January 9, 2025: Great Society Laws: Medicare and Medicaid

[60 years ago this month, President Lyndon B. Johnson—fresh off his successful re-election campaign—created his Great Society program, pushing Congress to help him (as he put it in his 1964 speech acceptance the presidential nomination) “build a great society, a place where the meaning of man’s life matches the marvels of man’s labor.” So this week I’ll AmericanStudy a number of Great Society laws, leading up to a post on what we still desperately need to learn from these histories.]

How the Great Society reflected two distinct ways of thinking about health care, and why the second in particular is still urgently needed.

One of the life lessons we all learn—or rather we hope to live long enough to learn—is that aging ain’t for the faint of heart. I don’t know how long exactly a relatively healthy human body is designed (not in an Intelligent Design sense, to be clear, just in the biology and chemistry/nature and evolution sense) to live, but it seems clear to me that in the modern world our life expectancies well outpace that plan, leading to all the potential (and likely, if not indeed inevitable) health and medical issues that come with aging. Before the creation of Social Security in the 1930s, aging Americans were pretty much entirely on their own when it came to such challenges; but that new program alone wasn’t quite sufficient to really deal with those health and medical realities, and so the Great Society added a vital new element, the health insurance program for seniors known as Medicare. As the son to a pair of older parents, I’ve seen first-hand how vital both Social Security and Medicare are to helping folks and families navigate these inevitable challenges of aging, and I truly can’t imagine how anyone survived the arc of life in America without them (and it seems clear that many, many more folks did not, or at least did so with far more challenges still).

Although Medicare is an entirely communal and indeed a socialist program (yeah, I invoked the American Bogeyman, but it’s the truth, folks), I would argue that it nonetheless reflects an individual approach to health care, or rather a resource designed to help individuals and families navigate their own health and medical challenges. Given the Great Society’s emphases on both a “War on Poverty” and social safety nets, it’s not surprising that in the same years—and indeed in the same law, the Medicare and Medicaid Act (also known as the Social Security Amendments) of 1965—the administration also created a more overtly community-focused health insurance program, Medicaid. Designed as a way to guarantee a baseline level of health insurance and thus health care for the most disadvantaged Americans, Medicaid quickly evolved to include a number of related and even more overtly community-focused programs, including for example the Children’s Health Insurance Program (CHIP) that offers access to not just health insurance but also community health programs for all American children and families.

Medicare and Medicaid are in many ways, as their names suggest, parallel and complementary programs. But I do believe that the latter is more community focused than the former, and likewise and even more importantly represents a recognition that health insurance and health care are communal needs, that access to them profoundly affects not only individuals but also and in many ways especially communities for the better (and the absence of them does so for the worse). One of the most frustrating aspects of the last couple decades in American politics (an incredibly long and competitive list to be sure) has been the collective unwillingness of so many Americans to a) recognize that programs like Medicare and Medicaid are already collective and governmental and, again, socialist; and b) extend that awareness to a recognition that collective health insurance and policies, such as the idea of “Medicare for All,” would represent a vital step forward in guaranteeing access to health insurance and care for all Americans. That’s one Great Society lesson we desperately still need to learn.

Last Great Society law tomorrow,

Ben

PS. What do you think?