Transactions of Society of Actuaries

Are abortions covered by Medicare? While Bob Myers does not tell us, he does answer more questions than you are likely to ask about Medicare and Medicaid. This is a textbook on three aspects of Medicare and Medicaid: (1) historical and legislative development, (2) cost estimates, and (3) benefits and administration. Most likely, i t will initially be read for its detailed description of current Medicare and Medicaid benefits and the reimbursement procedures therefor. I believe, however, that its important long-range contribution to the actuarial profession will be, first, as a history of medical care legislation in the United States and, second, as a textbook on the cost-estimating processes of governmental medical programs. Since today's college graduate was still in high school when Medicare began, we must realize that, within a few years, our students and younger actuaries will probably take Medicare for granted much as the generation that matured in the 1940's and the 1950's accepted the existence of the universal income tax or old-age and survivors benefits. Knowledge of the road that medical care legislation traveled from the first proposals in this century's initial decade to the passage of the Medicare law fifty-nine years later will be necessary both to understand the present structure of these governmental programs and to anticipate future changes and how they are likely to be enacted. Starting with the formation of the American Association for Labor Legislation (AALL) in 1906, Mr. Myers I (who resigned from the Social Security Administration in 1970 after thirty-six years of service, having been chief actuary since 1947) leads us through the model bills, private movements, presidential commissions, and congressional proposals that reached a climax with the 1965 social security amendments that established Medicare and Medicaid. From out of the past comes the roll call of congressional authors: Wagner-Murray-Dingell, Flanders-Ives, King-Anderson, Forand, and Kerr-Mills. The lobbying, hearings, and political stances on the many legislative proposals, their rejections, and their revisions which finally led to the 1965 Act are