Medicare has a long history that has spanned many years. During the years 1915-1918 the American Association for Labor Legislation made an effort to push its model medical care insurance bill through several state legislatures but to no avail (Marmor, 2000). The origin of renewed interest in government health insurance was President Roosevelt’s advisory Committee on Economic Security, beginning in 1934 to draft a social security bill giving a minimum income for the aged, the unemployed, the blind, and the widowed and their children (Marmor, 2000). The by-product was the Social Security Act of 1935. The passage of this bill began to pave the way for Medicare. Americans denounced the thought of government-mandated health insurance but supporters wouldn’t take no for an answer. The federal government commitment to this issue started in 1934. The Social Security Act of 1935 enabled the Social Security Board to study similar topics so Roosevelt assigned an Interdepartmental Committee to Coordinate Health and Welfare Activities to seek the health insurance issue. The Interdepartmental Committee formulated a group that decided it would be beneficial to have a comprehensive National Health Program.
Healthcare bills were introduced nearly every session of Congress from 1939 onward. In 1943 a succession of bills, named the Wagner-Murray-Dingell bills tried to enact universal compulsory national health insurance at the federal level. Legislative strives in the 1930s and 1940s went nowhere but occurrences in 1950-51 attested to consequent passage of Medicare. Key Social Security Administration officials came to the conclusion that universal compulsory health wouldn’t pass so they confined their proposal to the elderly. Using an incremental approach they targeted a section of society that would induce the most sympathy but resistance sustained.
Disability coverage was adjoined in 1956, which sparked the battle for compulsory health insurance. Medicare advocates Wilbur Cohen, Robert Ball, and Nelson Cruikshank established a law posing hospital, surgical, and nursing home benefits for Social Security recipients. This bill introduced by Aime Forand did not pass nor did the subsequent Kerr-Mills bill which would provide medical aid for the aged poor, establishing a needs-based program of Medical Assistance for the Aged. In 1961 and 1963 Cecil King and Clinton Anderson launched moves centered on the Forand bill but the bill didn’t pass. Politics started to change in 1964.
The 1965 Medicare bill and the processes used in its enactment were engulfed with transaction-cost augmentation enabling government officials who supported it to deter public opposition. Accordant with theory simultaneous changes in the factors believed to be determinants of this conduct more vigorously encouraged legislators to endorse such transaction-cost increasing measures on the Medicare issue than at any previous point in U.S. history. In 1964 democrats won the general elections in November. The election of President Johnson was thought to be authorization of compulsory national health insurance and various social programs esteemed as pillars of his Great Society vision. The public was misled about what Medicare would cover. The “avoiding dependency” logic gave a reasonable interpretation to adult children’s desire to not support their parents, which boosted support for Medicare. Another important aspect of the “avoiding dependency” logic was the portrayal of senior citizens as poor. Additional struggle to Medicare legislation was concern that compulsory federal insurance would bring about federal control over medicine and doctor-patient relationships so the bill’s authors composed a plan forbidding such control.
Social Security Amendments of 1965 included a 7% increase in cash benefits to Social Security recipients, grants for maternal and child health services, and liberalization of disability coverage. Another critical point in passing Medicare was Wilbur Mills, chairman of the House Ways and Means Committee, realizing that some form of Medicare would pass. Therefore he wanted to control the direction Medicare would go in. Wilbur demanded that there be no open public hearings on Medicare in 1965.
Zealous presidential support for Medicare and the transaction-cost increasing standards needed to pass it reassuring other government officials to use transaction-cost-augmenting measures regarding this issue were used like never before. Democrats held the White House and two-thirds of the seats in the House and Senate. Notwithstanding Democrats being elected anti-Medicare Democrats took the place of pro-Medicare Democrats. Since no public hearings were held the media was less capable of informing the public about the transaction-cost increasing features of the bill. Medicare’s intricacies were favorable to transaction-cost augmentation making it easier for experts to disintegrate and for amateurs to blunder. Strategies most effective in passing Medicare manipulated political transaction costs. By connecting Medicare with a 7% increase in Social Security benefits and misrepresenting its cost and coverage supporters of the bill was able to get it approved.
Nearly fifty years later the battle continues with Medicare. Until the passage of the Medicare Modernization Act prescription drug coverage was not covered. The passage of the new Medicare bill in ways resembles the passage of the original Medicare bill. Different ways to cut, change, or privatize Medicare have been made, but little attention has been given to containing the costs of providing healthcare (Gilleard & Higgs, 2002). The new Medicare bill has made drastic changes to the original bill. Advertisement to the public has been misleading only portraying seniors being able to receive drug coverage. Little to no attention has been given to the donuthole in coverage which has a $250 deductible with 25% coinsurance up to $2250 at which point coverage ceases until out-of-pocket costs reach $3600 or $5100 in total drug spending (Cochran, 2004). With the passage of the new Medicare bill we probably will see more changes made to the Social Security incrementally. The passage of Medicare in 1965 as well as the Medicare Modernization Act of 2003 shows the importance that politics play in pushing bills to becoming law. As citizens we should pay attention to who we are voting for and how their policies will impact society.
Cassandra Hill, M.A. Gerontology, LBSW