By Matt Dallek
Aug. 20, 2009

The prospects for enacting a bipartisan healthcare plan have dimmed in recent weeks. The Senate's leading Republican negotiator on legislation, Charles Grassley, recently called on Democrats to scale back their plans for a comprehensive overhaul. Meantime, the White House staff chief Rahm Emanuel has charged that Republicans are now refusing to engage in serious, bipartisan negotiations with Democrats on Obama's healthcare agenda.

Despite this outbreak of August partisanship, however, it’s still conceivable that a bipartisan consensus will ultimately come to fruition around the issue of healthcare reform in 2009. While the final shape of the healthcare legislation is highly uncertain, there is an emerging consensus in favor of fundamental changes to the nation's healthcare system. The history of Medicare -- after its enactment -- suggests what can happen once healthcare reform is enacted.

During the early and mid-sixties, Medicare proposals encountered fierce opposition on a variety of fronts. Ronald Reagan, then still an actor, argued on a record album sponsored by the American Medical Association that government reform of medical care was “one of the traditional methods of imposing…socialism on a people.” The Kennedy White House orchestrated grassroots rallies of senior citizens in support of Medicare, but those rallies failed to sway lawmakers in Congress.

Moreover, the AMA expressed skepticism of such sweeping changes to the nation's medical system, and even Lyndon Johnson, in the early days of his presidency, championed a Commission on Heart Disease, Cancer and Strokes as his signature medical issue -- not Medicare. But once Congress enacted Medicare on a bipartisan basis in 1965, the new program gained a strong foothold in the nation's political life.

After 1965, it was extremely difficult for any major presidential candidate to run on a promise to abolish medical insurance for Americans over the age of 65. Even Ronald Reagan as president in the eighties came to embrace Medicare and merely sought to contain its skyrocketing costs, not scrap it altogether.

Senior citizens -- a crucial voting bloc -- strongly supported the government-run medical insurance program. And as recently as 2003, President Bush, a conservative Republican, joined together with a Republican-dominated Congress to add a prescription drug benefit to the Medicare program for the first time.

Reading today's headlines, it'd be easy to throw up your hands and express disappointment at the hopes of finding any sort of consensus on the topic of overhauling America's healthcare system. But if this president and Congress can find a way to enact sensible reforms that will expand coverage, rein in costs, increase competition in the insurance marketplace, and provide Americans with more choices in their medical coverage, it's possible that with the passage of time these reforms will come to enjoy strong backing from the voting public, interest groups, and Republicans and Democrats alike. The story of healthcare reform circa 2009 remains unwritten; it still could wind up looking a lot like the history of bipartisan support for Medicare after its passage in 1965.

Matthew Dallek is a visiting scholar at the Bipartisan Policy Center and the author of The Right Moment: Ronald Reagan’s First Victory and the Decisive Turning Point in American Politics