The Lessons of Success

Noting that analysts search for lessons that might be gleaned from the past with each new presidential election, this article explores lessons to be learned from the U.S. health care reform of the enactment of Medicare and Medicaid in 1965. After retaining the presidency in 1964, President Johnson made health care reform his highest priority. The authors examine how his administration quickly achieved this expansion of health care coverage, drawing on new sources recently released that detail the shaping of this health care reform. The article describes the conventional story of the presidential role in, and the lessons of, Medicare and Medicaid.

Key Findings:

  • President Johnson's involvement with Medicare and Medicaid predated the Democratic victories in the 1964 election.
  • Johnson effectively recruited a talented legislative staff, working with them throughout the process to move the legislation quickly and deflecting credit to Congressional leaders.
  • President Johnson's management of the campaign for Medicare and Medicaid pointed to important lessons for future presidents, including strong commitments, swift action, prioritization of issues and deft management.  

Successful expansion of the health care system requires committed executive leadership. The article argues that the accepted story of Medicare and Medicaid minimizes the ability of the president to guide important legislation.