Precedents for Federal Action: Securing the Health of Veterans and Seniors

When the Affordable Care Act became law, more than 95 million Americans (35% of the U.S. population) already had access to some form of government funded health care or insurance, including federal employees, former service members, Social Security recipients, and people living below the poverty level. The ACA thus rests on the shoulders of a variety of incremental government programs meant to assist specific groups. This paper examines the early history of two such programs – the Veterans Health Administration and Medicare – to analyze how particular portions of the citizenry have historically gained the right to accessible health care.

The veterans’ health system, rooted in the early 1920s and Medicare, established in 1965, are primary examples of how federal entitlements were allocated in the twentieth century United States. In many respects, their creation indicated a massive expansion of the reach of the state. But the programs also illustrated the wider tendency of the government to award privileges selectively. In the case of veterans, government funded medical care came about haltingly, in response to a crisis situation; the nation, powerful advocates maintained, was failing to meet the most basic needs of those who served and sacrificed. In contrast, Medicare encompassed a more “top-down” approach. The elderly were handpicked by officials within the Truman administration as a group that could be nationally recognized as both worthy and needy. For Truman and Medicare’s early crafters, the aged constituted a first step toward achieving national health insurance for all Americans.

The Affordable Care Act marks a major departure in American social policy. By exploring two historical examples of government action in the health care realm, this paper will explain how and why.