When was medicaid and medicare created

Americans interested in bringing sickness insurance to this country looked to Europe for inspiration. In , for example, the English passed the British National Insurance Act, which complemented existing programs in Germany, Austria, and Hungry, as well as parts of Scandinavia and eastern Europe. Although the German program contained such features as surgical and medical care for as many as 26 weeks, it, like its European counterparts, emphasized cash benefits to workers that were designed to replace a portion of foregone wages.

Only manual laborers and other members of the working class were covered by the German program. In England, the emphasis on workers, rather than the entire population, meant that even the wives of workers were not covered for primary benefits Rubinow, ; Falk, American reformers with an interest in establishing a sickness insurance program in the U.

Hence, what later came to be called temporary disability insurance took precedence over health insurance. In common with other progressive reformers, Rubinow did not dismiss the problem of paying for medical care.

He pointed to data from the eighteenth annual report of the U. Without need of further research, he judged that amount to be too little to spend on medical care and argued American workers deserved to receive more medical care Rubinow, Still, he kept the primary focus of social insurance related to health on cash benefits rather than on the payment of medical services.

Rubinow concentrated on the passage of sickness insurance laws in the States, rather than on the creation of a national health insurance law. At the time, the focus of social reform was on the State and not the Federal Government for reasons related to the weight of precedent, the constitutional constraints on Federal activity, and the heterogeneous conditions across the American continent.

A program that worked well in rural Nevada might not be appropriate for a heavily urban State in the northeast. Hence, the major battles over health insurance in the progressive era took place in Sacramento, California and Albany, New York rather than Washington, D. Hoffman, ; Hirshfield, Despite the fact that New York, California, and other States made careful investigations of the need for sickness insurance and gave serious consideration to creating such programs between and , the measure was defeated in every State in which it was raised Hirshfield, Unlike workers' compensation, which covered the costs of industrial accidents, including medical care for injured workers, health insurance or sickness insurance proved to be a relatively controversial item.

The fact that it was so closely associated with Germany detracted from its popularity during the First World War Lubove, More importantly, the American Medical Association AMA , which represented the interests of doctors across the Nation, came out against the measure that had been developed by the American Association of Labor Legislation and discussed in a number of States by Hoffman, ; Numbers, The AMA, in common with many Americans, thought of medical care as largely a private transaction between a medical practitioner and a patient.

There was no need for the State to intervene in this relationship. In the face of political difficulties and the opposition of the medical profession, reformers continued to study the measure in the next two decades. By the middle of the thirties, some 25 countries in Europe, South America, and Asia had some form of national health insurance program. The most significant American development was the transformation of the measure from sickness insurance to what could properly be described as health insurance.

Falk wrote the definitive New Deal-Era study of health insurance in which he announced that the costs of medical care were now a greater concern than the costs of foregone wages due to illness.

The new conditions reflected improvements in medical care and the rise of the hospital as an important center for the provision of medical care Rosenberg, Falk and many of his contemporaries owed their interest in health insurance to the studies made by the Committee on the Costs of Medical Care during the twenties.

This Committee funded for 5 years by eight private foundations interested in medical research and medical care, issued reports between and The reports highlighted the costs of medical care and the need to make some sort of societal provision to assure an adequate supply of medical care and a means for people to pay for it.

The committee therefore, publicized the need for medical insurance, but it did not necessarily endorse national health insurance. Indeed, a majority of the committee members thought that health insurance could be provided through a voluntary, private system Fox, Those who favored national health insurance, such as Falk, hoped that the New Deal might provide the political means to assure its passage.

The Social Security Act served as a possible legislative vehicle to create a Federal health insurance program. In , Falk and a colleague went to Washington to advise the cabinet-level committee in charge of what became the Social Security legislation on the subject of health insurance. They argued that, not only should the payment of medical care be recognized as an important barrier to economic security; but that a national health insurance scheme would be relatively easy to implement.

