Latest / Off the Chart: A Business of Medicine Podcast / Special Report: 60 years of Medicare
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- Speaker 1 00:00:00 This is an off the chart special report. Welcome to a special episode of Off the Chart Business of Medicine podcast. I'm Austin Littrell, assistant editor at Medical Economics, and I'd like to thank you for joining us today. On July 30th, 1965, President Lyndon B. Johnson signed Medicare & Medicaid into law at the Truman Library in Independence, Missouri, fulfilling a vision that President Harry Truman had first proposed two decades earlier. At that ceremony, Johnson handed Truman the very first Medicare card and called him "the real daddy of Medicare." Today, 60 years later, more than 66 million Americans depend on the program. In this special report, Medical Economics senior editor Richard Payerchin speaks with President Truman's eldest grandson, Clifton Truman Daniel and Mark Adams, the director of the Truman Library. They reflect on Medicare's legacy, Truman's push for universal care, and how his ideas still resonate in today's health policy debates. Thanks again to Clifton and Mark for the conversation. And now let's get into 60 years of Medicare. Speaker 2 00:01:17 I'm Richard Payerchin, reporting for Medical Economics. Speaker 2 00:01:20 With me today are two guests. Clifton Truman Daniel is the eldest grandson of president Harry S. Truman, and he serves as honorary chair of the Truman Library Institute. Thank you for joining us today. Speaker 3 00:01:32 Thanks for having me. Speaker 2 00:01:34 And Mark Adams is director of the Harry S. Truman Library and Museum in Independence, Missouri. Thank you all for being here. Speaker 4 00:01:42 Thank you for the invitation. Speaker 2 00:01:44 Absolutely. And sort of a unique element to healthcare that we're going to discuss today, because it's going to involve an anniversary coming up about Medicare, which is definitely important to our physician audience. Before we get into those details. Can you both introduce yourselves a little bit with some background, some information about your family background and research and historical interests. Speaker 3 00:02:06 I'm again, as you said, I'm Clifton Truman Daniel, I'm Harry and Bess Truman's oldest grandson. I had a dual career at a desk one the first half of it was as a reporter and editor for a New York Times own paper in Wilmington, North Carolina. And the second half of it was as the public relations director for Harry S Truman College in Chicago. Speaker 3 00:02:31 Not sure how I got that job, and I have. Since taking early retirement, I have been lecturing on my grandfather's presidency all their presidencies. I am a founding member of the Society of Presidential Descendants, so I talk about other descendants behind their backs, and I also play my own grandfather on stage and the one man show, give Em Hell, Harry. Strangest retirement program ever. However. Speaker 4 00:03:00 I'm Mark Adams, as you said, director of the Presidential Library, Truman Presidential Library and Museum in Independence, Missouri. I've worked here 28 years. I started in 1997. I've been the director, though, just since January of this year. So just about seven months. being here for 28 years, I started out as the education director. And then after that, I was the museum curator and now the director of the library museum. I've previously worked at the Kansas State Museum in Topeka, Kansas, for six years. And you might notice an accent. I'm originally from Liverpool, England. I was born and, went to school there and moved here in the early 90s. Speaker 2 00:03:47 And July 30th marks the 60th anniversary of President Lyndon B Johnson signing the Medicare and Medicaid Act into law. But there is a unique historic connection with president Harry S Truman. Can you explain that connection? Speaker 3 00:04:02 I mean, I, I still I was talking to Mark a little earlier, and I am still friends with President Johnson's daughters, Linda and Lucy. So the family connection is still there. My grandfather, I think, in terms of this conversation, and he was friends with President Johnson regardless. But in terms of this conversation, it was because after years of trying to establish universal health care during his own presidency, President Johnson got that done. And my grandfather was very grateful for that. If you if you look at the film clips from the event or even the still pictures, you can see that my grandfather is, mostly smiling from ear to ear. He was grateful to President Johnson. He thought it was a job well done, and he was just delighted by the whole thing and gratified, Lucy Johnson said. Speaker 3 00:04:58 Also, she had asked her father. I guess in the run up to that event, she said, why are we doing this in independence, Missouri? Shouldn't we do this at the Capitol? Shouldn't this be at the white House? And her father turned around and said, because of his efforts, I'm able to get this done. He laid the groundwork, and