Why LBJ’s fight for Medicare sounds familiar

The battles over passage of Medicare and Obamacare had plenty of similarities, but they weren't identical, says history podcaster

  • By
  • medicareresources.org Contributor
  • September 9, 2015

EDITOR’S NOTE: The editors at medicareresources.org have long been big fans of Bruce Carlson’s podcast, My History Can Beat Up Your Politics. This week, Bruce is addressing a topic near and dear to us – the origins of America’s beloved safety net for seniors: Medicare. We’re especially thrilled to be able to be the exclusive publisher of the episode’s transcript.

Of course, we encourage you to listen to the audio of this podcast and explore the archives of My History Can Beat Up Your Politics.

LBJ: “For God sakes, don’t let dead cats lie on your porch, Wilbur!”

Bruce Carlson: President Johnson knew how to make a point. It might not have sounded like the erudite policy discussion one might imagine preceded the enactment of one of America’s largest and arguably most cherished government programs. But thanks to the recording of a crude Dictaphone executive recording system, we know that this …

LBJ: “Don’t let dead cats lie on your porch” …

Bruce Carlson: … is one of many things that President Lyndon Johnson said in the short private meeting that probably launched Medicare as we know it.

The Wilbur that Johnson was talking to there was Wilbur Mills, Congressman from Arkansas, and the force behind the bill.

LBJ: “Sam Rayburn used to always say that. Don’t let dead cats lie on your porch!”

Carlson: This March 1965 Oval Office discussion with Mills, who was also the House Ways and Means Committee Chairman, in regard to his Medicare bill … was recorded for history though not all participants knew it. The program … Medicare … is not Johnson’s alone. It is shaped in the Kennedy-Johnson campaign of 1960 and the idea is proposed well before that.  But the proposed Medicare program of the Kennedy-Johnson ticket was a little different; it was only paying seniors’ hospital bills, not for all their healthcare or all their trips to the doctor.

But at this moment, what weighed heaviest on the President’s mind was not hospitals, not physicians, not diseases. It was Easter.

LBJ: “For God’s sake, let’s get this bill finished before Easter.”

Carlson: The Constitution, Article 1, Section 7 says that revenue bills originate in the House of Representatives. So it could be said it was the Founding Fathers’ fault that Mills was getting harangued by the Leader of the Free World at this moment.

LBJ: “You know they make a poll every Easter … and it says what Congress has done up until that point. And for the rest of the year, that’s what they write the editorials about.”

Carlson: Mills was the person who could start this bill. Now Lyndon Johnson is in the Oval Office at this time with another man named Wilbur. This Wilbur is Wilbur Cohen, his undersecretary of Health, Education, and Welfare … you could say, Supreme Policy Wonk of the Johnson administration. It could be said that Cohen was the invisible hand behind Medicare.

Only Lyndon Johnson knew that this conversation with this powerful member of Congress and his undersecretary was being recorded. It was not recorded in crystal clear sound; it was not recorded for future historians, but recorded so that the secretaries could take dictation later.

See, LBJ had an issue. He was out there making so many promises, extracting so many promises in return from many a member of Congress, that he could forget at times what he owed, and what he was owed. And a few sneaky Washington types even tried to take advantage of old Lyndon for his forgetfulness. Thus, he wanted a record.

And though he didn’t intend to make history, thanks to the recording, we know a little a bit about how Medicare was created, the way that it was, with its various parts and policies. And, what’s rendered visible to us is how the enactment of Medicare is a little bit similar to the creation of the healthcare reform act known as the ACA … or Obamacare now … at least in why both bills were created the way that they were.

A borrowed idea

LBJ [to Cohen]: “Explain to me what you stole from Byrnes.”

Carlson: For those expecting a senior policy discussion, this comes off more Tony Soprano than leader of the free world.

LBJ: “Explain to me the supplemental you stole from Byrnes.”

Carlson: John W. Byrnes was a top Republican in Ways and Means. He was proposing an alternative to Johnson’s program. That had in addition to the snappy name “Bettercare,” it had support from doctors. It also had something that Johnson’s Medicare bill did not; it had a feature, that Medicare did not: coverage of doctor’s bills.

“Well,” Cohen responded to the President, “generally speaking, it’s about physicians’ services.”

LBJ: “Physicians? Now a fella pumps my stomach to see if I got any ulcers. That’s a physician?”

Carlson: Cohen indicated that the President was correct.

