US Medicare, Medicaid, and nurse practitioners all turn 50

This month marks the 50th anniversary of the creation of Medicare and Medicaid in the United States. In 1965, when President Lyndon Johnson signed the law that had been a dream of two of his predecessors, John F Kennedy and Harry S Truman, he handed the first two Medicare cards to the then 81 year old Truman and his wife. Truman had fought for a more comprehensive national health insurance system during his presidency, but political realities limited Johnson’s law to two separate programs that covered just elderly people (Medicare) and poor people (Medicaid).

Johnson was able to include coverage of poor people in the law only because conservative opponents to universal health insurance thought that including them initially would prevent later changes leading to a truly comprehensive program, what the critics called “socialized medicine.”1 And it did, for 45 years, until the passage of the Affordable Care Act in 2010.

Before Medicare older Americans were often medically destitute. Less than half had health insurance in 1962, compared with 2% today. Within a decade of the passage of Medicare, older people’s access to care had improved, with increases in rates of admission to hospital and physician contacts. The rate of cataract …