Back in the Day, Medicare Had Its Haters Too

"Write those letters now. Call your friends, and tell them to write. If you don't, this program, I promise you, will pass just as surely as the sun will come up tomorrow. And behind it will come other federal programs that will invade every area of freedom as we have known it in this country. Until, one day ... we will awake to find that we have socialism. And if you don't do this and if I don't do it, one of these days, you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free."

Sound familiar? But back then, the target wasn't Obamacare.

The 1961 recording of then-actor Ronald Reagan was part of Operation Coffee Cup , an elaborate campaign waged by the American Medical Association to put the fear of god into people and help stave off the spread of "socialized medicine" in the United States.

The AMA's efforts to prevent Social Security from funding health insurance for the elderly and the poor, though influential (helping to curb President Kennedy's attempts), eventually failed.

Fifty years ago -- on July 30, 1965 -- President Lyndon Johnson, as part of his War on Poverty, signed into law the bill that created the Medicare and Medicaid federal health insurance programs. The first was for Americans ages 65 and up, regardless of income (and later expanded to include younger people with permanent disabilities). The second, for low-income people.

Like Obama's Affordable Care Act, the programs faced staunch opposition and lofty implementation challenges.

Take Medicare: for one, notes the Washington Post's Sarah Kliff,  benefits were to go into effect in July 1966, giving the Johnson administration less than a year to reach 19 million seniors, a daunting deadline the New York Times tagged "M-Day."

As part of "Project Medicare Alert," the government hired 5,000 workers -- paid $1.25 per hour for 20-week stints --  to enroll seniors across the country. The "$2 million crash effort," The Washington Post reported at the time, was meant to "inform isolated elderly Americans of the availability of Medicare benefits."

Social Security Administration Commissioner Robert Ball  even "enlisted the U. S. Forest Service to send Forest Rangers out into the woods in search of elderly hermits whom he might be able to enroll."

As the start date approached, the program also faced another major hurdle: segregation. The Civil Rights Act, signed the year before, barred federal funding of institutions that discriminated on the basis of race.  That, of course, included hospitals, which under Medicare, would be major recipients of federal dollars. A front-page Washington Post story in 1966 reported that Johnson made "an 11th-hour appeal for hospitals to end discrimination, but he failed to prevent Medicare's start from being marred by segregation."

But as NPR's All Things Considered recently recounted, the fear of losing federal funds "became a powerful motivator" for segregated hospitals to accept black patients. An under-staffed team of government inspectors were supported by hundreds of volunteers who ensured that hospitals  complied with the new rules, Temple University professor David Barton Smith told NPR.

"Early on, they were making sure that all of the white and colored signs were removed," Barton said. "But then, they would go back and insist that hospital employees and patients not self-segregate in the waiting rooms. They were pretty fierce about it. And they had an invisible army in the sense of local civil rights groups that would guide them in their inspections, including a lot of black health workers that helped in providing the eyes and ears for making sure that the hospitals were not just trying to cover everything up."

Within several months, about 2,000 hospitals around the country had been desegregated, according to Barton.

Overall, the enrollment effort was incredibly successful, with near to total enrollment of the 19 million eligible seniors by the summer of 1966.

Today Medicare accounts for roughly 15 percent of total federal spending. The program covers some 55 million seniors and people with disabilities.

Medicaid, which is jointly financed by federal and state governments, today covers one in five Americans -- nearly 70 million people -- including one in three children and two in three nursing home patients, according to the nonpartisan Kaiser Family Foundation.

Together the two programs provide healthcare to  roughly three in 10 Americans.

Perhaps most notable is that Medicare -- that harbinger of "socialism" and destroyer of freedom, as Reagan warned -- has long been one of the most popular federal programs.  A recent KFF poll found that more than three-quarters of those surveyed called it a "very important" public program. That, remarkably, includes a solid majority of both Democrats (89%) and Republicans (69%).

Support for Medicaid is somewhat more divided, particularly along partisan lines, as evidenced by recent state actions rejecting federal  funding for the program's expansion.  Still, a full 63 percent of the poll's respondents considered Medicaid to be "very important," which by U.S. political standards, makes it a downright crowd-pleaser.