Tape: WH6503.11

Conversation: 7141

Date: March 23, 1965 4:54PM

Notes:

John McCormack, Wilbur Mills, and Carl Albert also participate in conversation, but not in this excerpt (2:56.6 to 6:21.315). The original full audio can be found here.

Transcript:

Wilbur Cohen: I think it’s a great bill, Mr. President.

President Johnson: Is that right?

Cohen: Yes, sir. I think you’ve got not only everything that you wanted, but we got a lot more than…on this thing. It’s a real comprehensive bill.

President Johnson: What . . . How much does it cost my budget? Over what we estimated?

Cohen: Well, I think it would be around, I’d say, $450 million more than what you estimated for the net cost of this supplementary program.

President Johnson: Now, what do they do under that? How is that handled? Explain that to me again, over and above the King-Anderson, this supplementary you stole from Byrnes?

Cohen: Yes. Well, generally speaking, it’s physician services.

President Johnson: Physicians?

Cohen: Yes. In the–

President Johnson: All right now, my doctor that I go out and he pumps my stomach out to see if I got any ulcers. Is that a physician?

Cohen: That’s right.

President Johnson: Any medical services that – or M.D. services?

Cohen: Any M.D. services, now–

President Johnson: All right, now, how do we know…what, does he charge what he wants to?

Cohen: [Johnson acknowledges throughout.] No, he can’t quite charge what he wants to because this has been put in a separate fund, and what the Secretary of HEW would have to do is make some kind of an agreement with somebody like Blue Shield, let’s say. And it would be their responsibility under the way the Chairman has provided the bill that they would regulate the fees of, in effect, the doctor, because what he tried to do is to be sure the government wasn’t regulating the fees directly. It shouldn’t deal with the individual doctor. And the bill provides the doctor could only charge the reasonable charges, but this intermediary – the Blue Shield – would have to do all the policing so that the government wouldn’t have its long hand in –

President Johnson: All right, that’s good. Now, what does it for you, the patient, on doctors? It says that you can have doctor bills paid up to what extent, or how much, or any limit?

Cohen: [Johnson acknowledges throughout.] Yes. The individual patient has to pay the first $50, [a] deductible, and then he’s got to pay 20 percent.

President Johnson: Of everything after that.

Cohen: [Johnson acknowledges throughout.] Everything after that. So that if you went to the doctor and you had a $1000 bill, you’d pay the first $50, and then for the other $950 you’d have to pay 20 percent of that.

President Johnson: All right, bet that keeps your hypochondriacs out.

Cohen: That keeps the hypochondriacs out, [and] at the same time for most of the people, it would provide [an] overwhelming proportion of their physicians’ costs.

President Johnson: Yes, sir. And it’s something that nearly everybody could endure. They could borrow that much, or their folks could give them that much to pay their part, even if they didn’t have any money. Now, what does it get you on hospitals and nurses home under the King-Anderson act?

Cohen: [Johnson acknowledges throughout.] Well, under the King-Anderson part, you get the first sixty days of your hospital care with a $40 deductible. We finally compromised on forty.

President Johnson: That’s good.

Cohen: [Johnson acknowledges throughout.] And then in addition, it has the three other benefits that were in your bill, namely the home health services, the outpatient diagnostic. And we fixed that amendment up the way – you remember the way the Mayo brothers talked to you and me about? And then the only one change was for the home health services. That has to be after you get out of the hospital.

President Johnson: That’s good, all right.