Sickness pay, they admitted, was a tricky concept to enact during a time of major depression when jobs were scarce and people were looking for any means of income available. For that reason Falk and his colleague wanted a strict separation between disability insurance and health insurance and did not want treating doctors to certify people for disability insurance. They envisioned health insurance as a means of budgeting health care costs on a group basis. Instead of paying highly variable costs out-of-pocket, a worker could pay the average, rather than the individual, cost of care, thus making health care affordable Berkowitz, In the depression, however, national health insurance was not a particularly pressing concern.

The more general problem of unemployment took precedence. Progressive reformers tended to think of sickness insurance as an investment in the Nation's productivity. Healthy workers were also productive workers. Hence, the investment in health care promised to pay lower dividends in the thirties than in the twenties—an argument against giving it priority among the hierarchy of the Nation's needs. Nonetheless, Falk and his colleagues continued to press for the inclusion of national health insurance in the Social Security Act and, failing that, in separate legislation, such as the bill introduced by Senator Robert Wagner D-NY in If health insurance had been passed in this era, it would have featured State-run programs Hirshfield, ; Poen, ; Gordon, Falk and others understood the Federal Government's role as establishing minimum standards for health insurance practice and as providing subsidies, grants or other financial aids to the States.

There should also be no commercial or other intermediary agents between the insured population and the professional agencies which serve them Committee on Economic Security, During the war years, the idea of national health insurance underwent another transformation. The most important change was the transition from the States to the Federal Government as the preferred administrators of health insurance and other forms of social insurance.

The change reflected changing attitudes on the part of Federal officials who worked in Washington administering the programs created by the Social Security Act. Some of the programs, such as unemployment insurance, were run by the States with Federal oversight, and other programs, such as old-age insurance, were administered at the Federal level. In time, Federal officials came to regard the States as unreliable and inefficient partners who, by handling the same social problems in such disparate ways, created chaos rather than coherence Altmeyer, States, lauded as the laboratories of reform, often produced inferior products, and a race to the bottom—a desire to keep social welfare taxes and expenditures below those of competing States—only reinforced that tendency.

We began to come out with a perspective that none of us had when we first began doing these things. It was tempting and, in the mobilization for war, apparently plausible for the Social Security Board to take the daring step of recommending to Congress that the States be bypassed in any national health insurance program that Congress chose to create.

State administrators, such as Mary Donlon of the New York State Workmen's Compensation Program, of course felt differently about being superceded in the administrative structure of the American welfare State Howard, As a practical matter, the States were already too imbedded in the welfare system to be swept aside. Federal bureaucrats nonetheless entertained notions of making unemployment compensation Federal and of creating national, rather than State, health insurance and disability programs.

They hoped this manner to establish a unified comprehensive system of contributory social insurance with no gaps, no overlaps, and no discrepancies Altmeyer, Legislative proposals for national health insurance which appeared in , , and —the latter two with the endorsement of President Truman—thus featured Federal rather than State administration.

If national health insurance had passed in this era, it would have provided health care for people of all ages Poen, National health insurance, which formerly had been linked with the States and the unemployment insurance program, now became associated with the old-age insurance or the Social Security program. In effect, health insurance was to be an extension of Social Security David, There were two major problems with this approach.

One was the fact that until the Social Security Program covered only about one-half of the workers in the labor force. Agricultural workers and self-employed people were excluded from coverage. Hence, national health insurance was attached to a vehicle that was not yet widespread enough to be particularly popular. Congress narrowed, rather than widened, the scope of Social Security during the s, by further reducing the occupations that the program covered. The other problem was that, as the forties progressed, private health insurance became more and more common, thus undercutting political support for public health insurance Klein, More than one-half of the hospital patients in America entered with some form of health insurance the percentage had been 9 percent in ; in that same year, more than 40 million people had some form of private insurance to pay for doctors' bills.

The private sector had scooped the public sector Berkowitz, ; Hacker, This tendency not only blocked the passage of national health insurance; it also reinforced the tendency to think of health insurance as a State program, rather than a Federal program concern, since private health insurers were regulated at the State level.

