In 1965, the majority of elderly Americans did not have health insurance. The same can be said of low-income and disabled Americans. President Lyndon B. Johnson changed that with a stroke of a pen. On this day 50 years ago, two of the most controversial and economically hazardous programs came into being: Medicare and Medicaid.

Today, nearly every person over the age of 65 has healthcare coverage- far more the rate of young people covered. Medicaid covers around 69 million low-income and disabled people. All told, 1 out of every 3 Americans receives health insurance paid for by the government.

“We have a tendency to forget the history of laws that extended the obligations and commitments of the federal government. But the passage of Medicare and Medicaid, which shattered the barriers that had separated the federal government and the health-care system, was no less contentious than the recent debates about the Affordable Care Act,” said Julian Zelizer, a Princeton historian.

Although Johnson signed it into law, it was the previous president, John F. Kennedy, who did the most to garner voter support for the bill. He urged for the creation of a program that would help those in “every city and town, every hospital and clinic, every neighborhood and rest home in America – wherever our older citizens live out their lives in want and despair under the shadow of illness.”

Over the next five years, a bill was meticulously developed. The final program would cover the costs of doctors’ visits but not the medication. It would be financed by tax revenues and Social Security. The federal government would administrate Medicare while Medicaid would be run by individual states. Both programs were voluntary.

The House passed the bill with a vote of 313-115. The Senate passed another version 68-21.

Yet those in Washington at the time never considered the long-term viability of the program. They certainly never foresaw the ballooning demands and costs requisite of health coverage.

“It’s the typical American style of doing things,” said economist Gail Wilensky, Medicare administrator under President George H.W. Bush. “Add a little here, add a little there. It’s messy, but it’s how we do things.”

The health-care system know makes up a fifth of the US economy. Medicare alone costs about 3 percent of GDP each year- a number set to rise steadily as more and more baby boomers become eligible to receive benefits.

President Obama’s Affordable Healthcare Act or Obamacare was supposed to at least partially remedy this situation by reigning in the costs of healthcare. His program is also highly controversial and may well prove to economically hazardous.

50 years on, it is important to reflect on President Johnson’s famous declaration, given at the time of signing the Medicare Bill.

“No longer will older Americans be denied the healing miracle of modern medicine,” said Presidet Johnson on July 30, 2015. “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.”