In 1944, President Roosevelt called for an “Economic Bill of Rights” proclaiming that every American had the “right to adequate medical care . . .” With Roosevelt’s untimely death, Harry Truman took up the mantle and tried unsuccessfully to push national health insurance through the clenched jaws of the Republican Congress.

The President’s tepid approval ratings, the postwar Congress’s conservative bent, and the powerful alliance of anti-national health insurance special interest groups, spearheaded by the American Medical Association (AMA), combined to thwart health insurance legislation from 1945 to 1947.

Ewing became the much-maligned face of Truman’s thwarted National Health Insurance program. In a profile titled “Ewing: Deeply Sincere Man or Designing Politician?” The Sun attempted to get a handle on the vitriol. Was Oscar Ewing, “a quiet, mild-mannered, deeply sincere man who left a lucrative law career to serve his country,” or a “skillful, designing, power-thirsty politician bent on fastening the ‘welfare state’ tighter and tighter upon the American people…”? Ewing, The Sun would agree, desperately needed a break.

At a cocktail party in 1949, the famed publisher William Randolph Hearst Jr. gave him one. Hearst, Ewing recalls, leaned in and said, “I’m very much in favor of your idea for national health insurance. But the thing that worries me about it is that if anything went wrong, if it didn’t work, the upheaval that would result would be catastrophic because we would have a completely different system of medicine….Isn’t there some small segment of the problem that you could pick out, apply your health insurance program to it, use it as a pilot plan operation?”

Ewing liked the idea, but which segment of the population could quiet the conservative opposition?

Louis Pink, a former client and insurance expert with New York Blue Cross/Blue Shield, suggested covering the elderly, a high-risk group that insurance companies avoided. Ewing understood the value of Pink’s suggestion. The government, he thought, could start slowly, insuring those over 65 and then expanding to other groups.

National health insurance, like the history of voting, would be incremental, bestowed to one group at a time. The brains behind Truman’s social security legislation, Arthur Altmeyer, Wilbur Cohen, and Isadore Falk, were less persuaded. In fact, Ewing recalled, they “were completely wedded to national health insurance and didn’t want to take less.”

Then came the “oldsters.”

In April 1949, the few existing elderly experts assembled at the FSA offices to discuss the mounting demographic problem of unemployed, impoverished, and discarded elders. The problem of old age, these experts claimed, was as much existential as it was physical.

Old age, explained Ollie Randall, one of the few known elder activists working at the time, “is a period of losses—loss of family, of friends, of job, of health, of income, and most important of all, of personal status.” It doesn’t begin at the same time for everyone but when it does, Randall explained, it is the loss of personal status or of social usefulness that elderly men and women described as the most crushing. “To feel useless or unimportant,” she argued, “is the most devastating experience a person can have.”

To put the elderly back to work and salvage their dwindling reputation as employable and capable citizens, the FSA, with Randall’s and others’ urging, decided to host a conference on old age.

The first National Conference on Aging held in 1950 achieved mixed results. Although the Conference established the elderly and their hardships as national issues, replete with federal committees and popular journals, the content goals stated by the conference participants came to be overshadowed.

The lasting results of the First National Conference on Aging would be the demonstration of the growing power of America’s senior citizens and the marriage of this power to Oscar Ewing’s old-age hospital insurance program.

The Aged Matter

“You should live so long,” chirped N. S. Haseltine, in a snarky Washington Post piece. “And because you will,” he continued, “national experts convened here to talk over what should be done for you.”

The day was August 13, 1950; the place was Washington, D.C., where over 5,000 “out of towners” descended on the sweltering city to attend a conference-packed weekend. In addition to the meagerly populated National Conference on Aging, the Army and Navy Union of the U.S.A., the International Typographic Union, the Croatian Fraternal Union of America, and the Pi Phi Fraternity competed for broadcast minutes.

With only 816 people in attendance, the National Conference on Aging, at the stately Shoreham Hotel, still managed to capture the country’s attention. Newspapers from California to New York reported on the massive implications of this recently discovered social problem.

For one thing, the guests were colorful. Dr. Francis E. Townsend arrived prepared to push his latest pension plan, $150 a month for everyone over sixty.

Then came the “Texas cyclone,” an avuncular figure with “the longest name, longest beard, and longest tongue of Texas,” Arlon Barton Cyclone Davis, to advocate for pay-as-you-go pensions and demonstrate his sixty-nine years of impeccable health.

Representatives from General Electric, Eastman Kodak, the Motion Picture Association of America, life insurance companies, hospitals, and social welfare agencies hunkered down for back-to-back sessions on the indignities faced by America’s elders.

For three days, interested parties gathered to confer on the “problem of old age.” Despite a wide range of professional training, and active debate, the participants settled on surprisingly similar conclusions.

Whether they attended the meeting on “Employability and Rehabilitation” or “Living Arrangements,” these new experts claimed that the hardships of old age could be discussed primarily through the language of dependency. The problem of old age, they concluded, was not actually a problem of passing birthdays. Rather, it was part of an intergenerational plight of physical and financial dependence.

