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U.S. Health-Care Reform: Lessons Learned – A Brief History of Medicare Legislation and Its Relevance to the Health-Care Reform Debate in the 111th Congress

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By Thomas J Reid III MD PhD FACP
Posted Sep 28, 2009 in Health
LESSONS LEARNED
The proponents of the rush to complete a health-care reform bill for the purpose of meeting an arbitrary deadline have failed to visit the congressional efforts and legislative chronology for enacting an earlier albeit much smaller health-care reform: Medicare. The take home lessons from a review of pre-enactment history of Medicare include: (1) take your time [8 years, shy one month, from submission of the Forand bill to the signing by President Lyndon B. Johnson of the 1965 amendments to the Social Security Act which contained the Medicare and Medicaid legislation]; (2) success is incremental (many fits and starts in the process); and (3) congressional hearings are an integral part of the process (at least 6 major hearings between 1957 and 1965).
BRIEF HISTORY OF MEDICARE
Though proposals for government run health-care, including a nationalized health-care system, preceded the enactment of Medicare legislation by decades, the introduction of the Forand bill is a reasonable place to start as it was the first serious attempt toward Medicare and because the key players in the end-game were in position.
When President Franklin D. Roosevelt signed into law the Social Security Act of 1945, there was no health insurance clause in the legislation. He correctly diagnosed that such a clause was unpopular with Americans and inclusion should wait for a later time. His successor, President Harry S. Truman wanted to incorporate national health-care into his Fair Deal program. This approach proved unsuccessful; however, the seeds were sewn for limiting government assisted health-care to those eligible for Social Security (that is, over age 65).
After ten years, false starts and much push by the AFL-CIO* as well as others, on August 27, 1957 REP Aime J. Forand D-RI of the House Ways and Means Committee introduced H.R. 9467 (health-care legislation targeting Social Security beneficiaries only) to the 85th Congress. As this was submitted at the end of the session, nothing further was done until the next session when Congressional hearings were held in June 1958. The bill was re-introduced on February 18, 1959 by REP Forand in the next Congress (86th) as H.R. 4700. From March 14, 1960 the House Ways and Means Committee held extensive sessions in an attempt to amend the Social Security Act. The Forand bill was defeated twice in committee: first on March 31, 1960 and again, this time with a stripped-down bill (hospital only benefits), on June 3, 1960 – however, these were the first official votes regarding health-care legislation ever held by the Ways and Means Committee. Between these defeats, hearings were held by the Senate Subcommittee on the Problems of the Aged investigating issues related to the health-care of the aged – these hearings further clarified the plight of the elderly. During the presidential campaign of 1960, candidate SEN John F. Kennedy D-MA and others popularized the moniker “Medicare”, later attached to health-care proposals for the elderly.
Soon after, REP Wilbur D. Mills D-AR introduced another health insurance bill H.R.12580 (the Mills bill) on June 13, 1960; the bill offered a program for States to provide medical care to elderly considered “medically indigent” and who did not meet State criteria for welfare – this was not a fully fledged insurance program. Sponsored in the Senate by SEN Robert F. Kerr D-OK, the bill was modified and became known as the Kerr-Mills bill. The bill passed both the House and the Senate, the first time health-care legislation reached a floor vote in the Senate. This bill was signed into law September 13, 1961 (Public Law 86-778).
On February 13, 1961, SEN Clinton P. Anderson D-NM and REP Cecil R. King D-CA introduced hospital insurance bills as S. 909 and H.R. 4222 in the Senate and House, respectively; known as the King-Anderson bill, it covered some hospital and nursing home costs. Hearings on the bill were held during July and August. A compromise health-care amendment (Anderson-Javits [SEN Jacob I. Javits R-NY] amendment) was attached to a welfare bill (H.R. 10606) on July 17, 1962; this bill was tabled by the Senate. The following year, revised King-Anderson bills were re-introduced as H.R. 3920 and S. 880 (February 21, 1963). The House Ways and Means Committee started hearings on the King-Anderson bill in November 1963; these were completed in January 1964 after being interrupted because of President John F. Kennedy’s assassination.
After postponing action on Medicare in June 1964, H.R. 11865 (which included amendments to Social Security but without a health-care component) was introduced July 7, 1963 and passed by the House on July 24th. The Senate Finance Committee took up H.R. 11865 and began hearings on August 6. The Senate attached Medicare as an amendment to H.R.11865 and the bill passed September 2, 1964. By October 2, it was clear the House-Senate Conference Committee could not reach a consensus to address differences in the House (without Medicare) and Senate (with Medicare) versions of the bill.
As the first bills in the new year, the King-Anderson bills were re-introduced as H.R. 1 and S. 1 in January 1965. On March 23rd, the House Ways and Means Committee replaced the King-Anderson bill with H.R. 6675 (the Mills bill) which was passed by the house on April 8th. From April through June, the Senate Finance Committee held further hearings; the bill was passed by the Senate on July 9th. The House-Senate Conference Committee met for one week (July 14 – July 21) and resolved differences in the House and Senate bills. Over July 27th and 28th, the report by the Conference Committee was passed by the House and Senate and included two amendments to the Social Security Act: Title 18 (Medicare; Parts A and B) and Title 19 (Medicaid). On July 30, 1965 President Lyndon B. Johnson signed the bill into law – Public Law 89-87.
LESSONS LEARNED – REPRISE
The present health-care legislation before congress has not been adequately vetted with the American people. One month (August 2009) of scattered Town Hall meetings cannot adequately substitute for extensive hearings required of such comprehensive legislative measures.
The April 1959 report from the Department of Health, Education and Welfare (predecessor of the present Department of Health and Human Services) to the House Ways and Means Committee contains a segment that is germane today:
In our society the existence of a problem does not necessarily indicate that action by the Federal Government is desirable. The basic question is: Should the Federal Government at this time undertake a new program to help pay the costs of medical care…, or should it wait and see [first if other options are effective]?
Eight years were necessary to enact Medicare from the time REP Aime J. Forand D-RI submitted his bill to enactment into law. Medicare has serious issues with cost containment in large part because of fraud and waste; not anticipated by proponents and Congressional authors. Do we want to repeat this error?
*AFL-CIO: American Federation of Labor-Congress of Industrial Organizations; this group is lobbying hard for the present congress to steadfastly keep the public option.
Thomas J. Reid III MD PhD FACP

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