The Democratic proposals being debated this year could lead to the biggest shift in federal health care policy since the advent of Medicare in the 1960s. That raises an interesting question: What did the debate over Medicare look like? There was a big fight — and LBJ suppressed the true projected costs of the program as he pushed it through Congress, according to an NPR interview with James Morone , a Brown political scientist. Morone wrote a book on presidents and health policy, and listened to tapes LBJ made of his phone conversations during the Medicare debate. He concluded that “if the true costs of Medicare had been known — if Johnson hadn’t basically hidden them

— the program would never have passed,” Morone said. That kind of behavior would be difficult today, because there are stricter rules about projecting the costs of new programs and figuring out how to pay for them, Morone said. Republicans staunchly opposed Medicare for years. LBJ won some Republican support by bolting Republican proposals onto Medicare plans (which also tripled the size of the program). And once it became clear that Congress was going to pass the Medicare legislation, the remaining opponents largely switched sides and voted in favor. “That’s not likely to happen this time,” Morone said. Photo: Library of Congress

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Health Reform: Looking Back at LBJ and Medicare