Cover image for The politics of medicare
The politics of medicare
Marmor, Theodore R.
Personal Author:
Second edition.
Publication Information:
New York : A. de Gruyter, [2000]

Physical Description:
xxv, 228 pages : illustrations ; 23 cm.
Reading Level:
1470 Lexile.

Format :


Call Number
Material Type
Home Location
Item Holds
RA412.3 .M37 2000 Adult Non-Fiction Central Closed Stacks

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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 questions: 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?

Author Notes

Theodore R. Marmor teaches politics and public policy in Yale University's management and law schools as well as in its political science department. Educated at Harvard and Oxford, Marmor has written widely about the politics of the modern welfare state, and has served on a number of governmental commissions and scholarly editorial boards.

Table of Contents

Preface to the Second Editionp. xi
Acknowledgmentsp. xv
Preface to the First Editionp. xix
Introductionp. xxiii
Part I The Origins and Enactmentsp. 1
1 The Origins of the Medicare Strategyp. 3
Twentieth-Century Medicine: The Paradoxes of Progressp. 3
Origins of the Government Health Insurance Issuep. 4
Universal Health Insurance Proposals in the Fair Dealp. 6
The Politics of Incrementalism: Turning toward the Agedp. 10
The Appeal of Focusing on the Agedp. 11
Focusing on Social Security Contributorsp. 15
Pressure Groups and Medicare: The Lobbying of Millionsp. 17
2 The Politics of Legislative Impossibilityp. 23
Medicare under a Republican Presidentp. 23
The Forand Bill versus the Welfare Approachp. 25
Kerr-Mills Bill of 1960p. 27
3 The Politics of Legislative Possibilityp. 31
Medicare, 1961p. 31
The Obstacle Course in Congress: First Try with Ways and Meansp. 32
The Southern Democratsp. 35
The Kennedy Administration versus the AMAp. 38
Medicare's Near Miss, 1964p. 41
4 The Politics of Legislative Certaintyp. 45
The Impact of the Election of 1964p. 45
The Administration's Proposal: H.R. 1 and S. 1p. 46
The Ways and Means Committee and the House Take Action: January-Aprilp. 47
H.R. 6675 Passes the Senate: April-Julyp. 53
Medicare Comes out of the Conference Committee: July 26, 1965p. 55
The Outcome of 1965: Explanation and Issuesp. 56
5 Medicare and the Analysis of Social Policy in American Politicsp. 63
Case Studies and Cumulative Knowledgep. 63
Conceptual Models and the Medicare Casep. 64
The Origins of Medicare: The Rational Actor Modelp. 64
The Responses of Medicare, 1952-64: The Organizational Process Modelp. 67
The 1965 Legislation: The Bureaucratic Politics Modelp. 69
Processes and Policy in American Politics: The Case of Medicarep. 71
Medicare and the Character of American Social Policyp. 80
6 Legislation to Operationp. 87
Part II The Politics of Medicare: 1966-99p. 93
7 Medicare's Politics: 1966-90p. 95
The Origins of Medicare Revisitedp. 95
The Politics of Accommodation: Medicare's Implementation and Subsequent Evolution from 1966 to 1970p. 96
The 1970s: Ineffectual Reforms and Intermittent Progressp. 99
The 1980s: The Challenge of the Reagan Erap. 107
Conclusionp. 115
8 The Politics of Medicare Reform in the 1990s: Budget Struggles, National Health Reform, and Shifting Conflictsp. 123
Introduction: The Changing Context of Medicare's Politics in the 1990sp. 123
Medicare and the 1992 Elections: The Reawakening of Concernsp. 124
A Negative Consensus on Health Reformp. 126
The 1995 Trustees' Report and Claims of Insolvencyp. 135
From Legislative Impasse 1995-96 to Medicare "Reform" in 1997p. 137
The Medicare Reforms of 1997: Understanding the Politics of Balancing Budgetsp. 141
Medicare Flip-Flopp. 147
9 The Ideological Context of Medicare's Politics: The Presumptions of Medicare's Founders versus the Rise of Procompetitive Ideas in Medical Carep. 151
Introductionp. 151
Medicare's Philosophical Roots: Social Insurance and the Presumption of Expansionp. 152
The Rise of Procompetitive Ideas about Medical Carep. 157
10 Reflections on Medicare's Politics: Puzzles and Patternsp. 171
Introductionp. 171
Understanding Medicare's Politics: Patterns, Puzzles, and Explanatory Approachesp. 171
Puzzle One: Structural Explanations and Medicare's Limited Evolutionp. 173
Puzzle Two: Insider Politics, Medicare's Price Controls, and the Puzzles of the Reagan/Bush Erap. 175
Puzzle Three: Medicare 1995-99--Macro Politics and the Emergence of Unexpected Remediesp. 176
Conclusionp. 179
Medicare Scholarship: A Selective Review Essayp. 183
Glossaryp. 193
References to Part Ip. 207
References to Part IIp. 213
Indexp. 221