Debate promises: Medicare (1960)

In the last two weeks, the First Year Project takes a look at some promises made in past debates. Today, we explore John F. Kennedy’s efforts to pass Medicare legislation.

On September 26, 1960, in the first presidential debate ever held, Senator John F. Kennedy stated:

…on medical care for the aged, this is the same fight that's been going on for twenty-five years in Social Security. We wanted to tie it to Social Security. We offered an amendment to do so. Forty-four Democrats voted for it, one Republican voted for it. And we were informed at the time it came to a vote that if it was adopted the President of the United States would veto it. In my judgment, a vigorous Democratic president supported by a Democratic majority in the House and Senate can win the support for these programs.

To make this happen, Kennedy would have to face the southern Democrats, including the Rep. Wilbur Mills (D-AR), the powerful chairman of the Ways and Means Committee.

Miller Center scholar, Guian McKee, provides an interesting history of the difficulties of passing Medicare from his volume 3 essay, Prescription for Success:

"By the early 1960s, roughly 70 percent of Americans had some form of coverage through this “insurance company model,” a development that further reduced pressure for national health insurance. 

Yet the elderly, who proved to be poor risks for insurance companies, remained largely outside this private coverage system. In 1960, House Ways and Means Committee chairman Wilbur Mills and Senator Robert Kerr sponsored a limited measure that provided federal matching grants to the states to cover low income seniors. Not all states took up the program (popularly known as Kerr-Mills), and its effectiveness remained limited. During the 1960 presidential campaign, John F. Kennedy called for a Social Security-based program of federal health insurance for the elderly, an idea that his campaign referred to as Medicare. 

In January 1962, late in the first year of his presidency, Kennedy submitted his Medicare proposal to Congress. Known as the King-Anderson bill after its chief sponsors, Kennedy’s Medicare bill covered hospital and nursing home expenses for recipients of social security and disability, but did not include coverage of physicians’ fees. Mills, one of the most influential policy figures in Washington, opposed the bill. The Kerr-Mills Act had just taken effect, and Mills did not want to undermine it by passing Medicare. He also feared that financing the new program through the payroll tax might jeopardize the long-term fiscal viability of the existing Social Security system. The AMA, meanwhile, remained uncompromising in its opposition and launched an all-out lobbying campaign, which included the distribution of anti-Medicare recordings made by actor Ronald Reagan. The Ways and Means committee held hearings but never voted on King-Anderson. This pattern repeated itself when the administration re-introduced the bill in 1963. 

The Kennedy administration used these defeats strategically, publicizing the nature of the AMA’s opposition and seeking to build public support for a renewed effort later in Kennedy’s term. Significantly, Kennedy also influenced new appointments to the Ways and Means committee: All new members of Ways and Means either supported Medicare or would at least vote to report it to the floor. One potential lesson for a first year president thus rests in the Kennedy role in Medicare’s ultimate passage: Even in defeat, look for opportunities to create future legislative opportunities."