nobody deserves to have the first and second cars more than Mr. and Mrs. Truman. So he went straight for independence to do that ceremony especially. Speaker 2 00:05:28 I'll be perfectly candid. I wasn't aware of that connection, until just this month. But it's always interesting to learn, you know, about the different historical elements that take place in every presidency. Mark, could you talk a little bit about maybe that connection? And I guess what was, you know, what was surprising or striking to you about that? Speaker 4 00:05:47 Yeah, I think part of it, it reflects the great friendship that they did have. They exchanged Christmas greetings. They would call each other on Christmas holidays, the two first ladies, Lady Bird and Bess Wallace, were also great friends, so it took some about their friendship. Speaker 4 00:06:02 But, you know, LBJ really wanted to recognize Truman's contribution. So to come here in the building I'm sitting in right now at the presidential library, on the stage in the auditorium, and sign this landmark piece of legislation in 1965, with President Truman sitting at his side, just tells you a lot about LBJ as much as it tells you about Harry Truman. Them, out of respect they had for one another for their great friendship. It is unusual to have a piece of legislation, you know, signed in a different president's, you know, building. So that's shows you really that the the level of thought that LBJ had for Truman, what he had tried to do and his presidency. Truman said it was one of his greatest disappointments, that he wasn't able to pass that during his two terms, but that we came through for him. Stand it here, gave him the pens. Came back later and gave him the first two cards to him and his wife. So he just says a lot about their relationship. Speaker 3 00:07:03 Yeah, they only had. Mark knows this story. They only had one rift in their friendships. When the Lady Bird called my grandmother in 1965, after LBJ had won election in his own right and said, Mrs. Truman, we want to hang your official portrait, but we can't find it. Speaker 5 00:07:20 My mother. Speaker 3 00:07:21 My grandmother said, that's because it's on my wall. And Mrs. Johnson said, that doesn't belong to you. That belongs to the American people. My grandmother says it does not. It's a picture of me and it's on my wall, and that's where it's going to stay. And Mrs. Johnson argued no longer, but commissioned the artist, Greta Kempton, to paint two copies. One is in the white House collection. One is now on the wall of Mark's building down there in independence, Missouri, at the Truman Library. The original is still on my grandmother's wall. Speaker 6 00:07:57 Say, Keith. This is all well and good, but what if someone is looking for more clinical information? Speaker 5 00:08:02 Oh. Speaker 7 00:08:03 Then they want to check out our sister site, Patient Care Online. Speaker 7 00:08:06 Com the leading clinical resource for primary care physicians. Again, that's patient care online. Com. Speaker 2 00:08:16 Just not being an elected official myself. You know you look at especially at the highest levels. The presidency of the United States is the leader. You know, the president is the leader of the free world. And, you know, sometimes it may be easy to forget that, their human too. And they have friends, they have people that they like. They probably have personalities that they sometimes kind of rub the wrong way, you know, back and forth. So I really like that personal connection. Speaker 3 00:08:45 They, they were they had a very good friendship. And then the friendship obviously survived the great painting debacle. Speaker 2 00:08:51 If that's the worst thing that happens in a relationship, then hopefully that's a pretty strong relationship. You know what? One of the things that that was really striking to me and looking at some of the historical archives. President Truman's special message to Congress in November of 1945 shows that he had a pretty sophisticated understanding about problems in the American health care system in the aftermath of World War Two. Speaker 2 00:09:16 Why did that issue of health care become so important to him? Speaker 4 00:09:19 I think that President Truman was part of his ideal program. You know, he was trying to rebuild, really, the country after World War Two. He's looking at housing. He's looking at rebuilding the country. He's concerned about national security, civil rights. And he saw health care is just part of that of this Fair Deal program. A lot of those different pieces, unfortunately for him, didn't get passed. But he just saw health care as being this really a right for the American people. And he had seen as Clifton. We'll talk about, I'm sure. you know, the the rates of health before World War two and soldiers that weren't passing the medical tests and things like that, that it certainly needed addressing. But he just saw it part of his radio program is huge domestic agenda that he had. But he also looked