Medicare at 60: President Johnson’s signature brought life to President Truman’s vision

President Harry S. Truman, left, and President Lyndon B. Johnson talk at the signing of Medicare and Medicaid Act in Independence, Missouri, on July 30, 1965.
_{© Truman Library Institute}

July 30 marks the 60th anniversary of President Lyndon B. Johnson signing into law the Medicare and Medicaid Act.

It was landmark legislation that would change the American health care system by offering a form of health insurance to older people and those with disabilities. Medicare and Medicaid remain highly influential in the nation’s health care finance and policy and, of course, patient health.

Johnson had a signing ceremony to celebrate the bill — but not at the White House, not in Washington, D.C. Instead, he traveled to Independence, Missouri, as a tribute to his predecessor, political ally and friend: President Harry S. Truman.

Long before he became “Give ’em hell, Harry” on the presidential campaign trail, health care was an issue that resonated with Truman as a soldier and veteran of World War I, a candidate and an elected official. World War II also showed the importance of health care, not just to treat wounded defenders of democracy. Americans had to be healthy as a matter of national security, or the nation would not be in the fight.

After the war, Truman began planting the seeds for a national health insurance program and the need for real reform within the American health care system. Later, Harry and Bess Truman would get the nation’s first and second Medicare cards. Medical Economics spoke to two Truman experts to explore his ideas and influence, starting in 1945, 20 years before Johnson, Truman, their wives and supporters gathered for the bill signing ceremony.

Clifton Truman Daniel

Clifton Truman Daniel is the eldest grandson of Harry and Bess Truman and honorary chair of the Truman Library Institute. He has written a memoir about growing up as the president’s grandson, edited a volume of the president and first lady’s letters to each other, and portrayed his grandfather on stage in the play “Give ’em Hell, Harry!” by Samuel Gallu.

Mark Adams

Mark Adams is the director of the Harry S. Truman Library and Museum and an ex officio member of the Truman Library Institute board.

This transcript has been edited for length and clarity.

Medical Economics: July 30 marks the 60th anniversary of President Lyndon B. Johnson signing the Medicare and Medicaid Act into law. There is a unique, historic connection with President Harry S. Truman. Can you explain that connection?

Clifton Truman Daniel: I am still friends with President Johnson’s daughters, Lynda and Luci. So the family connection is still there. In terms of this conversation, it was because after years of trying to establish universal health care during his own presidency, President Johnson got that done, and my grandfather was very grateful for that. If you look at the film clips from the event, or even the still pictures, you can see that my grandfather is mostly smiling from ear to ear. He was grateful to President Johnson. Thought it was a job well done, and he was just delighted by the whole thing and gratified. Lucy Johnson had asked her father, in the run-up to that event, she said, “Why are we doing this in Independence, Missouri? Shouldn’t we do this at the Capitol? Shouldn’t this be at the White House?” And her father turned around and said, “Because of his efforts, I’m able to get this done. He laid the groundwork, and nobody deserves to have the first and second cards more than Mr. and Mrs. Truman.” So he went straight for Independence to do that ceremony.

President Harry S. Truman, left, and President Lyndon B. Johnson talk at the signing of Medicare and Medicaid Act in Independence, Missouri, on July 30, 1965.
_{© Truman Library Institute}

Mark Adams: I think part of it reflects the great friendship that they did have. They exchanged Christmas greetings, they would call each other on Christmas holidays. The two first ladies, Lady Bird Johnson and Bess Wallace Truman, were also great friends. LBJ really wanted to recognize Truman’s contribution, so to come here in the building I’m sitting in right now, at the presidential library, on the stage in the auditorium, and sign this landmark piece of legislation in 1965 with President Truman sitting at his side, just tells you a lot about LBJ, as much as it tells you about Harry Truman, the amount of respect they have for one another, for their great friendship. It is unusual to have a piece of legislation signing at a different president’s building, so that shows you really the level of thought that LBJ had for Truman, what he had tried to do in his presidency.

