The enactment of Medicare in 1965 coincided with several favorable political and economic conditions. This proposition states a correlation: To contend that Medicare passed because these factors converged would be too strong and essentially unprovable. But (as a Marxist might say) it was \u201csurely no accident\u201d that these circumstances\u2014conveniently, 10 in number\u2014were in place.<\/p>\n

In 1965, the Nation had a strong activist president working with a House and Senate that were controlled by his (Democratic) party and, more important, were ideologically sympathetic to his policy goals. Such legislative-executive likemindness had not been seen since Franklin Roosevelt’s New Deal and has not reappeared since Johnson’s tenure ended in 1968. This atypically placid flow of national power meant, among other things, that the president and congressional leaders could control the inclination of would-be reformers to float their own proposals and then refuse to compromise with the obviously inferior alternatives promoted by others.<\/p>\n

The economy was very strong and the Federal budget in surplus. Those most visibly left out of the general economic progress were the poor and minorities, not beleaguered \u201caverage\u201d working and middle class Americans. Moreover, the analytical tools for gauging the budgetary costs of large new public programs were relatively crude.<\/p>\n