LBJ: “Any M.D., and he charges what he wants?”

Carlson: What doctors would charge was of interest to the President right now. The American Medical Association was opposed to Medicare because they thought it would reduce physician fees and they were of course … then and now … the leading doctors’ association in the United States. Their members would have to make this bill happen at the end of the day.

“No,” Wilbur says, “He doesn’t quite charge what he wants; the Health Education and Welfare secretary would have to make arrangements with BlueCross BlueShield to regulate the fees of the doctor, and pay the doctor. This intermediary, BlueCross BlueShield, or one of those, would determine the policy, so the government would not have its long hand in the …”

This is where Lyndon Johnson cut him off.

LBJ: “Good explanation. Any limits on this ?”

Carlson: Cohen responds, “The individual patient pays 50 dollars, and then 20 percent of the bill.”

LBJ: “Twenty percent of everything after that. That’s good … keeps the hypochondriacs out.”

Carlson: “For most people,” Cohen said, “it pays the majority of the cost.”

LBJ: “They could borrow that amount, get their folks to pay their part. Good. And the insurance companies are still raising hell and mad about this?”

Carlson: “Yes,” Cohen answered here. “They’re going to go to the Senate and raise hell about this because, frankly, there’s no longer any need for them after this bill. No longer any need for private insurance companies to sell to the over-65 crowd.”

I should pause here to note that Cohen … despite what he said on the Dictaphone that day … was actually wrong at least in his prediction. There is actually, as it turns out, a good market for insurance companies – in supplemental insurance policies. LBJ wasn’t much interested though in that detail anyway.

LBJ: “Wonderful, now remember this: nine out of ten times I get into trouble it’s because things lie around.”

Carlson: Cohen was ready. “They want to bring it up next week, Mr. President.”

Not good enough for LBJ

LBJ: “They want to, but they might not. Doctors get organized on this … damn near lost my education bill letting it lie around. It’s like a dead cat in the door!”

Carlson: He then went on and on about his education bill to Cohen. And, as if he only then realized he still had Congressman Mills, the chairman of Ways and Means still on the line, he jumped back on … and gave him that line again:

LBJ: “For God’s sake, don’t let dead cats …”

Carlson: Well, welcome to the creation of the Medicare bill.

Medicare is 50 years old. Given that, I thought it would be a good idea to take another look at an episode I did a few years ago … actually five years ago … about the history of Medicare. But rather than just rerun it … to re-record it … adjust some of the information and add something.

There’s a transcript of this program available at medicareresources.org and you can go there and download it.

A couple of things are clear from our brief stint as flies on the wall here: Although the bill was created between a Democratic Congressman and an undersecretary for the Democratic President … no Republicans in that room … it contained a “borrowed” idea from the Republicans … an idea which, inadvertently, led to the expansion of the program. Thus a hospital insurance bill became a total healthcare bill for seniors.

So in an odd way Medicare was bipartisan even though the Republicans and Democrats did not hash the Medicare bill out in a private meeting in a room. The two parties addressed healthcare for seniors in public but in very different ways. The 1960 Republican platform called only for help with insurance payments for the aged. The 1964 Republican platform called for tax credits.

The American Medical Association and Republicans supported an existing bill known as Kerr-Mills. Kerr-Mills provided low-income coverage for the elderly’s hospital cost. But there was a problem with Kerr-Mills: it was only financed by federal grants to the states. The states had to apply for it, and the states had to match the money paid out by the federal government to them. They had to pay 20 to 50 percent of the cost of taking care of their older citizens.

Well, not all states had that money. And in the United States, an estimated 10 million seniors were considered low-income … could not benefit from the program. Only about half a million got coverage through Kerr-Mills.

Something borrowed …

John Byrnes’ “Bettercare” bill was more generous, though it could be said his bill was not so much proposed to provide anyone healthcare but as an attempt to undermine Lyndon Johnson’s … Wilbur Cohen’s … Wilbur Mills’ Medicare bill and to give Republicans a positive program to vote for rather than just being against healthcare for seniors. Despite all these differences, a kind of virtual cooperation happened. Virtual bipartisanship, you could say.

And, it might be said that this same type of virtual competition/cooperation occurred with the passage of the Affordable Care Act in 2010. Both bills had provisions designed to appeal to opponents, though the proponents of both bills were not sure they could get an opposition vote at all. In the case of Medicare and the 2010 Affordable Care Act, there were items added to attempt to reduce the opposition’s strength … to attempt to undercut arguments against it.

