In this chapter, "Improving Health Care: Treating the Nation's Ills," the author discusses the conflicts that arose as attempts were made to establish a national health care program amid political concerns and influences. The author, DiNitto, expresses a preference for a rational decision-making process as the best approach. However, when politics, scarce resources, and competing stakeholders vie for control of a major industry such as medical care, the outcome is seldom rational.
Every year beginning in 1935, law makers attempted to introduce bills to provide health care for the elderly and poor. Medicaid and Medicare were not passed until 1965. Medicare is a type of social insurance program paid for by payroll taxes and administered by the government to serve the elderly. Medicaid, established under Title XIX of the Social Security Act as an expansion of the Kerr-Miller Act, is a health welfare program limited to those over 65, under 21, handicapped, and members of certain dependent families.
A summary of the history of health care reveals that interest in national health care for the poor dates back to the turn of the century during the Progressive Era. From 1935 to 1965, attempts to introduce health care bills for the elderly and poor were successfully fought by the American Medical Association. Fear of government intervention in medical decisions, standards of practice, and fee setting aroused strong opposition from the medical community. They played a major role in the defeat of all attempts to provide health insurance to any indigent group for over 30 years. President Roosevelt tried in the 1930s and failed. President Truman tried in the 1940s and failed. In 1950, the government tried another tact and authorized states to use public assistance funds for medical services. The Kerr-Mills Act finally passed in 1957, establishing a separate federal and state matching program for the elderly and poor. Howe...