decades, having won seven out of the last nine presidential elections, while
averaging “a whopping 424 Electoral College votes compared to
Republicans’ 101.”^19 The question arises, then, why the struggle to pass
proposals by Truman or Kennedy? The answer is the ferociously cohesive
Southern Democrats, who “protected segregation, fought unions, and
subverted most social reform, [combined with the] seniority rules and the
South’s pattern of reelecting its members.”^20
The Democratic Party had two main coalitions during the New Deal era:
Northern liberals, who were fond of crafting socially innovative proposals,
like “Social Security expansion, national insurance, robust labor
protections, child welfare programs, and so on ...”^21 and Southern
conservatives, who functionally ruled Congress. Political scientist Ira
Katznelson has described it as “a coalition of Swedish welfare state and
South African apartheid, dominated by the latter.”^22 When the Civil Rights
Act did pass, it only did so after a filibuster of ninety days was broken by a
cloture vote, where twenty-seven of the thirty-three Republican senators
joined forty-five Democrats to break the Southern resistance.
Under a similar arrangement, many political pundits believe that the
Civil Rights Act facilitated, even enabled, Medicare’s passage.
Republicans sensed that Medicare was a fait accompli, and sponsored an
alternative bill nicknamed “Bettercare,” a voluntary insurance program
that would cover doctors’ fees, financed, in part, by general tax revenues.
For its part, the AMA recommended a different plan, entitled “Eldercare,”
which would have functioned as an expansion of the Kerr-Mills program,
covering doctor visits, nursing home care, and prescription drugs. In
essence, Eldercare was the forerunner to Medicaid.
The competing proposals of Medicare, Bettercare, and Eldercare were
simultaneously contradictory and complementary. Hospital coverage,
physician office insurance, and expanded indigent care were the three
pressing needs that had never been considered by Congress, not even by
those in favor of universal hospital comprehensive insurance for seniors. It
would be impossible for all three proposals to pass at once, adding a huge
obligation to the people and their government. Actually, that’s exactly
what happened.
Chairman Mills pulled one of the greatest legislative coups in history,
when on March 3, 1965, he proposed combining the main aspects of all
three bills. During a meeting of the House Ways and Means Committee,