Lyndon Johnson’s co-opt of a Republican feature is similar in a way to the borrowed private-sector mechanisms of the 2010 ACA bill … in other words that it’s a mandate, right? to buy health insurance from a private company. No universal coverage universally paid for by a single government payer. ACA in a way is a a program that would have made Senator Bob Dole happy in 1994 as he was fighting off the Clinton healthcare plan … a more expansive plan of that time, and it’s very similar to the Republican 2012 candidate Mitt Romney’s plan that he enacted when he was governor of Massachusetts.

If there are some similarities between the passage of the Affordable Care Act in 2010 and the passage of Medicare in 1965, it should be said that the two pieces of legislation had very different stories behind their passage. President Lyndon Johnson was much more involved in the creating of Medicare and providing the impetus behind Medicare than most think President Obama was of the congressionally authored healthcare reform bill even though the end result bears President Obama’s name.

Lyndon Johnson would allow Mills to temporarily get the credit, but he’d get the credit in history for the passage of Medicare. Conservative Mills it should be said was a reluctant supporter of Medicare. He was worried about the cost, yet after 1964’s election. It had been a Lyndon Landslide … scores of new liberal Democratic congressmen ready to enact a senior healthcare bill among other programs. Mills knew after that election that some kind of bill was going to go through and settled on the plan provided by Cohen; Cohen did the details. But so important in the passage of Medicare was that Johnson was acting as a catalyst – emphasizing the urgency with holidays and polls and dead cats.

Opposition to Medicare

Medicare was far more bipartisan than Obamacare has turned out to be. The program was passed by the House 313 to 115. Over 70 Republicans joined Democrats to pass Medicare. Their votes were not needed for passage; it could have been passed entirely with Democratic votes. And likely, Republicans at the time saw the writing on the wall in voting for the Medicare program that would benefit seniors in their district. In contrast, the Affordable Care Act of 2010 was supported only by Democrats, and the bill in the House received one Republican vote … that from a one-term GOP representative in New Orleans in a district that was overwhelmingly Democratic. One vote in the House that could be considered bipartisan at all. It was a party-line bill.

Yet, Medicare was not exactly passed in a spirit of bipartisanship either. The comparison to the 1965 vote is only valid if one considers the final House vote, where Republicans joined with Democrats. Yes, there Republicans voted for the measure. But in committee, for years – four years to be exact – Republicans provided ten solid “No” votes for Medicare. That, along with a few southern Democrats, held the bill up, and led to the bill not reaching the floor of the House until after the 1964 elections even though it was a fairly popular idea at the time.

Popular … but that’s not to say there was no opposition. The American Medical Association saw a government-run program for seniors as a precursor to doctors being employed by the government and, along with their spokesperson, Ronald Reagan, opposed the Medicare bill. Reagan at this time … not yet a governor … a former actor … was used on a special record that was sent to doctors’ wives to play to friends in coffee clutches. A kind of early viral marketing Meetup.com kind of thing before there was such a service.

Oh there was opposition. Arizona Senator and former Presidential candidate Barry Goldwater said of Medicare to the effect of, “Next the government will buy seniors fruit baskets, or cigarettes.”

Republican Gerald Ford … Republican Donald Rumsfeld (then a Congressman from Illinois) voted against it. George H.W. Bush, slowly becoming a candidate for Congress, spoke out against it and called it socialized medicine.

A Senator then, Bob Dole voted no as well. Republican Minority Leader Edward Dirksen said, “Why should I be allowed to take dollars from some young factory worker, paid on the promise that we will take care of him later. I’m wealthy. I don’t need the government to pay for my health care.” Those were the type of things that were said then.

Ronald Reagan, campaigning for Governor of California in 1966 … a year later … was attacked for his opposition to such a popular bill. Then he said, “Well, I  would have gone for a program that provided care for all … not just seniors if they were low-income. If they’re low-income, I’ll go for a program that provides healthcare for everyone.”

Jacob Javitz, Republican Senator from New York, opposed Medicare on a similar argument. “Why is it universal? Why do even rich seniors get it?”

President Johnson, though, knew what he was doing. He wanted Medicare to be universal, to apply it to all seniors with no income test. In a very similar fashion, Franklin Roosevelt … 30 years before … made the same decision about Social Security for the same political reasons. Everybody gets it … so everybody has some stake in keeping the program around.