at the world, and he was also concerned about national security and that he wanted a healthy populace with, you know, building new hospitals. Speaker 4 00:10:24 And, this the it's not just about giving everybody health care. There's a lot of other people to the initiative that he was trying to put forward, increasing, medical awareness, increasing medical education, improving the quality of doctors and so on. Speaker 3 00:10:44 Yeah. As, as, as Mark was saying that, I think, I think they found that, during the war, one out of every three recruits, or more than more than 8 million Americans were unfit for military service. They would not. They could not cut the physical aspects of it. He was appalled that that many people were unhealthy. Unhealthy, too unhealthy to serve. Beyond that, after the war and what Mark said about strength is exactly what grandpa was thinking. A country's strength depends on the strength of its people, and that means not only access to health care, but housing. You need a roof over your head. You need to have a job. He was also as part of the fair deal he was looking at at producing it, creating full employment by supporting businesses, supporting large and small businesses. Speaker 3 00:11:39 so he was looking at the whole the whole package of strengthening the backbone of this country, which are people. Speaker 2 00:11:47 President Truman was particular about the role of physicians and the importance of medical education. How did he envision the role of physician leadership in the health care system? Speaker 3 00:11:59 The it's an interesting question to sort of turn it around on you, because, of course, what he talked about in his memoirs and talked about in other places was one of the one of the problems facing his health care agenda was the AMA, not run of the mill physicians? Not, not the folks in the front lines, but the folks way up at the top who opposed universal health care on the grounds that it was. And I believe they came up with the term socialized medicine. I'm sure they weren't the only ones, but so that was his his real issue was with was with the top tier. I think he had a great affinity for doctors and nurses in the same way that he he always fought with newspaper publishers, but he got along great with reporters and photographers. Speaker 3 00:12:47 So it was it was the the leadership that was stymie him. He depended or would have liked to have depended on universal health care on a decentralized system. He wanted this to be run by the states, by local communities, therefore by local doctors and local nurses to determine how they carried out their own careers and how they helped their patients. Speaker 2 00:13:12 You know, and maybe not to belabor that point, but I, I did notice among some of those historical documents also, I came across that that quote in the address to the American Hospital Association from 1952, when the president said, I have recommended programs which I believe will provide better medical and health services for all our people. Some groups have received these proposals enthusiastically. Others have been strongly against them. When President Truman began proposing a potential health and disability insurance program, who were some of the supporters? Speaker 4 00:13:46 And the most obvious group is going to be his fellow Liberal Democrats, but he also got lots of support from the labor unions. They saw that the health benefits would benefit the their members. Speaker 4 00:13:58 There were a number of different foundations and funds that were advocates of, health policy reform. I guess you could put it. those involve like the the Rockefeller Foundation, the Carnegie Corporation, the Milbank Memorial Fund, all of these big groups that were really in really looking at improving, social work and looking at really where, like the idea of being on a local level rather than from the top. those are the ones in favor. in fact, you know, some health care initiatives have been tried under the FDR administration. John Dingell, senior Michigan congressman, had put forward a bill in 1943 calling for national health insurance. And just like Truman's, it didn't. It didn't succeed. I think the opposition is interesting too, though. Clifton mentioned the American Medical Association already. Certainly the conservative Republicans were worried. I think the other piece of it, too, is that that idea of it being labeled socialized medicine for the first time. that did put people off, along with concerns about increased taxation to help pay for the program. Speaker 2 00:15:19 Taxes and the perception of taxes is never an easy sell. So. Right. On the other hand, I mean, clearly he wasn't the only one who had recognized some of those problems that he outlined. You know, in his address to Congress. So I'm sure that didn't exist in a vacuum. Speaker 4 00:15:33 I mean, some of these initiatives had started under Teddy Roosevelt at the turn of the century. he used it as part of his 1912 campaign that he lost. That