Miller Center

Medicare and LBJ’s “Three-Prong Approach”

In this call, President Johnson and House Ways and Means Committee Chairman Wilbur Mills of Arkansas discuss the status of the administration’s Medicare bill. In a key passage, Mills suggests that they might build support for the bill by combining its proposed coverage of hospital costs with the expansion of an existing program for state-based coverage of the poor and an expansion of Social Security benefits.

Johnson then suggests, somewhat opaquely, that, “I’d be for all three of those, if you could put that fourth one in on it, your 13. If you didn’t, I’d wait until I could get them all together because… if you don’t, why, you just murder the other one.” Johnson’s reference to “that fourth one” may have simply referred to building political support on Mills’ committee— “your 13” supporters of the bill—but it also may have been a suggestion that Mills add coverage of physicians’ fees to the Medicare program.

In 1965, Mills would adopt, seemingly suddenly, the “three-pronged approach” that he mentions here (minus the Social Security increase). Combining the administration’s proposed coverage of hospital costs with a Republic alternative that would cover doctors’ bills and an American Medical Association proposal to expand an existing program for state-based coverage of the poor into a single bill, Mills formed the legislation that created Medicare and Medicaid. Scholars had long believed that Mills came up with the strategy on the spot, but this call demonstrates that he and Johnson had discussed variations of it nearly a year before.

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