Lyndon Johnson knew the passage of Medicare would be part of his legacy. It was a big event. One of the three bills he most wanted: Education. Healthcare. Voting rights. At the last minute, handed a bill for his signature from the Congress, Lyndon Johnson decided to go to Independence Missouri and sign the Medicare bill with Harry Truman, the former President.

LBJ: “This is your bill,”

Carlson: … he told the former President on the phone. Truman was frail from a recent fall, but he became the first U.S. citizen to get a Medicare card.

Implementation fiasco

Now the interesting this is outside of the former President Truman and his wife Bess, others were not so quick to sign up. Not sign up for Medicare? Sounds crazy, right? But that’s what happened in ’65 and ’66.

Indeed, in its first year, Medicare, which required a signup, right? The citizen had to actually proactively sign up for it and it required some money … a $3-a-month premium payment … almost started like a flop. It was to begin in 1966 in June, with signups ending as of December 1965. There were only 2 million seniors that had joined Harry S Truman in obtaining a Medicare card by the end of ’65. The Johnson administration and its new Bureau of Health Insurance got in gear. Millions of brochures went out to encourage seniors on social rolls to join Medicare.

This was new. Federal government wasn’t exactly used to … outside of a war situation … having to advertise its programs. Bit of a new tactic for them. Computers were set up in Baltimore to manage the new rolls. 622 offices for the Bureau of Health Insurance were set up in regions thought the country. Nine thousand workers were brought in … some brought in from other departments to process all of these senior applications. What happened was a tremendous turnaround. In just a month – between December 1965 … when it almost looked like a flop … to January 1966 – 17.8 million seniors were signed up for Medicare. Wilbur Cohen called it the greatest operation of the American government since D-Day.

Indeed, it was the cornerstone of the Great Society that Lyndon Johnson announced in his re-election run in his Ann Arbor, Michigan speech. It remained constantly popular. When Republican Richard Nixon reached the White House, he never attempted to dismantle Medicare, and in fact, he’d recommend to Congress to expand the program. Ronald Reagan – not as a spokesman anymore, but now as a Republican President – was loathe to attack the program.

The 1966 cost of the program was $3 billion. The cost of the program in 1993 was $144 billion. In 2008, $350 billion … so obviously, the cost of Medicare has expanded over time as healthcare services have improved, populations increased and there’s just simply more to pay for. But to some extent, it comes back to the deal that Wilbur Mills and Wilbur Cohen worked out to limit partisan rancor and to limit the opposition of doctors. Medicare would pay doctors the fee that they could expect in the market.

Once passed, there was a larger problem with Medicare. How do you administer it? How do you deal with the opposition of the very people who had to make the services happen? That is doctors and insurance companies. They hate you for passing this bill and now, they have to take care of the patients. It would do no good to give seniors a Medicare card if there was no one that would take care of it. Insurance companies, despite raising hell about the deal, pretty quickly came to the Social Security office in Bethesda to make a deal with the Johnson administration.

After all, what Medicare essentially did is create something like a huge employer … a big pool of people. A huge commission of healthcare services for millions of Americans. An insurance company would need to actually make the payment, and work with doctors. Insurance companies wasted no time in forgetting their opposition to the bill and seeking those huge contracts with the newly created Bureau of Health Insurance.

Doctors get the ‘Johnson Treatment’

Getting doctors on board … that was quite a bit harder. It was thought that doctors might oppose Medicare simply by refusing to see patients who used Medicare as a form of payment. Many doctors had called for a boycott. Johnson though never took the threat seriously. That would border on a violation of the Hippocratic Oath, right? and in any case was a really lousy public relations situation for those doctors. “Just like chickens,” he told George Meany of the AFL-CIO, “they’re going to know where they’re fed.”

But the call for boycott was so strong at the grassroots levels among doctors, that there were calls to impeach the President of the AMA when he didn’t support a boycott of Medicare. The Ohio branch of the AMA called for a boycott of its own involving Ohio physicians.

President Johnson’s staff suggested a meeting at the White House between the President and doctors. Lyndon Johnson did just that. He invited the AMA board to the White House. Now here we get a little bit of what was called the Johnson treatment, some that charm/disarm/arm-twist tactics that were so famous with him and were probably easier for President Johnson to pull off than any President could now.

We know now what happened at this meeting between doctors and Johnson from the notes of a member from the AMA board.

