This month marks the fifty-sixth anniversary of Medicare, signed into law by president Lyndon Johnson on July 30, 1965. The effects of the program were expansive and immediate: three years after its creation, some 96 percent of those sixty-five and older had hospital insurance, up from only 54 percent in 1963.  

Today, despite decades of attempts to undermine it, it remains among the most popular of all government programs — vastly outperforming private alternatives in a huge survey recently published by the Journal of the American Medical Association. A June poll also identified high, and in some cases stratospheric, levels of support for various proposed enhancements currently being debated in Congress, including one which would lower the age of eligibility to sixty.  

Predictably, even the faint prospect of Medicare expansion has sent the private insurance racket into a tizzy, with corporate astroturf groups like the Partnership for America’s Health Care Future (PAHCF) taking out seven figure ad buys to defeat it. The kinds of arguments deployed by PAHCF — formed in 2018 with the explicit goal of neutralizing large-scale health care reform — are by this point quite familiar.

In the present context, PAHCF has mostly run with the claim that expanding Medicare will be unduly expensive, necessitate tax increases, and lead to all kinds of spooky and unintended consequences. More broadly, its messaging has condemned all proposed expansions of public health insurance as heavy-handed attempts to impose a “one-size-fits-all system . . . whether you call it Medicare for All, Medicare buy-in, single-payer, or a public option.” (One wonders how an “option” could be “one size fits all.”)

As to its own priorities, the group cites exactly five, all of them vaguely defined and innocuously positive: expanding access, providing better care, protecting the vulnerable, strengthening coverage, and empowering patient choice — each of which PAHCF and its Uruk horde of lobbyists insist will be imperiled by even the smallest expansion of public health insurance.

It’s nonsense, of course: the formalized agitprop of a vast and profitable industry that would become substantially less vast and less profitable if something like Medicare For All ever became a reality. With access to the same data and polling the rest of us can see (and probably much more besides), the industry and its PR flacks know all too well that Medicare is both efficient and popular, and that any expansion would be difficult to roll back for exactly these reasons.

When it comes to the provision of health care, there’s ultimately an irreconcilable divergence of human needs and private profit — a divergence which historical evidence suggests becomes patently obvious to people who experience the socialized version (Britain’s NHS, to take an obvious example, was found to be more popular than both the army and the monarchy in one 2013 poll). 

It’s for this reason that efforts to arrest the march of socialized medicine have always been so absurdly histrionic and alarmist: characterized by dire warnings about the unintended consequences of humanitarian ambition, the threat of Orwellian government overreach, and the destruction of personal freedom that supposedly await all Americans just beyond the next proposed Medicare expansion. Though liberal and conservative politicians throughout the decades have assumed different rhetorical postures in making the case against universal health care, it’s striking how little the underlying arguments have actually changed.

For proof, we need look no further than the iconic 1961 screed recorded by none other than Ronald Reagan under the aegis of the American Medical Association as part of its wider campaign against the proposed Medicare program (commonly known as Operation Coffee Cup). In the just over ten minute recording, Reagan (then still known as a figure of the silver screen) showcased the basic template still employed by industry hacks, right-wing talking heads, and centrist Democrats to this very day.

Minus a few of the more explicit anti-communist talking points born of its Cold War context, the core ideas of “Ronald Reagan Speaks Out Against Socialized Medicine” can still be found in industry press releases, presidential primary debates, and on cable news panels to this day.  

You can read the full transcript here, but the crux of Reagan’s case can be summed up in a few representative highlights:

One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project, most people are a little reluctant to oppose anything that suggests medical care for people who possibly can’t afford it…

Under the Truman administration it was proposed that we have a compulsory health insurance program for all people in the United States…Walter Reuther said, “It’s no secret that the United Automobile Workers is officially on record of backing a program of national health insurance.” And by national health insurance, he meant socialized medicine for every American…

…in our country under our free-enterprise system we have seen medicine reach the greatest heights that it has in any country in the world. Today, the relationship between patient and doctor in this country is something to be envied any place. The privacy, the care that is given to a person, the right to choose a doctor, the right to go from one doctor to  the other. But let’s also look from the other side . . . The doctor begins to lose freedoms. . . . From here it’s a short step to all the rest of socialism, to determining his pay, and pretty soon your son won’t decide when he’s in school, where he will go, or what he will do for a living. He will wait for the government to tell him where he will go to work and what he will do…

What can we do about this? Well, you and I can do a great deal. We can write to our congressmen and to our senators…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…

In Reagan’s rather paranoid telling, then, the creation of Medicare was nothing less than a stalking horse for the indefinite expansion of the federal government and its intrusion into every area of life. Though this sort of hyperbole is mostly confined to the Right today, his suggestion of an irreconcilable conflict between public health insurance and personal freedom has found unexpectedly broad buy-in on the liberal side of the spectrum — the specter of “one-size-fits-all“ health care being wielded as a cudgel against Medicare For All throughout last year’s Democratic primary.

The same bogus conception of personal freedom — in this case, the freedom to choose between various pricey insurance plans and to lose all access to care the moment you’re fired or laid off — has animated opposition to public health insurance since the days of Operation Coffee Cup and before. It’s a reminder, among other things, of the lengths a powerful and entrenched industry will go to protect its balance sheets.

Given the consistency and hyperbole of the talking points (regardless of whether what’s being debated is a relatively small Medicare expansion, a public option, or actual socialized medicine) it’s also a reminder that what motivates opponents of public health insurance is less the fear that it will fail than an understanding that it will inevitably succeed.