There are rumblings that the glitches attending the rollout of the Affordable Care Act — along with the relentless campaign to sabotage or delay it in numerous states — mean the program is dead on arrival. But the history of an equally controversial and vast government effort, Medicare, indicates that predictions of Obamacare's demise are greatly exaggerated.
Medicare became law July 30, 1965, after a decades-long legislative struggle to create government-sponsored health care for all Americans 65 and older. Like the Affordable Health Care Act, Medicare required that people register for it. Then, as now, problems immediately surfaced, threatening to imperil the program.
For starters, few in the government seem to have realized that more than 45 percent of those born between 1890 and 1920 couldn't prove their age because they lacked birth certificates. While the government accepted other documentation such as military records or naturalization records, some pretty unorthodox records ended up being used. The New York Times reported that in one case, a man “bared his chest as a last resort. Tattooed there was the date of his enlistment in the Navy and the date of his birth.” Another applicant dug up his mother's tombstone and carted into the local office, arguing that it constituted proof of his age. This, too, was accepted.
In the fall of 1965, millions started to enroll, no doubt aided by the reasonable ease of proving one's age. But ignorance of how the law actually worked became a serious problem by that time. More than 700,000 of those eligible for supplemental coverage refused to sign up in the opening months. Despite an elaborate public-relations campaign featuring celebrities such as Jimmy Durante and Bob Hope, and a door-to-door effort by canvassers who sought out the elderly at home, many older people believed that signing up for Medicare meant they would cease receiving Social Security. Others thought they couldn't afford the $3 monthly premium, even though the law had provisions to assist low-income enrollees.