Lyndon Johnson meets with them … he starts talking on and on about how much good doctors do in America, and how doctors treated his father and himself … nothing that these AMA doctors really wanted to hear. He read many parts of the bill to the AMA doctors, including parts of the bill that said the government would not interfere with medical practice, and doctors would be paid their usual and customary fees. And then,  as the account of the AMA board member has it, Johnson got up and stretched.

You must understand, when you’re in a meeting in the Oval Office, and the President stands, so does everybody else. So all the members of the AMA board had to stand when the President got up to stretch. If there was any doubt that his stretching was unintentional, Johnson did it three more times during the meeting … stood up and stretched and all the doctors stood up three times.

Finally, he turned to the AMA president and said, “Your President needs your help.” He asked the AMA if they could help the administration out with recruiting doctors to go to Vietnam. “Of course,” the president of the AMA said … maybe a little bit relieved that they were talking about something else but this tricky subject of Medicare.

Johnson’s eyes lit up immediately.

“Well that’s wonderful,” and he signaled to his press aide Bill Moyers to”get the press in here to announce this.”

Little did the AMA doctors know, they were walking right into a trap. And the reporters come into the Oval Office … cameras … notebooks … and Johnson relays the news that the AMA has agreed to help the Administration and recruit doctors to go to Vietnam. While the reporters took note of this news … that the doctors would be helping the Administration … they also knew that this meeting in the Oval Office was really about something else. They were interested in … and LBJ certainly knew this … in what the AMA’s position was now on the Medicare bill.

Would they boycott? The news reporters asked the doctors. But President Johnson takes the question.

He says, “these guys are helping our boys defending our freedoms of our land.” And then he adds, “I’m sure they will abide by the law.”

Then, in a classic “Johnson treatment” move, he points to the AMA president … the chief doctor of all the doctors in the United States and says, “Why don’t you tell them?”

The AMA president … Appel … was now on the spot … tells the reporters, “Of course doctors will follow the law.”

It was a done deal after that. About two weeks later, the AMA announced that they would work with Medicare and all their members would. Now that it was passed, they would not boycott.

A year later, at the AMA’s convention, most members had a positive view of the Medicare program. Medicare turned out to be actually good for the individual doctor’s business. They were indeed paid their usual and customary fee. Some may have made even more; they have made a deal with a patient who was indigent and couldn’t pay in the past. Now, there was no need to make such deals.

Medicare was a success story of the Great Society … the one that’s probably remembered most. The bill is consistently popular. Woe to any politician in the United States who attacks it. It has … along with other enhancements to the Social Security Act … reduced senior poverty, and it has provided relief to older Americans as they reach an age where they are prone to health issues. Medicare also provides a silent benefit … not often discussed … to the family of those seniors who no longer have to take money out of their own savings for their parents’ medical care.

Medicare did not succeed immediately, though. In fact supporters of health care reform … the ACA … may find some solace in that perhaps, knowing that Medicare had its hiccups, too, in its first nine months.

Medicare, the space program and the ACA

If one listens to the record that the AMA sent out to doctors’ wives with Ronald Reagan saying, “In your sunset years you will tell your children about how you were once free.” You could almost compare it to an opponent in Congress saying, “Freedom died a little bit today” on the passage of the healthcare bill.

So there was some concern about the effects of Medicare, and there was kind of violent opposition and it mirrors today’s concerns and the battles over Obamacare / ACA. Yet there’s a crucial difference … and it’s more apparent now, five years out from the passage of the Affordable Care Act. The fight didn’t continue with Medicare. It stopped. It didn’t continue in 1966, in the way it has five years after the passage of ACA.

Republicans didn’t control the House or Senate after the 1966 elections, so they couldn’t reverse the program but they made no attempt to repeal or reverse the program that 95 percent of seniors … many in their districts … were utilizing. Republican Richard Nixon gets elected in 1968. He doesn’t knock the program when he’s running for office and he doesn’t repeal the program in his presidency. In fact, he asks Congress to expand it.

Medicare’s sacredness has continued to be a political factor. It’s telling … one of the major attacks against the Affordable Care Act of 2010 was that it would hurt Medicare, a reference to cut in doctor payments included in the bill to attempt to make it more deficit neutral. And a recent bill to put those payments back … the Doctor Fix so called … got bipartisan support. Medicare is popular, and it was popular. So while there are similarities to Medicare legislation’s passage and that of the Affordable Care Act now known as Obamacare, there are differences. Make no mistake.

