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Public Opinion and the Passage of the Medicare Bill blog

February 22, 2017

The early days of public opinion research captured Americans’ response to the first major efforts by the U.S. government to provide health care to its citizens, an undertaking that saw success in the passage of Medicare in 1965. A review of polls from the forties to the sixties reveals the battle for public support that ended in that landmark bill.

Truman’s Attempt

Health insurance itself was a relatively new notion in the 1940s, but most Americans liked the idea. A 1944 NORC poll found 92% thought it was a good idea to pay a certain amount each month for insurance to cover any hospital care they might have in the future. But only 34% said they themselves had any insurance against hospital bills, and just 15% against doctors’ bills. Though a 54% majority said they would prefer to have insurance, 38% said they would rather pay medical bills each time. Still, support in this poll for a large-scale government health insurance bill was high; 68% thought it would be a good idea if the Social Security law also provided paying for the doctor and hospital care that people might need in the future.

Among those who opposed expanding Social Security in this way, a plurality of 37% thought it represented too much government interference or might lead to socialism. Overall, however, the public approved of government taking the lead on health care. When asked in a 1945 Gallup poll which they preferred, a mandatory government health plan or an optional plan set up by the medical profession, 53% of respondents chose the former; just a third the latter. After President Truman called for a national health insurance program in November 1945, 59% in a Gallup poll approved of the plan; 25% disapproved.

Despite public support, the American Medical Association opposed Truman’s plan strongly and loudly. The proposal languished. By 1949, those in a Gallup poll who had heard about the Truman plan were equally divided between supporters (38%) and opponents (38%). When provided descriptions of the president’s plan and an alternative put forth by the A.M.A., only 33% preferred the former. A May Gallup poll the same year found the country divided between 44% who would have Congress pass the government’s compulsory health insurance program which would require wage or salary deduction from all employed people to provide medical and hospital care to them and their families, and 47% who would not. By 1950, a Gallup poll found that, of those who had heard about the Truman plan, only 24% approved, while 61% disapproved. Over the next few years, repeated Gallup polls found majorities opposing a government health insurance plan run by the federal government. A 1953 ORC poll showed just 30% saying the federal government should provide government health insurance for all. Government-supported health insurance seemed to be a non-starter.

The Kennedy Plan

Over the fifties, growing numbers of employer-sponsored health care plans greatly increased the proportion of insured Americans. But health care costs for the uninsured remained a serious problem, one President Kennedy was determined to address when he took office. Kennedy believed the key to achieving passage of a health care bill was to focus on the specific problem of covering the elderly, a popular position. In May 1961, support for a Social Security tax to pay for old age medical insurance was a solid 68% in a Gallup poll. In a January 1962 ORC poll, 51% of American believed there was a great, urgent need for payment of doctor, hospital, medicine bills of old people. An additional 33% saw some need; only 10% saw no need. Of those who believed there was any need, 52% thought the federal government should meet it; 33% thought state government should deal with it. Very low proportions thought private industry (2%), voluntary agencies (6%), or individuals (6%) should deal with this problem.

But the fight over what would be Medicare had just begun. The A.M.A.,along with insurers, vehemently opposed Kennedy’s proposal  on the grounds that the president was introducing socialism to America’s medical system. One letter in the Archives of Otolaryngology read:

Before swallowing the attractively flavored bait of hospitalization under social security for the aged, the public should become better informed of the philosophical implications of adopting the principle of medical and hospital services through Social Security, for unquestionably, once accepted, this mechanism is capable of infinite expansion in every direction until it includes the entire population.

A major campaign to influence public opinion was undertaken to prevent such a scenario, much to Kennedy’s frustration. He countered with an unusually aggressive outreach effort of his own, including 33 AFL-CIO rallies. In a May 1962 speech, he argued that a minority of Americans had been unduly alarmed by misrepresentation of the bill, while the majority supported it:

All these arguments were made against Social Security at the time of Franklin Roosevelt. They are made today. The mail pours in. And at least half of the mail which I receive in the White House, on this issue and others, is wholly misinformed. Last week I got 1,500 letters on a revenue measure–1,494 opposed, and 6 for. And at least half of those letters were completely misinformed about the details of what they wrote.
And why is that so? Because there are so many busy men in Washington who write-some organizations have six, seven, and eight hundred people spreading mail across the country, asking doctors and others to write in and tell your Congressman you’re opposed to it. The mail pours into the White House, into the Congress and Senators’ offices–Congressmen and Senators feel people are opposed to it. Then they read a Gallup Poll which says seventy-five percent of the people are in favor of it, and they say, “What has happened to my mail?”

Kennedy’s number was touched with a kiss of blarney; that 68% approval in Gallup’s poll the May before had represented peak support for the initiative. Despite his efforts, public support for expanding Social Security to provide medical benefits weakened over 1962. In a March Gallup poll, a 55% majority supported a plan that would be paid by increasing the Social Security tax deducted from pay checks. Thirty-five percent preferred a plan that would let each individual decide whether to join Blue Cross or buy some form of voluntary health insurance. By May, opinion had shifted slightly, with the Social Security approach favored by 48% and private insurance by 41%. In July, just 44% of Americans preferred the Medicare plan; 41% private insurance. With the public split, the bill backed by Kennedy stalled in committee in the House. A revised version amended to a welfare bill was defeated in a July vote in the Senate.

In an ORC poll following the vote, a plurality of 44% said the bill should have passed, while 37% said Congress did right in not passing it. In respondents’ evaluation of the problems with the bill, no one problem stood out as much more important than the others; substantial proportions considered each of several possible problems to have been serious. The country remained split between changing the government Social Security program to cover medical insurance for older people (43%) or expanding voluntary medical insurance plans (41%).

Johnson’s Success: Medicare

Not put off by Kennedy’s failure, in 1964 Johnson looked to use the fallen president’s initiative as a springboard for again attempting to pass an elder care bill. Public approval of the idea of Medicare had rebounded from the lows of two years before. Gallup polls during the 1964 election found approval between 57% to 62% for a compulsory elder medical insurance program financed out of Social Security taxes.

In this somewhat arcane debate over financing of medical care, wording mattered. In a February 1965 Harris poll, 62% favored President Johnson’s program of medical care for the aged under Social Security. But 56% also said they favored the AMA plan in which everyone who could afford it would be covered by private health insurance and those who couldn’t would be covered under a government health plan. As is often the case with health policy, the public seemed more certain that something ought to be done than what exactly that something should be.

The Medicare bill was successfully passed at last in July 1965. A Harris poll in August found that 82% approved of the passage of the bill. When asked which of ten bills passed by the last Congress was the most important to them personally, a plurality of 28% chose Medicare. By 1967, only 8% of the country in a Harris poll wanted Medicare to be cut back, 51% wanted it to stay as it was and 35% expanded. The road to acceptance had been long and hard, but the American public was firmly behind the new program.