Medical Economics: Looking at some of the historical archives, President Truman’s special message to Congress in November 1945 shows that he had a sophisticated understanding of problems in the American health care system in the aftermath of World War II. Why did that issue of health care become so important to him?

President Lyndon B. Johnson, left, and President Harry S. Truman, trade pens at the signing of Medicare and Medicaid Act in Independence, Missouri, on July 30, 1965. Looking, from left, are First Lady Lady Bird Johnson, Vice President Hubert H. Humphrey, and First Lady Bess Truman.
_{© Truman Library Institute}

Mark Adams: The president, as part of his Fair Deal program, was trying to rebuild, really, the country after World War II. He’s looking at housing, he’s looking at rebuilding the country, he’s concerned about national security, civil rights. And he saw health care as just part of that, of this Fair Deal program. A lot of those different pieces, unfortunately for him, didn’t get passed. But he just saw health care as being this, really, a right for the American people.

Clifton Truman Daniel: I think they found that during the war, one out of every three recruits, or more than 8 million Americans, were unfit for military service. They could not cut the physical aspects of it. And he was appalled that that many people were unhealthy, too unhealthy to serve. Beyond that, after the war, and what Mark said about strength, is exactly what Grandpa was thinking. A country’s strength depends on the strength of its people, and that means not only access to health care, but housing. You need a roof over your head. You need to have a job. He was also, as part of the Fair Deal, he was looking at creating full employment by supporting businesses, supporting large and small businesses. So he was looking at the whole, the whole package of strengthening the backbone of this country, which are people.

From left, Vice President Hubert H. Humphrey, President Harry S. Truman, and President Lyndon B. Johnson, celebrate at the signing of Medicare and Medicaid Act in Independence, Missouri, on July 30, 1965.
_{© Truman Library Institute}

Medical Economics: How did he envision the role of physician leadership in the health care system?

Clifton Truman Daniel: It’s an interesting question, to sort of turn it around on you, because, of course, what he talked about in his memoirs and talked about in other places was, one of the problems facing his health care agenda was the AMA (American Medical Association). Not run-of-the-mill physicians, not the folks on the front lines, but the folks way up at the top who opposed universal health care on the grounds that it was, and I believe they came up with the term, socialized medicine. I’m sure they weren’t the only ones, but his real issue was with the top tier. I think he had a great affinity for doctors and nurses in the same way that he always fought with newspaper publishers but he got along great with reporters and photographers. So it was the leadership that was stymieing him. He depended, or would have liked to have depended, on universal health care, on a decentralized system. He wanted this to be run by the states, by local communities, therefore, by local doctors and local nurses to determine how they carried out their own careers and how they helped their patients.

Medical Economics: When President Truman began proposing a potential health and disability insurance program, who were some of the supporters?

Mark Adams: The most obvious group is going to be his fellow Liberal Democrats. But he also got lots of support from the labor unions. They saw that the health benefits would benefit the members. There were a number of different foundations and funds that were advocates of health policy reform, I guess you could put it, like the Rockefeller Foundation, the Carnegie Corporation, the Milbank Memorial Fund, all of these big groups that were really, really looking at improving social work and looking at the idea of being at a local level, rather than from the top, those are the ones in favor. In fact, you know, some health care initiatives have been tracked under the FDR (President Franklin D. Roosevelt) administration. John Dingell Sr., Michigan congressman, had put forward a bill in 1943 calling for national health insurance, and just like Truman’s, it didn’t succeed. I think the opposition is interesting too, though. Clifton mentioned the American Medical Association already; certainly the conservative Republicans were worried. I think the other piece of it too is that idea of it being labeled socialized medicine for the first time, that did put people off, along with concerns about increased taxation to help pay for the program.

President Lyndon B. Johnson, seated at the table at left, signs the Medicare and Medicaid Act as President Harry S. Truman, seated right, looks on, in Independence, Missouri, on July 30, 1965.
_{© Truman Library Institute}

Medical Economics: From 1945 to 1965, can you describe that social and historical context that developed that allowed the development of even more support for programs such as Medicare and Medicaid?