These problems led to yet another iteration of the national health insurance idea during the fifties. As Social Security became more popular in that decade and Congress passed bills raising Social Security benefit levels in , , , , and , reformers thought in terms of extending health insurance coverage to Social Security beneficiaries who were, with the exception of the dependents of deceased workers and other beneficiaries, elderly individuals Derthick, These individuals fared less well in the private health insurance market than did their younger counterparts.

Many of them, after all, had lost their ties to employers, who had financed their health care at least at the end of their working lives, as employer-based health insurance became more common. With relatively high morbidity rates, they represented a particularly bad risk for private companies to insure Marmor, The Federal Government could therefore insinuate itself as a provider of health insurance through the creation of what ultimately came to be called Medicare.

First proposed publicly in , this idea of limiting federally financed national health insurance to the elderly received attention in Congress beginning in Corning, ; David, By , a Medicare bill had received the endorsement of President John F. Kennedy, and a long campaign for its congressional passage began. By now, the idea of national health insurance had undergone, if not another transformation, then at least a major change in an effort to find common ground with private health care providers.

Wilbur Cohen, who coordinated the legislative activities related to Medicare for Presidents Kennedy and Johnson, expressed what the legislation would not do, rather than what it would do. As the campaign for Medicare unfolded, the desire to accommodate private health providers continued to play an important role.

In , Senator Jacob Javits R-NY helped to negotiate a feature, accepted by the Kennedy administration, which allowed elderly people with private health insurance coverage to keep their coverage. Medicare would reimburse the private carriers for benefits that coincided with those covered by the program.

Together, these two constituted virtually the entire aged population. Among those elderly persons not protected by virtue of the special transitional provision are federal employees to whom similar health insurance coverage is available under the Federal Employees Health Benefits Act of Others to whom the transitional provision does not apply are aliens other than those who have been lawfully admitted for permanent residence and have resided in the United States continuously for at least 5 years and certain subversives.

The hospital insurance benefits provided for as part of the social security Amendments of were first available on July l, , the only exception being benefits to post-hospital extended are which became effective on January 1, As Provided for under the legislation, the services for which hospital insurance benefits were payable included: A. Inpatient hospital services for a maxilmn of 90 days in each benefit period. Post-hospital extended care for a maximum of days each benefit period if the beneficiary is admitted to a qualified facility vithin 14 days after he has been hospitalized for at least three days.

Outpatient hospital diagnostic services furnished by the same hospital during a day period. Posthospital home health services for as many as visits in each benefit period, within one year following discharge from a hospital or an extended care facility Payment of bills under the hospital insurance plan is made to the providers of service on the basis of the "reasonable cost" incurred in providing care for beneficiaries.

Basic responsibility for administration rests with the Secretary of Health, Education and Welfare. The Secretary uses appropriate State agencies and private organizations nominated by providers of services to assist in administering the program. Provision was made for the establishment of an advisory council to advise the Secretary on policy matters in connection with administration. All contributions to finance the hospital insurance plan are placed in a separate trust fund--the Federal Hospital Insurance Trust Fund--and all benefits and administrative expenses of the plan are paid from this fund.

Employers, employees, and self-employed persons pay social security contributions, at equal rates, on annual earnings up to a specified limit, generally called the contribution and benefit base.

Supplementary Medical Insurance SMI Plan A package of benefits supplementing those provided under the hospital insurance plan is available to all persons aged 65 and over. For persons age 65 before January 1, an enrollment period began September 1, , and ended May 31, Future general enrollment periods were to be from October 1 to December 31, in each odd year beginning in Coverage could be terminated by the individual, by filing notice during a general enrollment period, or by the Government for nonpayment of premiums.

But Medicare per capita spending has been growing at a much slower pace in recent years, averaging 1. Per capita spending is projected to grow at a faster rate over the coming decade, but not as fast as it did in the first decade of the 21st century. President Lyndon B. Johnson signed Medicare into law in As of , nearly Medicare per-capita spending grew at a slower pace between and Today's Medicare Poll.