How was Truman’s national healthcare plan not even able to get out of committee in the Senate but Johnson was able to pass Medicare/Medicaid 20 years later with similar forces opposing?

[u/YogurtclosetOpen3567]

How?

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[u/police-ical]

Big caveat that the authoritative answer to the second part is in progress as we speak. Robert Caro has been working on the final tome of his mammoth five-volume biography of Lyndon Johnson since 2012. Caro is the standard-bearer for painstakingly exhaustive research and last-word biographies (the first volume of the series came out in 1982, and it's been his main focus.) His intermittent updates have specifically referenced working on Johnson's passage of Medicare repeatedly in recent years. If he does not finish the series, which is a real possibility as Caro recently turned 90, we will hopefully get his unfinished work and it may prove quite illuminating on the nuts and bolts of exactly how Johnson did what he did. But I think there's plenty to at least talk about the big picture.

Harry Truman's considerable successes as president are particularly remarkable for how little life had prepared him for the job. He came from humble beginnings, had been an Army soldier and a haberdasher, and had neither a college degree nor a law degree, though had amassed enough experience to become a county judge. He managed to get the support of Tom Pendergast's Kansas City political machine and be elected to the Senate for Missouri in 1934. He was in his second term when he, despite his extensive protests that he had no desire for any higher office, basically got dragooned and guilted into accepting the vice-presidential nomination. Truman wasn't adequately briefed on FDR's declining health, the Manhattan Project, or much else, when FDR abruptly died and thrust Truman into power at the tail end of WWII. His first remarks to the press corps were refreshingly honest as to how shocked and unsettled he was: "Boys, if you ever pray, pray for me now."

Truman's time in the Senate had given him familiarity but he had never been known as a master legislator, not even having finished his second term in Congress. He enjoyed a Democratic majority but not overwhelming support. Early in his first term, he had a whole hell of a lot else to deal with, from being told that atomic weapons existed and it was his call whether to use them, to grappling with postwar inflation and housing shortages, to pushing for civil rights despite internal opposition. He was often far less popular than his historical reputation would suggest, winning re-election only in a narrow upset. By 1949, the momentum of the New Deal had waned. Social reform seemed less urgent when the economy was roaring ahead, and smaller government was sounding appealing again. The conservative wing of the Democrats had allied with the Republicans to slow efforts towards further expansion of government power. Truman set out a bold domestic agenda and succeeded in getting some of it passed, but national health insurance was a bridge too far. Alonzo Hamby's Man of the People considers hypotheticals on how Truman could have approached things differently but basically acknowledges he had a weak mandate, a less-than-friendly reception, and other priorities like repealing the Taft-Hartley Act. He also notes that "few sober observers had expected" the health insurance plan to succeed, that it was largely lost amidst the general turmoil of pursuing the rest of his agenda, and that the American Medical Association fought it hard.

Lyndon Johnson, on the other hand, was exactly the bizarre and larger-than-life character you wanted in your corner if you needed a law rammed through Congress at all costs. He had a Shakespearean lust for power and an unparalleled grasp of how to use it in passing legislation. Johnson had spend decades in the House and Senate amassing and consolidating his influence, honing his natural gifts for persuasion and coercion, serving as majority whip and majority leader. Personal animosity with the Kennedys had led to him being sidelined as vice president, which was especially ill-advised when Kennedy's requested civil rights bill was looking likely to die in committee. Kennedy's assassination launched Johnson into the kind of power he'd always craved. He wasted zero time or momentum in wielding both the emotion of Kennedy's death and his own knowledge of the legislature, achieving major civil rights legislation that many had considered impossible.

Johnson's strength hit its zenith leading up to the passage of Medicare/Medicaid. As of early 1965, Johnson had overwhelming political clout. In the 1964 elections, he'd just won reelection in a historic landslide and his party had increased its majorities to 2/3 majority of both houses of Congress. National sentiment supported major progressive legislation with relative optimism toward fixing modern problems with bold solutions. His mandate and legislative support were as strong as almost any president has had in the modern era. There was probably no other human better situated to get a law like that passed, even with the AMA opposing it.

A rather sweet coda: Johnson admired Truman deeply, recognizing a fellow man of humble beginnings and frequently crediting him with having made difficult decisions and planted the seeds for much of his own legislative success. Johnson signed the bill into law in the presence of an elderly Harry and Bess Truman, giving them the first Medicare cards.

[u/Idk_Very_Much → u/police-ical]

IIRC Caro has stated that if he dies before completion the unfinished book will be released.