The idea of the government ensuring that people have access to health care began long before Medicare. While local governments experimented with health care for centuries, the first national health insurance program came from Germany’s Otto von Bismarck in the 1880s. Other European countries followed with their own versions of government health care for workers, and by the early 1900s, reformers in the U.S. were advocating for a similar system.
The push was closely tied to the labor movement, according to Northern Illinois University history professor Beatrix Hoffman, who studies the politics of health reform. But businesses and doctors attacked the idea of government health care, and it soon died. This opposition also killed President Franklin Roosevelt’s desire to add health coverage to the Social Security Act in 1935. And when President Harry Truman took up the cause after World War II, the American Medical Association and other opponents used Cold War scare tactics to paint “health security,” as it was known then, as socialized medicine and kill the plan again.
“The defeat of the Truman plan was so massive, it was such a big failure, that supporters decided they were going to stop trying for universal coverage,” Hoffman says. “That’s when they invented the idea of Medicare for the elderly only.”
From Medicare’s start, it was a popular program. But it also quickly became expensive, and the 1970s turned to discussions about how to control health care costs — not exactly a helpful political environment for those looking to expand coverage.
The first major change to Medicare came in 1972 when Richard Nixon added individuals with disabilities and those with end-stage renal disease. But this took the program in a fundamentally new direction: serving as a fallback for people who couldn’t get insurance through their employers, rather than building toward universal coverage as Medicare’s designers had hoped.
Amid these discussions about how to rein in health care costs, Sen. Ted Kennedy introduced his first national health insurance plan in 1971, proposing financing it through payroll taxes. But this failed, along with the rest of the plans discussed at this time.
Still, someone else did see hope in Medicare. One of these failed plans came from Republican Sen. Jacob Javits, who proposed expanding Medicare to cover the entire country’s population. Javits still used the language of “national health insurance,” but he became one of the first people publicly associated with the phrase “Medicare-for-all” when the New York Times used it to describe his plan, declaring on April 15, 1970: “Medicare For All Is Asked By Javits.”