In 1965, after winning in a landslide against Barry Goldwater and helping to carry Democratic supermajorities into both houses of Congress, President Lyndon Johnson set out to enact a battery of Great Society reforms, including Medicare, government insurance for seniors. Despite his political mandate, 60 years of conservative opposition to such a measure meant proceeding with caution. Later, California Governor Ronald Reagan, for example, would characterize the Medicare bill as the advance wave of a socialism that would “invade every area of freedom in this country.” Reagan predicted that this reform would compel Americans to spend their “sunset years telling our children and our grandchildren what it was like in America when men were free.”

With 63 percent of Americans favoring passage of Medicare, Johnson believed that diehard conservative Democrats such as Wilbur Mills, the chairman of the House Ways and Means Committee, who had repeatedly blocked a Medicare bill from reaching the House floor, would be hard-pressed to maintain his opposition. Johnson had little leverage over Mills, who had a safe seat and feared that Medicare would bring fiscal disaster upon the country. Privately, Johnson complained that Mills was a “prissy, prim, and proper man . . . who was afraid to put his reputation behind a risky bill.”

Johnson’s accute political instincts told him that—even with popular support for Medicare pressuring the congressman—he would do better to place a compromise bill before Mills’s committee rather than one that would provoke the gentleman from Arkansas into bitter opposition. To combat charges of socialized medicine and signal his desire to reach an accommodation with the opponents of his initiative, Johnson advanced a limited bill that covered only hospital costs for seniors through expanded social security. He omitted coverage for doctors’ fees, aware that by doing so he could avoid charges of introducing a British-style national health care system by creating a new class of fee-compensated government employees.

Ironically, when the opposition tried to sidetrack Johnson’s reform by proposing “Bettercare” and “Eldercare,” bills that would cover only the indigent for both hospital and doctors’ costs through government-subsidized private insurance, Johnson expanded his original proposal to include physicians’ costs, determined not to let the other side outdo him. He accurately saw the conservative proposals as a giveaway to the insurance industry, which would leave elderly citizens who were above the poverty line uncovered.

Johnson called Senate leaders to the White House in front of TV cameras to discuss the prospects for the legislation. This tactic forced Harry Byrd Sr., chairman of the Finance Committee and another longstanding opponent of Medicare, to make a public commitment to prompt action by his committee. As Johnson understood, the changed political climate and moderate proposal he had put before Congress had made all the difference in compelling Byrd to accept what he no longer could stigmatize as a radical reform.

But, even after Johnson had disarmed Mills and Byrd, he felt compelled to corral every possible vote by instructing his aides to treat all members of Congress as if