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On July 30, 1965, Medicare was signed into law. In eleven months, 19 million Americans were automatically enrolled, half of whom were previously uninsured. And within that same transition period — as a direct result of the policy — every segregated hospital in the South took down their “Whites only” signs, integrating their services for the first time. Medicare came in three parts: a universal hospital plan for the elderly (part A), voluntary doctor insurance for the elderly (part B), and a means-tested health care plan for the poor (Medicaid). At the age of sixty-five, virtually all Americans would become eligible for Medicare. Echoing the debut of Britain’s National Health Service, Lyndon B. Johnson framed Medicare “not as an act of charity, but as the insured right of a senior citizen.” On its birthday, we must fiercely and proudly defend Medicare, while recognizing that its protection relies on expanding it to all. Doing so — achieving Medicare for All — means providing comprehensive reproductive health care, including abortion. It means providing health care to all residents, regardless of immigration status. And it means creating a system that covers everyone equally, without means-testing. The history of Medicare can teach us how to get there. Universal programs don’t simply generate solidarity once they’re won — they require solidarity to win in the first place.

From Medicare for All to Medicare for Some Why didn’t America pass a national health insurance plan that covered all ages, as other Western democracies did after World War II? Before Johnson passed Medicare, both Franklin Delano Roosevelt and Harry Truman supported such a program, but only timidly. They caved to the zealously anti–single payer American Medical Association (AMA) and Southern Democrats who feared desegregation. In 1957, the scope of American health reform narrowed to a program for the elderly: Medicare. Morally, the case for seniors was obvious. In 1962, Michael Harrington stirred the nation with his book The Other America, which devoted an entire chapter to the elderly: “Loneliness, isolation, and sickness are the afflictions of the aged in every economic class. But for those who are poor, there is an intensification of each of these tragedies: they are more lonely, more isolated, sicker.” Economically, the case for seniors was equally apparent. In Health Care for Some, Beatrix Hoffman describes the history of America’s unequal health care system, explaining that the failures of the market were glaring when it came to seniors. Seen by the insurance industry as risky (and therefore costly) customers, seniors were dealt high premiums and sudden or outright denials. Many were put in the undignified position of having to ask for charity — or, worse, simply foregoing desperately needed care. It was clear that if seniors were to gain access to care, the state had to take on the responsibility.

The Coalition That Won Medicare Harrington’s book deeply moved John F. Kennedy, who made Medicare a central piece of his domestic agenda. Kennedy, unlike his predecessors, actually went to war with organized medicine. He toured the country, speaking to tens of thousands of senior citizens at Medicare rallies organized by the AFL-CIO. Organized labor was one of the staunchest proponents of Medicare, pouring heavy resources into Congressional pressure campaigns. The most prominent union fighting for universal health care at the time was the United Auto Workers, led by Walter Reuther. Reuther himself debated the president of the AMA on network cable in 1961. The AMA’s propaganda, which included a red-baiting LP recorded by Ronald Reagan, prompted Reuther to joke about the anti-Medicare campaign: “If they put it in bags, it would help your lawns grow better.” Following Kennedy’s assassination, Johnson made Medicare a central piece of his presidential campaign. He won in a landslide, alongside the most liberal Congress since 1938. Johnson saw Medicare as inseparable from his civil rights agenda, raising it in the same breath as voting rights on calls with Martin Luther King Jr. King similarly connected these issues, and in a speech rebuking the AMA he delivered an enduring rallying cry: “Of all the inequalities that exist, the injustice in health care is the most shocking and inhuman.” The Jim Crow hospital system was a deadly one, in which even emergency care was regularly denied on the basis of race. Prematurely discharging patients in need of emergency care is known as “patient dumping,” and still happens today to people who are uninsured (often homeless or undocumented). An Afro American editorial in 1952 blasted the practice for what it was: “This exclusion is another form of lynching by proxy.” Unlike Social Security, which left out agricultural, domestic, and unwaged workers, Medicare was a universal program. And because Title VI of the Civil Rights Act required federally funded programs to prohibit discrimination, Medicare could be a weapon for fighting both disparities in health outcomes and segregation in hospitals. Though it required presidential leadership, Medicare was not a gift from on high — it was a concession made after social movements created unignorable crises. The 1960s was an explosive period for militant protest and mass activism. Medicare would never have been won without such a mass movement in the streets. Euthanizing the insurance industry today will be no different.