Columns » Ernest Dumas

Getting it done


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In some ways the good old days were just that. Forceful men who were elected to the government got things done to meet the needs of the citizenry.

Government was the servant of the people, and only a few thought of it as their enemy. Those were the handful of Republicans who equated government and socialism. Now, of course, they all do.

The good old days in this instance were the '50s and '60s, when three presidents and a succession of congresses set out to fix, among other things, legal discrimination based on race and a health crisis among the elderly and disabled.  The tallest of the tall, in the health crisis anyway, was a conservative Arkansas lawmaker, who gave us Medicare and Medicaid.

President Lyndon Johnson went to the Truman Library at Independence, Mo., on July 30, 1965, to sign the bill into law in the symbolic presence of Harry S. Truman. Medicare was the down payment on Truman's goal of universal health insurance. As they assembled for the signing ceremony Truman noticed Rep. Wilbur D. Mills of Kensett, Ark., making himself inconspicuous in the background and hauled him over to share the limelight. It is not a stretch to say that Mills was the father of Medicare and Medicaid, which a few Republicans and the American Medical Association and the insurance industry were calling socialized medicine.

It proved to be so immediately popular that the Democratic ranks in both houses swelled at the next election to their highest in modern times, and there now is no program, public or private, that enjoys such overwhelming favor among the people it serves. It is so popular that Republicans, after trying for 50 years to undermine it, have resorted to stirring fears among seniors that Democrats will weaken it with their health reforms.

Facing nearly identical opposition and the same fear mongering that President Obama confronts today, how did the reformers do it then?

Ten years after a Republican Congress spurned Truman's call for a system of guaranteed medical care for all, there was a consensus that the country needed to help the elderly get care. Seniors either couldn't afford health insurance or were denied coverage because insurance companies considered them “bad risks.”

President Eisenhower waffled back and forth on a health program for seniors but his health and welfare secretary and other members of his administration worked out a plan with many Republicans to use federal taxes to subsidize states that would help the elderly poor buy private insurance. Both candidates for president, John F. Kennedy and Richard Nixon, favored some plan. The AMA, the U. S. Chamber of Commerce, the National Association of Manufacturers, the American Farm Bureau and a new combine of 260 insurance companies called the Health Insurance Association of America opposed a federal health-care law, calling it socialized medicine. Except for the AMA, the same groups are still crying socialism.

In 1960, Mills, who was chairman of the House Ways and Means Committee, worked out a compromise that became known as Kerr-Mills, after Sen. Robert S. Kerr embraced it. Kerr-Mills expanded the old medical vendor payments under state-run welfare programs to include “medical indigency,” which allowed very poor seniors to get state and federal help on their medical bills. Eisenhower signed it.

Most states were too poor to do their share, and nothing much came of the program. President Kennedy began a new battle for a government-run hospital program for all seniors under Social Security. Mills firmly opposed adding a medical program to Social Security. Eastern Republicans led by Sen. Jacob Javits of New York fashioned a different plan. The administration and Javits plans were merged but the Senate defeated the bill by two votes.

Johnson renewed the campaign in earnest after Kennedy's assassination and concentrated on Mills.

Three weeks before Johnson's landslide victory over Barry Goldwater in 1964, Mills hinted that he might support a government-run program of some kind in a speech at a Kiwanis convention at the Hotel Marion in Little Rock. A young reporter for the Arkansas Gazette who asked him why he had changed his mind got a stinging rebuke that he would always remember. Mills said he had always believed that workers should pay into a fund during the working years to take care of their ills when they were old. If he had, it had not been recorded.

A week after the election Mills said he would draw up a Medicare bill and introduce it in January if the president wanted him to. He took the principal Democratic bill and redrafted it into its final 265-page form in January, taking some of the administration bill and some from Javits. There would be a hospital insurance program paid for by a separate payroll tax from Social Security, a voluntary program covering physician fees and other services paid for by a premium from consumers matched by the government from general revenues, and a federal-state insurance program for the very poor under the age of 65. It was more elaborate than any previous plan. Mills pushed it through his committee over Republican opposition, 17-8, brought it to the floor and passed it on April 8 after one day of debate and no amendments, 313-115. It ultimately passed in the Senate, 68 to 21. Republican senators split 13-17 with three not voting, a slightly more favorable division than in the House.

Despite continuous efforts by pharmaceutical companies, medical equipment makers, doctors and insurance companies to defraud the programs and a successful GOP campaign in 2003 to overload the Medicare tax base and drive it toward insolvency, it is a marvel of efficiency.

Where is a semblance of Wilbur Mills today? Mike Ross? Blanche Lincoln? Please!


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