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• The Center on Addiction and Substance Abuse at Columbia University
• Mr. Califano's bio

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Tavis: Joseph Califano has enjoyed a long and respected career in public service. He was a domestic policy aid to Lyndon Johnson when Medicare was created back in the 1960s. He went on to serve as Secretary of Health, Education and Welfare under President Jimmy Carter. Today, he is the chairman of the board and the president of the National Center on Addiction and Substance Abuse at Columbia University. He joins us tonight from New York City. Mr. Califano, nice to have you on the program, sir.

Joseph Califano: Nice to be on your show, Tavis.

Tavis: Forty years ago. Does it seem like that long ago that these programs came into existence?

Califano: No, it doesn't. I never thought I'd be eligible for it. (Laughs) There were times when we were trying to get it passed when I wondered.

Tavis: Take me back to those days, to your point now, about what you all were doing, and what the struggle was like when you were, to your point, trying to get it passed.

Califano: Well, President Johnson, in his first message to Congress, his first State Of The Union message in 1964, said he would fight until he had no breath left to get Medicare passed. So, in late '64, we had Medicare attached to the Social Security increase bill. In those days, Congress voted to increase Social Security every two years, just before the election.

There were no cost of living increases. Johnson attached it to that bill in the Senate, the Senate went to conference with the House, and the House wouldn't take the bill. But Johnson was so concerned about having a momentum to pass Medicare that he killed the Social Security increase in order to have that coming back next year. In the following year, he won by this enormous landslide.

We had a liberal majority in the House and the Senate, not just a Democratic majority, and he pushed Medicare through. But we had, the doctors were opposed, so we finally agreed to give the doctors the right to be paid their usual, customary, and prevailing fees. The hospitals were opposed. They had the ability to beat us, too. So Johnson finally said, okay, we'll reimburse them on a cost-plus basis.

And we got the bill passed. We also, in the course of that, there had been the Medicaid bill. Medicaid, nobody really thought about it much, but there was a program in 1960 which provided sort of health care for old, poor people. And the southern power brokers on the Hill figured that that program would take care of their poor people. However, what happened was the big states, California, Michigan, New York, Pennsylvania, got 95 percent of the money of that bill.

So Johnson said to these two southern barons, Russell Long and Wilbur Mills in the Senate and the House, he said, you wanna get your fair share, he said, let's change that bill. Let's create Medicaid. Let's create a program where everybody on Welfare is eligible for healthcare, and we'll also take care of the medically indigent. And he sold it. So we had in one swoop in 1965, Medicare and Medicaid.

Tavis: In the telling of that story, there are a number of things I find fascinating, not the least of which is as you certainly know, given the work that you do, in a contemporary sense, we see SSI, Social Security, as the third rail of politics. You touch it as elected official, you die. Or certainly if you don't die immediately, you die a slow death. But if you're smart, you don't mess with Social Security.

Hence the debate we're having today about what to do with it. So Johnson, though, sacrifices an SSI increase to try to get Medicare passed? What did that courage - was that courage or was that stupidity back then?

Califano: No, that was absolute, total courage, and very hard ball. And enormous courage. Now you have to remember, even after we passed it, the doctors were indicating that they weren't gonna join it, they weren't gonna support it. They wouldn't provide services under it. So the doctors come to the White House about two months after Medicare is passed to meet with Johnson.

They walk in, the head of the American Medical Association, and before he can say anything, Johnson says, I've got a war in Vietnam, I've got doctors over there to take care of the military, but I need doctors over there to volunteer and help take care of civilians and the Vietnamese. And would you start a program to send doctors over there for six months?

And the head of the AMA says, of course, we'll help you with this. And Johnson says, wonderful. He says, bring in the press. The press comes in, and the first question from the reporters is to the head, are the doctors going to come into the Medicare program? Will they provide medical services? And Johnson said, turns to the head of the AMA, he said, these men are gonna send doctors to Vietnam, where they may die for their country.

Of course they're gonna support the law of the land. (Laughs) Medicare is the law of the land. And he turns to the head of the AMA and he said, "What about it?" He says, 'Yes, we will. We'll be there.' (Laughs)

Tavis: Well, LBJ was smooth. You can't fade him on his strategy. Talk about strategery. LBJ knew what he was doing back in the day. Let me ask you then, in retrospect, obviously, to assess what these programs mean today. There are a lot of people who think they've outlived their usefulness. We've got this Plan D. Talk about it 40 years later.

Califano: Well, 40 years later, more than 100 million Americans have signed up for Medicare over this time. More than 220 million Americans have been served by Medicaid. Of course we need these programs. We do have to get healthcare costs under control. And we recognized that by 1968, three years later, but we couldn't get Congress to change it.

Now the trick is to provide those services efficiently; to put more incentives, for example, in Medicare so people take care of themselves. Let me give you a little example, Tavis. Medicare pays for flu shots and pneumonia shots for the elderly. Only about 80 percent of them get flu shots, and only about, not even 40 percent or 50 percent get pneumonia shots.