The working group on health, the largest at the Conference, came to be one of the most vocal adversaries of age-based policies. In their written summary, the group asserted that the bulk of medical spending must be used for early intervention. Rather than attend to disease at the end of life, they argued that health-care professionals should focus on preparing middle-aged individuals for years of optimal health in their homes.

The emphasis should remain on creating the “well person” rather than coping with the sick one. For this reason, isolating the elderly from other age groups in terms of health care did not make sense. The group concluded, “health programs for the aging should be developed within the framework of our total health services. Further fragmentation would be wasteful and would perpetuate an undesirable social concept.”

Ewing took the Conference’s conclusions seriously. He realized the problems of old age were complex, intergenerational, personal, and societal.

Still, he couldn’t help but view the throngs of politically primed elders through his own policy prism. He saw their voting potential and realized that they would be a new and powerful constituency.

At the start of his duel with the AMA over national health insurance in the late 1940s, Ewing wanted to organize an equally powerful American Patients Association. After August 1950, he realized that the elderly could be that association. The numbers were on his side. “You had 19 million people over 65, and you had 185,000 doctors,” he exclaimed.

After the conference, Cohen and Falk came to Ewing’s side, completing a draft of the legislation by 1951. The duo found a way to make old-age insurance palatable to a resistant Congress.

First, they limited the insurance to hospital expenses, thus following the established path of federal support for hospital growth. Second, they decided to integrate hospital insurance into the newly expanded and nationally respected Old Age and Survivors Insurance program.

By restricting health-care benefits to Social Security recipients over 65 (and their spouses), they avoided a means test, as well as charges that they were giving benefits to the undeserving. In this case, the elderly would have prepaid for their health insurance through taxes over the course of their lives.

To persuade Congress, they began compiling data on the connection between old age and illness as well as deficits in insurance coverage for those over 65. Deployed to offer a simple causal relationship between old age and illness and then illness and poverty, the data ignored the complicated and multi-directional relationship between poverty, unemployment, depression, and disease.

As Wilbur Cohen would later write, “anyway, it’s all been very Hegelian. The state and federal proposals for compulsory health insurance were the thesis, the AMA’s violent opposition was the antithesis, and Medicare is the synthesis.”

In April of 1952, Senators James Murray (D-MT) and Hubert Humphrey (D-MN) and Representatives John Dingell (D-MI) and Emanuel Celler (D-NY) introduced Ewing’s old age hospital insurance bill in Congress. Truman gave Ewing permission to move forward but never truly put his weight behind the program. Neither the Senate nor the House had hearings on the bill. “They couldn’t even get hearings on Medicare, when I had it introduced,” lamented Ewing.

In the fall of 1953, the situation looked bleak. The Truman administration had failed to implement national health insurance and failed to implement restricted hospital insurance. With the end of the Truman administration, remarked Ewing, “also came the end of any real pressures for national health insurance.”

What did not end, remarkably, was the pressure for Medicare.

The Problem of Old Age Becomes the Problem of Illness

As the cost of medical care continued to rise, so did the organizational capacity of the elderly. Local old age groups, religious societies and Golden Ring Clubs began to agitate for help and a new lobbying group, The National Council of Senior Citizens, pushed Congress to enact Ewing’s hospital insurance program.

The definitions and solutions to the problem of old age voiced at the First National Conference on Aging gave way to the language of political expediency.

The problem was no longer dependency, but poverty caused by health failure and rising health-care costs. The AMA now had to battle with an organized front of aged activists, who argued that America’s deserving grandfathers and grandmothers were undeservingly poor because they were ill.

Between 1950 and 1965, the contours of American politics around health policy transformed. The power structures shifted in Congress, interest groups lost and attained influence, and a new American solution captured the hearts of the country.

From 1957 until 1964, bill after ill-fated bill bounced through Congress, until finally, on July 30th, 1965, the conclusion of decades of compromise actually stuck. An amendment to the Social Security Act providing hospital and medical insurance for Americans over 65 years of age became law.

But more than just policy changed.

By the 1960s, the conversation around the problems of old age grew ever more anemic; chronological age came to be an accepted way of dividing the old from the young, and aging became a disease to be solved.

Old age is not a static concept. It is defined, like so many other animating categories, by social assumptions, political necessities, and biological mechanisms.

In the United States, old age has come to mean something chronologically specific with very concrete policy benefits. Sixty-five continues to mark a person as “old.” Yet, this arbitrary number makes increasingly less sense in an age where life expectancy at birth has jumped to a man’s late 70s and a woman’s early 80s.

As 78 million baby boomers turn 65, live decades with degenerative diseases, and prepare for a new kind of retirement, the definitions and lived experiences of old age are undergoing a fundamental transformation.

How policy should follow these changes is a debate worth having.

For more on this topic, read Tamara Mann's article "Dying Well" in the Harvard Divinity Bulletin.