Mark Adams: I think the thing that helps Lyndon Johnson in the ’60s is his Great Society plan, because that really starts this whole social agenda reform with the Civil Rights Movement. In 1964 we have the Civil Rights Act, the Voting Rights Act of 1965, the social and political climate behind all of that, and the social welfare reforms really help when it comes to passing the Medicare bill in 1965.

Medical Economics: In 1945, President Truman outlined five basic problems across health care: the number and distribution of doctors and hospitals; the need for public health services and maternal and child care; medical research and professional education; the high cost of individual medical care; and the loss of earnings when patients get sick. Since that time, there have been many scientific and policy advances that we’ve experienced. And yet, in 2025 we’re still talking about these issues. What do you think President Truman’s response would be?

President Lyndon B. Johnson, left, flips pages as President Harry S. Truman hold up pens at the signing of Medicare and Medicaid Act in Independence, Missouri, on July 30, 1965. Looking on, from left, are First Lady Lady Bird Johnson, Vice President Hubert H. Humphrey, and First Lady Bess Truman.
_{© Truman Library Institute}

Clifton Truman Daniel: There’s a quote that you’ve obviously heard before from my grandfather: “There’s nothing new in the world but the history you don’t know.” And we as a country, we as human beings, tend to repeat ourselves over and over and over and reargue and re-legislate the same problems generation after generation. In the play “Give ’em Hell, Harry!” people sometimes ooh and ahh in the audience because they think that as Grandpa, I’m taking potshots at the current administration. But it isn’t. It’s taking potshots at the then Nixon administration, or the 80th Republican Congress. But it still sounds like we’re talking about 2025, not 1945. We just do that, sadly, over and over again. So he’d be disappointed. To answer the question directly, he’d be disappointed, but I don’t think he’d be surprised.

Medical Economics: In President Truman’s Rear Platform Remarks in Minnesota and Wisconsin, he noted that federal laws would not be enough to create and sustain any kind of successful health care program. He did encourage state and local government involvement, with medical schools and hospitals, doctors and civic groups. Why are those such important elements in his vision?

Clifton Truman Daniel: I think that he really did emphasize it as a decentralized position program, and he felt like it could be tailored to local conditions, local needs, local environment, rather than be a top-down approach. I think he felt that state and local agencies could be trusted to do that. In the medical hospitals, I think we mentioned before, you have this idea that larger, well-equipped hospitals could help support small hospitals in a coordinated system. I think he felt like the doctors, the local doctors that we mentioned earlier, would be able to remain free to participate and choose their own patients. He really engaged civics groups so that they could help improve public health. He talked a lot about the ideas of sanitary conditions and things like that. That’s a local issue, right? It felt like it could improve economic productivity at a local level and improve local public health. Really, his idea of centralized administration of this and expanding the resources and engaging the local professionals and local communities was to make sure that the program is more comprehensive and more responsive to local needs.

President Lyndon B. Johnson, seated left, and President Harry S. Truman celebrate the signing of Medicare and Medicaid Act in Independence, Missouri, on July 30, 1965. Also visible looking on are First Lady Lady Bird Johnson, Vice President Hubert H. Humphrey, and First Lady Bess Truman.
_{© Truman Library Institute}

Medical Economics: There’s been some debate recently about different factors that have actually hurt life expectancy in America, and yet, life expectancy in the year 2025 still is greater than in 1965. How do you think President Truman would have felt about that?

Mark Adams: That was certainly one of his goals, to make the country healthier, to make everybody healthier. And so I think he would be pleased with that statistic.

Clifton Truman Daniel: I agree. That was his goal. And again, back a little bit to the decentralization, empowering local doctors, local nurses, local hospitals to take care of their patients in the way that their patients needed to be taken care of, which improves everybody’s health. And all that they really need is the federal government’s approval and support. Back them up, let them do their jobs. Give people access. You’re going to have an education. Prevention, preventative medicine — all of that builds, again, said it before, builds a healthier, stronger country.