The Politics of Medicare and Health Reform, Then and Now

It is not difficult to characterize Medicare as an element of public policy. The program launched and legitimated a major role for the Federal Government in funding health care for part of the population-a role that had been highly controversial before. It has spared millions of vulnerable citizens economic anxiety, avoidable pain, and premature death. It has encouraged major innovations in health care policy. The Federal enthusiasm for health maintenance organizations, for instance, began with Medicare savings in mind, and the later adoption of the prospective payment system and the resource-based relative value scale fee schedule not only protected the Federal treasury but also let providers know that concentrated purchasers would be working to slow the flow of dollars into health services. Meanwhile, Medicare has kept the acceptance and affection of much of the population, bearing increasingly lonely witness to the possibility of government as a force for good though two and a half punishing decades. Lyndon Johnson's words, inscribed on a wall of the Johnson Library in Austin, Texas, capture with eloquent simplicity the essence of Medicare: "Health care is guaranteed to every American over 65. With the passage of this act, the threat of financial doom is lifted from senior citizens and also from the sons and daughters who might otherwise have been burdened with the responsibility for their parents' care."