Well, if we said wait a minute, if you get the flu or you get pneumonia and you haven't gotten your shot, you're gonna pay the doctor's bill, we'd be up over 90 percent in two months. We have to start putting some incentives in to do that. And on Medicaid, that program has probably done more to extend life expectancy in this country than anything else.

People forget that life expectancy soared, but it soared largely because poor people got healthcare that they never had gotten before. Not because people are suddenly living to be 85 or 90. We always had people living to be that age. Not as many, but the big jump was poor people got healthcare, and poor people that were dying in their forties. People can't remember this, in the early fifties, were living.

Let me give you an example. If you were African-American in 1977, when I became Secretary of Health, Education, And Welfare, the odds were that you would never use your Social Security. Now think about it. Never use your Social Security.

Tavis: Now, what about...

Califano: You'd never get over 65.

Tavis: Yeah, one of my friends, Mr. Secretary, one of my friends, a great comedian named George Wallace, a Black comedian, tells the joke all the time that he does not understand why Black men, specifically, even pay into the system. You ain't gonna live long enough to get your money out. (Laughs) So why even, he tells that joke all the time. It's a joke, of course, born of the point you're making. That back in the day, so many African-Americans did not even live long enough to get their money back out of the system in the first place.

Califano: That's right.

Tavis: Yeah. Let me ask you about the solvency of this program. One of the things that I find fascinating in my own lifetime is that so many programs that courageous Americans like yourself and LBJ started back in the day are now coming full circle, whether there's a conversation about the economic vitality and the solvency of these programs. So are these programs solvent, as we speak?

Califano: Well, they are solvent as we speak, and they will be solvent. Now, this is a function of our society. Where are we gonna put our resources? Are we gonna put our resources into Iraq? What are we gonna put our resources into? We have plenty of resources in this country. The question is, where are we gonna put them? We can make the programs more efficient.

And incidentally, I don't think anyone's gonna stop Medicare. I think the real danger is that people will curb Medicaid. Because Medicare applies to everybody in the country. Social Security applies to everybody in the country. But Medicaid is only for poor people. The Welfare system and Social Security, and the supplemental security income system are basically for poor people. Those programs are the ones that are vulnerable, because poor people don't vote. They obviously don't have money to make campaign contributions.

Tavis: Do you understand this Plan D thing? 'Cause if you do, you're, like, one of three people who do.

Califano: Plan D is terribly confusing, and it's too bad. It didn't have to be that way. It's because Congress has created this crazy system of what they call scoring the cost of programs. So they create an enormous hole called the doughnut between when you get a little bit of coverage, then you have to pay for yourself for a long time, and then you get covered again.

I think that we should simply have a drug benefit. We shouldn't give the pharmaceutical companies the right to set their own price. I think that's what Congress had to do in order to pass the bill. But Tavis, we will never have, I'm sorry, we will never have a sensible health policy legislation in the future unless we have campaign finance reform. There's too much money from the doctors, the hospitals, the pharmaceutical companies, the medical equipment manufacturers. You just can't do anything that they can veto.

Tavis: Let me ask you, I got about two minutes left. Let me ask you right quick, 'cause I believe that given the high quality work that you're engaged in now, you must believe that the greatest threat to the health of Americans are addictions of all types.

Califano: Absolutely. The number one disease in this country, the number one cause of crime, the number one culprit in teen pregnancy and child abuse and domestic violence and the spread of AIDS is drug abuse. Alcohol and drug abuse, also tobacco. Let me tell you, we have got to deal with that problem. It is a problem that affects every single American.

And this is not something that just affects poor people or African-Americans. We thought, 50 years ago, oh, it's only something that happens in South Central Los Angeles or Harlem or maybe Bed-Stuy. But let me tell you, it happens everywhere. It happens on the Upper East Side and the Upper West Side and in Beverly Hills and in Georgetown. We have got to deal with it as a people.

We're not dealing with it. We've gotta get over the stigma. And it's all about kids. It's all about kids. If you get a kid through age 21 without smoking, without using illegal drugs, and without abusing alcohol, almost all of them drink, that kid's virtually will be home free for the rest of his or her life. We should focus on these kids.

Tavis: That's great advice, and I could not think of a better place to close our conversation than with that advice. Joseph Califano, that is. (Laughs) He screws up my name, I screw up his name, that's how it works.

Califano: I know it. (Laughs)

Tavis: You dog me, I dog you back.

Califano: Oh, you're great, though, you got a great show.

Tavis: (Laughs) I appreciate that, I'm just teasing. He's the chairman, of course, and the president of the National Center on Addiction and Substance Abuse at Columbia. Former Secretary of Health, Education and Welfare under Jimmy Carter, and of course, the top aide to Lyndon Johnson. What a great career he's had. I'm glad to have you on the program, Mr. Califano.

Califano: It's my pleasure.

Tavis: Take care of yourself.

Califano: Thank you.

Tavis: Up next on this program (laughs) from the hit summer series "The Closer,' actor Jon Tenney. Stay with us.