As many here have pointed out, it took Lyndon Johnson 18 months to get Medicare passed by a Democratic House and Senate. By comparison, Health Care Reform is moving at warp speed.
How Johnson got Medicare passed may be a lesson for us today. I was very surprised to learn how much LBJ deferred to Congress. President Obama is much more "hands on" than LBJ was (in the legislative process) and much more involved in crafting the bill (in terms of guidance on content).
At the very least, it is interesting history. Below is the history, along with a fascinating bit of dialogue between Johnson and Congressional leaders and negotiators.
President Kennedy came within two votes in the Senate of gaining Medicare passage in 1963. When President Kennedy was killed, the new President took Medicare on as his first priority. He made the issue a tribute to the dead President. He said often and publicly that Medicare was President Kennedy's legacy, and it had to be passed.
But Congressional committees dithered. In the House, the key committee was Ways and Means, chaired by Wilbur Mills. In the Senate, Russell Long's Finance Committee was the key committee. Both southern Democrats, Mills and Long were not inclined to favor Medicare, but they took their jobs seriously and knew their President wanted a bill.
For months, the bill was held up in Ways & Means. President Johnson, not wanting to step on Congressional perogatives, wouldn't even ask Congressman Mills for progress reports. They would talk about the bill, but always dancing around the issue and Johnson felt he couldn't press. (By comparison, President Obama has been much more aggressive with Congress).
In the Senate, President Johnson's key advisors told him they didn't have the votes. Senator Ribicoff of Connecticut proposed a compromise that would make Medicare voluntary. (A senior would have the option of slightly increased Social Security benefits, or health care). Liberals didn't like the compromise (a compromise that in some ways can be compared to co-ops instead of public option), but White House tapes show that President Johnson told Senators he would accept the Ribicoff compromise.
In the House, Wilbur Mills was opposed to a payroll tax to fund Medicare, but after Johnson's 1964 electoral victory, he conceded that point. But for five more months, the Ways and Means Committee continued it's debate. On March 23, 1965, the Ways and Means Committee passed the bill... but President Johnson didn't know what was in it.
In a remarkable conference call with Wilbur Cohen (Johnson's legislative liaison), Wilbur Mills, Speaker of the House John McCormack, and House Majority Leader Carl Albert, Johnson learned what the bill would include. Here's a transcript of the White House tape of the conversation:
Mills: We wound up and I got instructions, we'll introduce the bill at noon tomorrow and will report it at 12:15. . . . I think we've got you something that we won't only run on in '66 but we'll run on from here after.
Johnson: Wonderful. Thank you Wilbur.
Mills: Now here is Wilbur Cohen.
Johnson: When you going to take it up?
Mills: We could have it on late next week, if not, early the following week.
Johnson: For God sakes, let's get it before Easter.
Mills: Oh, there's no doubt about that.
Johnson: . . . I sure do congratulate you on getting this one out . . . I congratulate you and thank you.
Cohen: I think it's a great bill Mr. President.
Johnson: Is that right?
Cohen: Yes sir. I think you got not only everything that you wanted, but we got a lot more. . . It's a real comprehensive bill.
Johnson: How much does it cost our budget over what we estimated?
Cohen: Well, it would be, I would say, around $450 million more than what you estimated for the net cost of this supplementary program. (40)
Johnson: What do they do under that? How is that handled? Explain that to me again, over and above the King-Anderson, this supplementary that you stole from Byrnes.
Cohen: Well, generally speaking, it's physicians services.
Johnson: Physicians. All right, now my doctor that I go out and he pumps my stomach out to see if I've got any ulcers, is that physicians?
Cohen: That's right.
Johnson: Any medical services that are M.D. services?
Cohen: Any M.D. services.
Johnson: Does he charge what he wants to?
Cohen: No, he can't quite charge what he wants to because this has been put in a separate fund and what the Secretary of HEW would have to do is make some kind of agreement with somebody like Blue Shield, let's say, and it would be their responsibility . . . that they would regulate the fees paid to the doctor. What he tried to do was make sure the government wasn't regulating the fees directly. . . the bill provides that the doctor can only charge the reasonable charges, but this intermediary, the Blue Shield, would have to do all the policing so that the government wouldn't have its long hand . . .
Johnson: That's good. Now what does it do for you the patient, on doctors. It says you can have doctors bills paid up to what extent or how much? Is there any limit?
Cohen: The individual patient has to pay the first $50 deductible, then he's got to pay 20% . . . of everything after that. . . .
Johnson: That keeps your hypochondriacs out?
Cohen: That will keep the hypochondriacs out. At the same time, for most of the people it will provide the overwhelming portion of their physicians costs.
Johnson: Yes sir, and that's something nearly everyone could endure. They could borrow that much, or their folks could get them that much to pay their part. . . . I think that's wonderful. Now remember this, nine out of ten things I get in trouble on is because they lay around. Tell the Speaker and Wilbur to please get a rule just the moment they can. . . . 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 better either bury that cat or get it some life.
Beschloss, Michael, Reaching for Glory: Lyndon Johnson's Secret White House Tapes, 1964-1965 (New York, 2002, Simon & Schuster)
Russell Long in the Senate still tried to block Medicare by proposing his own legislation, but the bill passed in July 1965.
There are a lot of parallels between the Medicare debate and the current Health Care Reform debate. The parallels include Democratic majorities in both houses of Congress; a Presidential priority; comprises to get the bill passed; and southern Democrats slowing the process. But there are some differences, and I think many of us are unaware of them. Among the differences:
- President Obama is much more engaged in the process than was President Johnson. Both Presidents (unlike President Clinton) have deferred to Congressional perogatives and let Congress take the lead, but Obama has been "hands on."
- President Obama is providing more of the shape and content of the legislation that did President Johnson. The transcript above is almost mind-boggling in its revelations about how little LBJ knew about the bill.
- Both Presidents were or are open to compromise to get the bill passed.
Perhaps the history will help those who feel the President ought to be guiding the process more, or who think the process has taken too long.