including plans that are both less and more encompassing than Medicare actually is). For their part, Republicans pretend to care deeply about preserving Medicare, even arguing that the reason it (or something like it) shouldn’t be extended to those under 65 is that doing so would threaten the sanctity of the program as it exists.

As President Trump wrote in a 2018 op-ed that was stunningly dishonest even for him, “I also made a solemn promise to our great seniors to protect Medicare. That is why I am fighting so hard against the Democrats’ plan that would eviscerate Medicare.”

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Smarter Republicans understand how this kind of rhetoric imperils their long-term project of scaling back public insurance. As Philip Klein wrote at the time, “perpetuating the idea that Medicare is a great program that needs to be protected at all costs" only "makes it easier for liberals to make the case for socialized medicine.”

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That kind of warning goes unheeded by politicians whose highest priority is getting reelected. So both sides view the popularity of this big-government, socialized program as their best rhetorical resource, either for showing voters what everyone might enjoy or scaring them about what might be taken away.

For all the challenges that sweeping health reform faces, that’s one thing Democrats have on their side: Those decades of history have shown which party actually cares about making sure everyone is covered. And even if this next round of reform should fail, Medicare and Medicaid aren’t going anywhere. Even Republicans understand that.