Differences in popularity

The lack of popularity generally of the program known as Obamacare means that it might be subject to changes down the line. Medicare was a popular idea, both for seniors, and for those with elderly parents. It was a popular idea among Americans facing increased hospitalization costs. The healthcare reform bill was not as popular. Polls from March and early April 2010 including CNN, Quinnipiac, Washington Post, FOX, show over 50 percent opposed the plan … and not all that much has changed.

A Rasmussen Reports national telephone survey in July 2015 found that 42 percent of Likely U.S. Voters share a favorable opinion of the law. 20 percent view it Very Favorably. Fifty-three percent view Obamacare Unfavorably, including 37 percent with a Very Unfavorable opinion. You will not get those kind of poll results about Medicare.

Yet this shouldn’t be surprising. Obamacare’s not simply an act to help a small, needy group of people … a revered part of the population who are perceived to have already delivered their work to the country. Right? It’s not a simple system … the ACA … of ‘Turn 65, get a card, and get coverage.” It is a sometimes confusing plan of exchanges, subsidies, mandates. It provides universal care in a form, but not a clearly stated universal benefit for a sympathetic group.

Implementation varies state to state. Most Americans are simply doing what they do now … obtaining insurance through their employer and so don’t feel the change that someone … say  … turning 65 certainly or even turning 60 and knowing they have five years to go … might have felt with Medicare.

The plan solves the uninsured problem in some cases. The White House claims 16.5 million Americans now have coverage where they did not before due to the ACA. But ACA/Obamacare became a focus of partisan activity beyond its passage in a way Medicare did not. And in the view of many, Congress is more partisan now in a way it was not in 1965.

Despite his heavy involvement in the program that we know (if we didn’t know before), I am certain that Lyndon Johnson would never, ever have allowed Medicare to be called JohnsonCare. He certainly enjoyed being associated with the achievement, but he did not want his name in the program’s name. President Obama didn’t choose to have the program’s name associated with him, but he grew to accept it and in any case did not counter it well.

The lack of a clear name for this program at all … Obamacare, ACA … a clear statement for what the program was, was I believe a contributing factor to lack of support in the program and the results of the 2010 and 2014 Congressional elections. The lack of branding, of salesmanship for healthcare reform goes to the White House and the Democratic Party who implemented it.

Starting with the name, Patient Bill of Rights, America, Bettercare, Eldercare, the aptly named Social Security … these were all good brand names of government programs explained to people what they do in a positive light. By the way, Social Security was changed from the more boring name Economic Security by crafty congressmen from California who spotted that. In terms of doctors, it’s interesting that this group is not a problem for the ACA in the way they were for Medicare. The AMA … as well as the American Hospital Association … supported ACA. Actually, the hospital group had supported Medicare as well, just as they supported the current reform bill. How could they not? It held the promise of new hospital customers and new physician customers paid for by the government.

Medicare was not created in a vacuum; it existed as a part of a series of measures designed to create a government expansion … the largest since the New Deal. Federal education aid, housing aid, permanent food stamp program … in addition, the nation was years away from landing a man on the moon. And that … at that time … gave a different focus to everything … something that’s missing now. The nation would spend between NASA and the Apollo missions, $20 billion to go to the moon. So, one fourth of that amount being used to pay for Grandma and Grandpa’s healthcare? It seemed almost trivial. Why not do it? We can do this.

Back on Earth and 50 years later, President Obama’s healthcare reform bill came at a time when the government was spending a lot more than Americans were recently used to … Fannie Mae, TARP, stimulus … but also at a time when this type of action, costs and the deficits associated with it are frowned upon by a certain group in our politics.

Obamacare’s place in the American mind and in American politics has not yet crystalized, and it is still the subject of harsh political talk in a way that Medicare was not five years after its passage. With two supportive Supreme Court decisions and a Presidential election, though, it seems like it is starting to become a fact of life. Time will tell.

I want to thank you for listening. If you’re listening to the program for the first time, I want to tell you that the website is at www.myhistorycanbeatupyourpolitics.com. There are more episodes available there.

You can subscribe to me on iTunes, you can subscribe on Stitcher and a variety of other places where you can get the podcast. My twitter is @myhist. There is a transcript of this program available at medicareresources.org … an exclusive transcript for this episode about the 50-year history of Medicare.

Thanks for listening.