An NPR story earlier this week included excerpts from Lyndon Johnson’s White House tapes, featuring his behind-the-scenes efforts to pass the bill that created Medicare and Medicaid in 1965.
The idea of a Medicare-type program for seniors had been debated for more than 20 years, ever since Harry Truman’s post-World War II calls for a national health care system. But it was Johnson, famous for his arm-twising skills, who finally succeeded in sheparding the legislation through Congress. He did so against the wishes of the American Medical Association and much to the chagrin of conservatives, who saw it as a step down the slippery slope toward socialized medicine.
The Oval Office tapes feature Johnson’s typically colorful language. As NPR describes it, “Just moments after [the] bill…got through a key House committee in March of 1965, Johnson sounds like he’s in no mood to celebrate. He gets on the phone to demand that legislators keep the bill moving”:
“You just tell them not to let it lay around. Do that,” Johnson barks. “They want to, but they might not,” he continues. “Then that gets the doctors organized, then they get the others organized. And that damn near killed my education bill. Letting it lay around. It stinks. It’s just like a dead cat on the door. When a committee reports it you’d better either bury that cat or get some life in it.”
The NPR story is based on an article in this week’s New England Journal of Medicine by David Blumenthal, who teaches at Massachusetts General Hospital and Harvard Medical School and served as an Obama campaign adviser on health care. Blumenthal thinks Johnson’s strategy–which included letting Congress take most of the credit–can be instructive to the new president as he seeks to pass health care reform.
But what Johnson had going for him was not only his skill in dealing with Congress, but his commitment to expanding Americans’ access to health care, regardless of the cost. In March 1965, he told Vice President Hubert Humphrey:
“I’ll go a 100 million or billion on health or education. I don’t argue about that any more than I argue about Lady Bird buying flour. You got to have flour and coffee in your house. And education and health, I’ll spend the goddamn money.”