was part of his campaign then. So it's certainly been, you know, been being discussed for the last 40 years prior to Truman's presidency, for sure. Speaker 2 00:15:51 You know what? I was curious about the time, not just during his presidency, but after, you know, from 1945 to 1965. Can you describe that social and historical context that developed that allowed the development of even more support for programs such as Medicare and Medicaid? Speaker 4 00:16:10 You know, President Kennedy did try to. He actually called the health coverage for older Americans. So we're getting more into the the Medicaid side of things in 1961. Speaker 4 00:16:21 There was the Mills Act of 1960, which provided federal grants to states to cover healthcare for the to the elderly, particularly the poor. That wasn't very effective, with limited state participation. I think the thing that helps Lyndon Johnson in the 60s is his Great Society plan, because that really starts this whole social agenda reform with the Civil rights movement in 1964. You have the Civil Rights Act. The Voting Rights Act of 1965, the social and political climate behind all of that. You know, there's social welfare reforms really help when it comes to passing the Medicare bill in 1965. Speaker 2 00:17:10 And once President Truman was out of office, I frankly, I guess I don't know enough to know. Did he? Did he continue to maintain, you know, observation about the different, political developments in the nation, whether it be with health care and certainly the range of other topics that presidents deal with? Speaker 3 00:17:27 Yeah, he, he he was interested. He was interested all of his life. And what was going on, I think he was a bit less engaged than he was when he was in office, and less engaged as he got older. Speaker 3 00:17:43 being, there's, there's a there are some fun stories about, his friendship with President Hoover. Both of them were the elder statesmen in the during the 1952 and 1956 presidential campaigns, and both were trotted out by their respective parties to shill for the candidates. And of course they would. They would in public. Grandpa would say these horrible things about President Hoover. You know, if you want to go back to Hoover carts, vote Republican. And then he'd have to call President Hoover that night and say, hey, I'm sorry. I you know, you know, I don't mean it. And President Hoover, well, yeah, I know, that's okay. Besides, I'm going to I'm going after you tomorrow. So sleep well. they but they put it all aside, so they he kept that up for in the 50s, I think. But as, as as he began to get older, he was less actively engaged. That's not to say he didn't have. You know, we were talking earlier about, LBJ called him regularly just to chat, to get advice to tell him what was going on. Speaker 3 00:18:48 To see what he thought. President Kennedy called him during the Bay of pigs and the Cuban Missile Crisis, so he was talking to ex-presidents. He knew what was going on. But I don't think as I think he felt, that the elder statesman role was not to go poking your nose too deeply in and making a nuisance of yourself. of course, George W Bush has taken that to new heights. You know, when he left, it's like, no, don't talk to me. I'm not. Nope. Not doing it. Going home to paint. Take care of my ranch. Leave me alone. So less engaged as he got older? Speaker 2 00:19:30 No, that's an interesting level of involvement. Only because somebody, you know clearly has just tons of experience in dealing with things. And yet, when you're not in that role, just like you said, you don't necessarily want to impose yourself in a role that maybe you're not. You know, you're not. You're not there anymore. So, you know, it's a question for you, if I may. Speaker 2 00:19:50 This was something again doing looking at some of those historical documents, the five basic problems that President Truman outlined across healthcare in 1945, the number and distribution of doctors and hospitals, need for public health services, and maternal and child care, medical research and professional education. High cost of individual medical care. Loss of earnings when patients get sick. Thankfully, since that time, there have been many scientific and policy advances you know, that we've experienced in our lifetimes. And yet in 2025, we're still talking about some of these issues. What do you think President Truman's response would be? Speaker 3 00:20:28 He I think there's a quote that you've obviously heard before from my grandfather. There's nothing new in the world but the history you don't know. And we as a country, we as human beings tend to repeat ourselves over and over and over and over, argue and legislate the same problems generation after generation in the play. Give them hell, Harry. People sometimes who are in the audience because they think that as grandpa, I'm taking potshots at the current administration. Speaker 3 00:21:01 But it isn't. It's taking potshots at the then Nixon administration or