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Sen. Bernie Sanders introduced his “Medicare for All” bill Wednesday, marking the latest chapter in a national conversation about the government’s role in health care.

Here’s a brief look back at the history of health care legislation, starting with the passage of Medicare and Medicaid, which were themselves the subject of long national debates.

Medicare and the Johnson era

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On July 30, 1965, President Lyndon B. Johnson signed the Social Security Amendments of 1965 into law. The landmark legislation established the Medicare program, which provided hospital insurance and medical assistance to Americans over the age of 65. It also created the program that would come to be known as Medicaid, giving medical assistance to those deemed unable to afford insurance. It was a pivotal moment.

“No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts,” Johnson said at the bill signing event in Independence, Missouri.

The passage of the legislation was far from easy.

“Until then there had only been unsuccessful efforts to create robust national health insurance programs,” said Julian Zelizer, a Princeton history professor and CNN contributor who wrote The Fierce Urgency of Now: Lyndon Johnson, Congress, and the Battle for the Great Society.

Presidents Franklin D. Roosevelt and Harry S. Truman had both pushed for forms of national health insurance and failed. President John F. Kennedy advocated for Medicare in 1962 and 1963, and Johnson took up the mantle following Kennedy’s assassination, Zelizer said. Advocates of the plans were faced with fierce opposition.

“Doctors mounted a fierce lobbying blitz against this bill unlike almost anything that has taken place until that time. Lobbying in local communities, threatening members of Congress that if it passed they would try to get them out of office,” Zelizer said. “The Southern Democrats who controlled all of the committees back then, they didn’t want this bill either. So it was a pretty brutal fight and it lasted many, many years. It took many tries until this finally happened.”

The 1964 elections, however, saw a shifting political tide. Johnson was elected over Barry Goldwater, a Medicare opponent, and Democrats gained control of Congress. Arkansas Democrat Wilbur Mills, once a staunch opponent of the Medicare bill, switched his position.

“Once he flipped, the whole politics of the issue changed,” Zelizer noted. With these conditions in place, the bill passed 70-24 in the Senate and 307-116 in the House.

The impact of Medicare’s passage and implementation had profound effects, both for individuals at the time and on the future of health care legislation in the US.

“It was a watershed,” Zelizer said. “Most important, you had a national health insurance program where that had been politically impossible, now the idea that the federal government would play a big role in health care was the law of the land.”

“The program itself has major impact early on. Medicare, within a few years, is covering huge parts the population, many Americans come to expect Medicare benefits as a right and they don’t see this even as some kind of dramatic government program, it’s just part of the health care system. Doctors start to depend on it by the late ‘60s, hospitals start to depend on this money,” he continued. “I’d say within five years it’s totally transformed both the role of government in health care, but even what health care meant for most people receiving the benefits.”