A Shared Goal: the Expansion of Social Security
This is the 7th in a series of posts outlining America’s exceptional history of problem solving. Read parts 1-6 here.
By the 1960s, the idea of a national healthcare system to provide medical care for the nation’s neediest populations was far from novel; it had first been proposed by President Harry S. Truman two decades prior.
But lawmakers had never been able to coalesce around a workable plan. Perhaps they didn’t yet see the need.
The Social Security system and other New Deal projects were already serving as a safety net for millions of older Americans. But a hodge-podge of federal-state medical care programs left many men and women without the medical care and financial protection they needed as they aged.
The private insurance market was inadequate. Nearly half of seniors, those 65 and older, were without hospital insurance at a time when their incomes were shrinking just as their medical needs were growing.
A lack of insurance wasn’t only a problem for the poor. Middle class men and women were often spending their hard-earned savings on medical expenses, which grew significantly later in life.
Lawmakers on both sides of the aisle were aware of this burgeoning problem, and in the late 1950s began to address it. Bills were introduced in Congress; studies were conducted; committees held hearings and considered expert testimony. Countless hours of thought, research and debate went into the process.
Congress even began taking incremental steps to address it, including making federal matching grants available to the states to help finance programs of medical assistance for certain populations of older Americans.
However, a more comprehensive program still was needed. And Congress needed leadership in clarifying the goal so they could figure out the details in hand.
Before his assassination, President John F. Kennedy called on Congress to enact a health insurance program for aged Americans. But his successor, Lyndon B. Johnson, would make expanding the Social Security Act of 1935 to include support for the healthcare of aging Americans, one of the primary goals of his administration. He would provide the vision Congress needed to get the job done.
Johnson was skilled at consensus-building; he knew he needed to work with lawmakers to achieve the goal of medical coverage for older Americans. He was, after all, proposing the most far-reaching amendment to the Social Security Act since its passage three decades earlier.
But policymakers were not caught off guard by this proposal. They had been in search of a solution for years — President Johnson helped them to coalesce around a goal.
Lots of issues needed sorting out.
How would the government pay for the care? What kind of care would be covered? How would benefits be distributed?
Policymakers needed to combine the best ideas of economics, health insurance and health care into a single program. They needed a program that would benefit all Americans and one the federal government could sustain.
Congress would craft a bill crammed with detailed and well-thought out provisions for putting the ideas behind health insurance into effect.
There was plenty of debate and even disagreement. But policymakers were motivated by their overarching goal.
On July 27, 1965, the Social Security Act amendments of 1965 passed the House by a vote of 307 to 116. Two days later, the Senate approved the legislation, 70 to 24. And by the end of the month, Johnson signed the amendments into law and went into effect the following year.
In 1966, some 19 million Americans were enrolled in Medicare.
Like Social Security, Medicare has become an essential part of the safety net for millions of hard-working Americans. Its importance can’t be understated, but neither can its precarious current state.
For all its care in crafting the legislation, Congress didn’t anticipate a bigger, longer living population that threatens the sustainability of the program for future generations.
Lawmakers and political leaders need to come together, as they did in 1965, to address this challenge. If they let history — and not partisan politics — serve as their guide, a new solution is within reach.
On October 12, an optimistic band of citizen activists, political leaders and other key influencers will convene in New Hampshire to sharpen the focus of the 2016 presidential election on a simple but essential concept: problem solving. Over the next four weeks, in the lead-up to this convention, we will be detailing the great history of problem solving in America to better understand how our leaders today can learn from these important lessons. Click here for more on the convention.