the then or the the 80th Republican Congress. What? Whatever. But it it still sounds like we're talking about 2025, not 1945. We just do that sadly, over and over again. So we're still I think he would not he'd be disappointed to answer the question directly. He'd be disappointed. But I don't think he'd be surprised. Speaker 2 00:21:30 Mark, anything to add in kind of a historical context about that one? Speaker 4 00:21:35 Yeah, I think that, you know, we've said before how he was disappointed at the end of his second term that he was not able to get Legislation passed as we've talked about. I think he was, as Clifton said, he was all smiles in the 1960s when LBJ signed that legislation here. I think that would have one of his crowning achievements in post-presidency that he could really point to. So I think today it's hard to comment. It's hard to make a comparison. I think he would say we've still got a long way to go, just like some of the issues that he faced, like civil rights and others, he dealt with the problems in the Middle East. Speaker 4 00:22:18 I think he would look at today's world and say, we've still got a long way to go. Speaker 7 00:22:26 Hey there, Keith Reynolds here, and welcome to the P2 Management Minute. In just 60s, we deliver proven real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale, or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before launch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow hack, an employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at K Reynolds at MG Lifesciences with your topic, quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching and I'll see you in the next P2 management minute. Speaker 2 00:23:18 You know, and again, not to rely on those historical documents too much, but firstly, I'm grateful because I actually, in a short amount of time learned a heck of a lot. Speaker 2 00:23:28 So thank you for kind of bringing those to our attention. But one thing, and you mentioned also earlier in conversation that really caught my ear was about the notion of a decentralized system. And in President Truman's comments in the rear platform remarks in Minnesota and Wisconsin. He noted that federal laws would not be enough to create and sustain any kind of successful health care program. He did encourage that state and local government involvement medical schools and hospitals, doctors and civic groups. Can you talk a little bit more about why those are such important elements in his vision? Speaker 4 00:24:04 Yeah, I'm glad you brought that up. I think that he really did emphasize it being a decentralized position program, and he felt like he it could be tailored to local conditions, local needs, local, environment rather than be a top down approach. So I think he felt like that state and local agencies could be trusted to do that. in terms of the medical schools and hospitals, we I think we mentioned before we had this idea that larger, well-equipped hospitals could help support smaller hospitals in a coordinated system. Speaker 4 00:24:42 I think he felt like the doctors, the local doctors that we mentioned earlier, would be able to remain free to participate and choose their own patients. I mean, we did really engage civic groups. so that they could, help improve public health. he talked a lot about, you know, the ideas of sanitary conditions and things like that. That's a local issue. Right. So it felt like it could improve economic productivity at a local level, and improve local public health. So really, his idea of a centralized administration of this and expanding the resource and engaging the local professionals and local communities was to make sure that the program is more comprehensive and more responsive to local needs. Speaker 2 00:25:35 One of the things, you know, when we talk about these type programs, I made a long career as a community journalist. And so we always one of the things that my, my editors emphasized for years and years was to, you know, people want to find out what's going to affect their pocketbook. They're going to find out how it affects their kids schools. Speaker 2 00:25:51 They're going to want to find out about how, you know, it's going to affect their lives when they show up on the job. And where I'm going with this is, you know, the the Truman Library has published some information sheets that talk about improvements to Americans life expectancy from the time the bill was signed until now. And I know there's been some debate recently about different factors that have actually hurt life expectancy in America. And yet life expectancy expectancy in year 2025 still is greater than in 1965. How do you think President Truman would have felt about that? Speaker 4 00:26:26 Well, that was certainly one of his goals, was to to make the country healthier and to make the, you know, everybody healthier. And so I think he would be pleased at that statistic. Absolutely. Clifton may want to add more to that. Speaker 3 00:26:38 No, I agree, he, that was