The Politics of Medicare

Social Institutions and Social Change

by Theodore R. Marmor

On July 30, 1965, President Johnson flew to Independence, Missouri to sign the Medicare bill. The new statute included two related insurance programs to finance substantial portions of the hospital and physician expenses incurred by Americans over the age of sixty-five. Public attempts to improve American health standards have typically precipitated bitter debate, even as the issue has shifted from the professional and legal status of physicians to the availability of hospital care and public health programs. In The Politics of Medicare, Marmor helps the reader understand Medicare's origins, and he interprets the history of the program and explores what happened to Medicare politically as it turned from a legislative act in the mid-1960s to a major program of American government in the three decades since. This is a vibrant study of an important piece of legislation that asks and answers several How could the American political system yield a policy that simultaneously appeased anti-governmental biases and used the federal government to provide a major entitlement? How was the American Medical Association legally overcome yet placated enough to participate in the program? And how did the Medicare law emerge so enlarged from earlier proposals that themselves had caused so much controversy?

Theodore R. Marmor teaches politics and public policy in Yale University's management and law schools as well as in its political science department. He is also the author of Understanding Health Care Reform and coauthor of America's Misunderstood Welfare State.

Genres: Health Care, Politics

254 pages, Hardcover

First published March 28, 1972

Reviews

[Tom · Rating 3 out of 5]

This is a surprisingly readable book despite its very textbook-looking exterior and subject matter. Anyone who has been following the current healthcare debate will recognize the same strawmen and shrill hysterics; though instead of Glenn Beck supplying the ignorance, it was the AMA:

(re: AMA's opposition to Murray-Wagner-Dingell Bill):

"The doctors had enlisted hundreds of voluntary organizations and pressure groups to oppose compulsory health insurance, and their crusade was conducted on a note of hysteria, holding out horrific visions of a socialized America ruled by an autocratic federal government...Ignoring the stipulations that doctors would remain free to choose their own patients, and patients to choose their own doctors, the AMA campaign pictured an impersonal medical world under the national health plan in which patients and doctors were forced unwillingly upon each other.”

Also, the fracture of the Democratic Party was happening then as well, with a few moderates standing in the way of greater reform:

“To find the most recent precedent, we must go back almost 30 years, to Franklin Roosevelt’s New Deal Congresses. In the intervening years, we find a different pattern. Democratic majorities in the Congress have not been uncommon, but normally the partisan margins have been sufficiently close on many issues to give the balance of power to minority groups within the party. Under these circumstances, states’ rights southern congressmen in coalition with Republicans have often been successful in blocking or delaying bills that entail the expansion of federal control.”

Similarly to the current reform, incrementalism wins out over real reform. Truman had pared down universal care to be Medicare, at first hospital-only, to assuage the AMA. And only for the elderly to make it an entitlement and not a means-tested program (and an easier sell politically).

All in all, an excellent book though there are two sort of ‘meta-analysis’ chapters that are rather uninteresting (and can be skipped/skimmed without losing any of the narrative). Also, I’d like to see a new afterword on Medicare Part D (current afterward is only as current as the creation of the Medicare Advantage plans). I looked up Marmor to see his thoughts on the current reform and he has published one article I found (Annals of Internal Medicine); though sort of uncharacteristically superficial. When the final reform is passed; I’d really be curious to read his thorough analysis. My guess is he supports the proposed leveling of the Medicare Advantage reimbursement rate to be comparable to the Medicare payments (i.e., MA plans get 100% of what Medicare spends, not 114%).

[BJ Cefola · Rating 5 out of 5]

A near contemporary, high level review of how Medicare was passed into law.

The shape of the conflict will be familiar to today's readers, it's striking to see ideologically driven partisanship described as an exception and not the rule.

I wonder, was Medicare an early warning of the re-aligning political forces, or a catalyst for that realignment?

[Herschel · Rating 4 out of 5]

A very good history of the politics and policy behind the development of Medicare and the U.S. health care system. This book is not just about health care though - it provides a good insight into the politics of the Great Society as well as politics today.