When the time came for final House action on the landmark health-insurance bill, the vote itself was something of an anticlimax.
While there was last-ditch opposition from Minnesota’s Republican delegation, the state’s Democratic congressmen voted “yes” and the legislation was easily approved on a vote of 313 to 115.
Unlike the high drama surrounding the House vote on the 2010 health care overhaul bill, congressional approval of the bill establishing Medicare was pretty much a foregone conclusion by the time the legislation reached the House and Senate floors in 1965.
Long a goal of liberal Democrats, national health insurance — at least in a limited form — became a political reality with the Democratic sweep of the 1964 elections. That year saw Lyndon Johnson gaining 61 percent of the popular vote in his lopsided win over Barry Goldwater. At the same time, Democrats increased their margins in the House and Senate, giving them a lock on both houses.
GOP alternative: Eldercare
Sensing that the political tide was running against them in 1965, House Republicans opted to deflect rising public support for national health insurance by fashioning an alternative to Medicare that they dubbed “Eldercare.” The Republican plan would have established a means-tested program that enabled low-income seniors to obtain federal subsidies for privately administered health insurance. But Eldercare was strictly voluntary and lacked the mandatory feature of Medicare’s Part A hospital insurance with its payroll-tax funding mechanism.
Minnesota’s four House Republicans supported their party’s alternative, but the Eldercare plan lost on a test vote of 236 to 191 when it reached the House floor on April 8. In statements to the Minneapolis Tribune after final House passage that same day, members of the Republican delegation justified their vote against Medicare — but in terms that were considerably more moderate than those used by their modern counterparts who opposed this year’s health-reform legislation.
After the Medicare debate in 1965, the Third District’s Clark MacGregor said he supported using general revenue funds to partially subsidize health-insurance coverage “for older persons who want and need it. This is far preferable to this compulsory plan where the rich and the poor pay the same taxes and benefits are available to people who don’t want or need them.”
The First District’s Al Quie echoed MacGregor’s views. “I support improvements in the Social Security plan and the voluntary medical plan in this bill (Medicare)” Quie said. “However, I am opposed to the compulsory payroll tax system as a principle. I felt the only way I could dramatize this was by voting against the bill after the Republican plan was defeated.”
DFLers were jubilant
In contrast to their Republican colleagues, Minnesota’s DFL congressmen were jubilant when the Medicare bill cleared the House. “This is going to be the biggest step forward in social legislation since Congress passed the first Social Security act in 1935,” declared the Fourth District’s Joseph Karth.
“This is not just a bill for the very poor but for many persons whose savings are wiped out and who are made wards of the state as the result of major needs,” added Karth, in terms that could have been repeated during this year’s congressional debate by Betty McCollum, the DFLer who now represents the Fourth Congressional District.
While the Medicare bill targeted the elderly, a politically acceptable demographic group, the 1965 legislation, in the context of its time, was more far-reaching in its extension of federal authority than the more controversial Obama administration health-care overhaul plan. Medicare, the “single-payer” of its era, established a major new federal entitlement funded by a permanent tax increase that applied to virtually all working Americans.
A more muted opposition
But then, unlike today, Republican opposition was relatively muted and low key. During the floor debate on Medicare, House Republican Leader Gerald Ford urged support for his party’s substitute measure, but said that it would be understandable for some members of his party to vote for the Democrats’ bill since it contained a number of provisions originally supported by Republicans. While Ford voted against adoption of the Medicare bill, 65 Republicans — nearly half of his caucus — voted with the Democrats on final passage.
That summer, after a companion bill easily cleared the U.S. Senate, both houses of Congress were able to reconcile their differences and send the landmark legislation on to the White House.
On July 30, 1965, with Vice President Hubert Humphrey standing by, President Lyndon Johnson signed Medicare into law, creating this country’s first federally administered national health-insurance system.