his goal. and again back a little bit to the to the decentralization, empowering local doctors, local nurses, local hospitals to take care of their patients in the way that their patients needed to be taken care of. Speaker 3 00:26:55 which improves everybody's health and all that that they really all that they really need is the federal government's approval and support. You know, give them some, you know, back them up, let them do their jobs. give people access. You're going to have an education, health, you know, prevention, preventative medicine, all of that, builds a again, I've said it before, but builds a healthier, stronger country. Speaker 2 00:27:24 This is a huge topic. We've had a great introduction, and I'm so grateful to you both for taking the time this afternoon. We covered a lot of ground in a short amount of time. What points did I not ask about that you would really like our audience to know? Speaker 3 00:27:37 I can't think of it. We talked about I talked a while ago about the fact that my grandfather's health was always good. I mean, he lived to be 88 years old. My grandmother was 97, still the oldest first lady of this country has ever had. they if you read their letters back and forth, she worried about his health, and he always had to tell her he was fine. Speaker 3 00:28:00 She worried about what he was eating, what he was doing. He had diphtheria as a child and was paralyzed for nearly a year, but was seldom sick after that. So good health was something on his mind. And he both of his parents got very sick. His father died of peritonitis after getting a hernia. Moving a boulder out of the road as a road overseer. but his mother, was similarly ill. So, you know, illness affected his family. My grandmother, grandpa was on the front lines of World War one, and my grandmother was home. She was the one closer to death. She contracted the Spanish flu and was was sick for weeks and weeks and weeks. They thought they were going to lose her and she lost, I think lost a lot of the hearing in her left ear because of the infection. So health, always on his mind. Always on her mind. Something very important to them. And my grandparents were people who believed that if it was important to them, it was important to everybody else. Speaker 3 00:29:03 And they ought to have they ought to have the means to achieve it. Speaker 4 00:29:07 And then in her letters to him that there's a few of them that survive from Basta, Harry, she's often badgering him about herself, telling him to take a rest. Take a break, go see the doctor. Things like that that you see in her personal letters to him, particularly in the 1920s and the 1930s. Speaker 3 00:29:26 When he was traveling, when he was a National Guard encampment or, or flying around on airplanes as a senator. She hated that. and, and all these wonderful, you know, the, the health issues, go down through the generations. Richard, my grandfather had very bad eyesight. I had to get holes drilled in both my, eyes to equalize the fluid. Because I have similarly shaped eyeballs. As my grandfather, I am prone to, heart palpitations when I get stressed. He had the same thing, which was why my grandmother was always fretting about him. So you know what fun. Speaker 2 00:30:01 I was going to say. Speaker 2 00:30:02 There's always a, element of, you know, we we do our best. All of us do our best with what we've got. But sometimes it's tough to escape the genes. Speaker 3 00:30:12 Well, I'm. Yeah, I'm waiting for. I'm. You know, I don't I don't know that I want to make it to 97, but, you know, there's there's a good track record out there. Speaker 2 00:30:21 If I have other follow up questions, I'd like to reach out by email here, but I really do. Thank you both for taking the time I I've enjoyed this assignment. I learned a heck of a lot, and I think our readers are going to get a kick out of it, so thank you. Speaker 3 00:30:32 Oh thank you. Thanks for having us on. Speaker 4 00:30:34 Oh thank you. Speaker 1 00:30:42 Once again, that was a conversation between medical Economics senior editor Richard Payerchin, Clifton Truman Daniel, the eldest grandson of president Harry Truman, and Mark Adams, director of the Truman Library. My name is Austin Littrell, and on behalf of the whole Medical Economics and Physicians Practice teams, I'd like to thank you for listening to the show. Speaker 1 00:30:58 And I ask that you please subscribe on Apple Podcasts, Spotify, or wherever you get your podcasts so you don't miss future episodes. Also, if you'd like the best stories that Medical Economics and Physicians Practice publish delivered straight to your email six days of the week, subscribe to our newsletters at medicaleconomics.com and physicianspractice.com. Off the chart: A Business of Medicine podcast is executive produced by Chris Mazzolini and Keith Reynolds and produced by Austin Littrell. Medical Economics, Physicians Practice, and Patient Care Online are all members of the MJH Life Sciences family. Thank you.