by Jonathan Cohn
Up through the late 1940s, the debate over how to pay for medical care in this country really didn't treat retirees as a separate group. But that changed after Truman's failed bid to establish national health insurance, when politics -- and the evolution of private health insurance -- forced the "special problem of the elderly" onto center stage. By that time, enrollment in private insurance had expanded to most of the working-age population, primarily through job-based coverage. Indeed, widespread satisfaction with those arrangements had been a major reason Truman's bid failed. But the elderly were not sharing in this progress, at least not fully. Most commercial insurers wouldn't allow beneficiaries to keep coverage when they retired from their jobs, particularly if they were past the age of sixty-five. Nor would they sell seniors insurance directly, since the elderly -- almost by definition -- were precisely the kind of high medical risks insurers tried to avoid. As a result, just 40 percent of seniors had health insurance by 1957. The figures improved in the next few years, as the insurance industry, in an apparent effort to prove that government intervention was unnecessary, aggressively offered coverage to more seniors.
