Bernie Sanders Wants to Expand Medicare to Everybody — Exactly What Its Architects Wanted

"We expected Medicare to be a first step toward universal national health insurance," wrote Social Security commissioner Robert Ball.

A spectators' section of Atlantic City, N.J.'s vast Convention Hall is jammed with senior citizens hours before the third session of the Democratic National Convention was due to start, Aug. 26, 1964.  They are supporting the Medicare program Pres. Johnson is trying to get through Congress.   (AP Photo)
Senior citizens gather to support the Medicare program at an Atlantic City, N.J. Convention Hall before the third session of the 1964 Democratic National Convention. Photo: AP

Bernie Sanders doesn’t just want to play defense on health care — he’s introducing a bill that would expand the Medicare program to everybody in America, creating a single-payer health care system.

Such a system would wipe out inefficiencies in our current, private insurance-run system, and polls very well — yet it is opposed by the health care industry and the Democratic and Republican establishments that relies on them for campaign cash.

But creating a “Medicare-for-all,” single-payer health insurance system for all Americans would be fulfilling the dream of those who created the Medicare system in the first place in 1965.

Medicare’s architects ended up compromising with Congress and establishing a system that offered public-run health insurance just for the elderly, but they never intended for only retirees to benefit from the program.

Retired Senior Citizens Carrying Pro-Medicare Signs

Retired senior citizens carry pro-Medicare signs in an undated photo.

Photo: Bettmann Archive

Medicare’s Roots and a Vision Unfulfilled

Yale political scientist Theodore Marmore, commenting on Medicare, once wrote that no “other industrial democracy” other than the United States “has compulsory health insurance for its elderly citizens alone, and none started a program with such a beneficiary group.”

The reason Medicare was offered only to senior citizens is a tale of legislative compromise, not intellectual intent.

Since Theodore Roosevelt ran on a platform of health insurance for all industrial workers as a presidential candidate for the Bull Moose Party in 1912, offering government-backed health insurance to workers has been a progressive cause. Franklin Roosevelt proposed guaranteeing a right to health care shortly before his death; his successor Harry Truman worked hard to pass a form of single-payer health insurance, but was defeated in Congress after a smear campaign led by the American Medical Association that associated the president’s plan with the Soviet Union.

Thus reformers decided to focus on the most sympathetic part of the population, which the health insurance industry had the least interest in covering: the elderly.

Robert Ball was the commissioner of Social Security under presidents Kennedy, Johnson, and Nixon, and one of the officials who was involved in the push to create Medicare. In 1995, he wrote a short history of how the Johnson administration and its allies in civic society passed Medicare for the journal Health Affairs.

For persons who are trying to understand what we were up to, the first broad point to keep in mind is that all of us who developed Medicare and fought for it — including Nelson Cruikshank and Lisbeth Schorr of the AFL-CIO and [Under Secretary for Health, Education, and Welfare] Wilbur Cohen, [long-time Social Security administration official] Alvin David, [the Health Insurance Benefits Advisory Council’s] Bill Fullerton, [Social Security Administration officials] Art Hess, Ida Merriam, Irv Wolkstein, myself, and others at the Social Security Administration — had been advocates of universal national health insurance.  We all saw insurance for the elderly as a fallback position, which we advocated solely because it seemed to have the best chance politically. Although the public record contains some explicit denials, we expected Medicare to be a first step toward universal national health insurance, perhaps with “Kiddicare” as another step.

After the passage of the initial program, Johnson administration officials didn’t wait long before calling for expanding health coverage. Johnson explained to Congress in his 1968 State of the Union address that he wanted a “child health program to provide, over the next five years, for families unable to afford it, access to health services from prenatal care of the mother through the child’s first year.” Cohen was tasked by the president to design the program, which Ball refers to above as “Kiddie Care.”

The war in Vietnam and Johnson’s fraying political coalition made Kiddie Care a vision that remained unfulfilled. Today, the United States continues to have the highest infant mortality rate in the industrialized world.

All that Sanders is trying to do is fulfill the original promise of Medicare, by expanding it to everyone.

Top photo: Senior citizens gather to support the Medicare program at an Atlantic City, N.J., convention hall before the third session of the 1964 Democratic National Convention.

Join The Conversation