We celebrate July 30, 1965, when President Lyndon Johnson signed Medicare and Medicaid into law. 

This amended the Social Security Act, which contained no public health insurance provisions when President Franklin Roosevelt signed it Aug. 14, 1935.

Led by Labor Secretary Frances Perkins, the New Dealers had proposed “Health Security” as part of Social Security. They proposed a federal system that included comprehensive benefits such as preventive care and care for chronic illnesses, with automatic enrollment, funding by contributions from employers, employees, and government, and power to control costs and expand access in underserved areas. It was integrated with other programs (unemployment insurance, old-age pensions, other New Deal social supports) to create a broad safety net.

Not winning this was Perkins’s biggest regret about the New Deal. 

Medicare 30 years later was a hard-won compromise. It is good health insurance, it’s a major anti-poverty program for folks over 65, and it forced desegregation of hospitals. It is provided by the government. It is earned and not means-tested. It uses a dedicated tax and a trust fund (“single payer”).

But it isn’t universal health care. From the beginning, Medicare Part B required premiums on top of the payroll tax; it only covered 80% and supplemental private insurance was needed; it didn’t cover drugs, dental, vision, long-term care; doctors could refuse to accept it. It’s worse now, even with a drug benefit. Part D drug coverage is confusing and has premiums. Private insurers extract profits via the “Medicare Advantage” option.

But, as a compromise, the next step for advocates was expanding Medicare to cover everyone with improved coverage. When Sen. Jacob Javits proposed Medicare expansion, a New York Times headline on April 15, 1970, said “Medicare for All Is Asked by Javits.” The phrase stuck. It arrived officially in 2003 in the alternative but popular title of Rep. John Conyers’s United States National Health Insurance Act: The Expanded and Improved Medicare for All Act.

Congress’s failure to pass such bills has led to robust state movements to establish a similar system state by state until Congress acts. After all, that’s how Canada got its system. In the state context, “Single Payer” was often used. By the time Massachusetts Jobs with Justice launched Mass-Care in 1995, the formal name chosen was the Massachusetts Campaign for Single Payer Health Care.

So, of course, on the occasion of Medicare/Medicaid’s birthday, Mass-Care has signed on to An Open Letter to those seeking to reform our health care system: Dream Bigger, Be Effective. The letter with current signatures is here. Some excerpts: 

  • We need to rally behind the boldest possible reform, Medicare for All, that brings together the broadest possible movement. Now is not the time for overly complex incremental measures that prop up the same systems we’re seeing fail under the weight of attacks by Trump and Republicans. The American people are hungry for bold ideas that will transform fundamental institutions that have failed them for too long. And they are looking for leaders who will take on powerful interests and fight for working people.
  • 90% of Democratic voters and 63% of all voters support Medicare for All. Americans believe the government should guarantee health care to everyone, and anything less means tens of millions of people in the U.S. will continue to suffer from the lack of necessary care and the prospect of medical debt if they do seek care. 
  • We can’t give in to half measures; we must fight for exactly what people need and deserve. Medicare for All is the only way that we can guarantee everyone’s care and finally take the profit-motive and corporate influence out of health care. 
  • Join us in dreaming of an economy that works for all of us. Where workers get paid a living wage and have expanded and enforced rights. A future where people can afford safe, healthy, and affordable housing and utilities. Where schools are robustly funded. It all starts with making health care a human right.

Jon Weissman is legislation chair and former board chair of Mass-Care: the Massachusetts Campaign for Single Payer Health Care, president of the Universal Health Care Education Fund, and co-chair of Western Mass. Medicare for All.