Johnson signed Title XVIII and XIX of the Social Security Act into law, known as Medicare and Medicaid. It was not until the summer of 1965 that Lyndon B. Studies estimated that prior to enactment of Medicare, almost half of all seniors did not have health insurance. This was felt to be more socially acceptable, as described by Marmor, “the aged could be presumed to be both needy and deserving because, through no fault of their own, they had lower earning capacity and higher medical expenses.” 6 With this change in paradigm of the proposed plans, the protracted political debate continued, spanning multiple administrations. ![]() Success did not come until later, when the proponents of public insurance recognized that they needed to narrow their focus to covering the elderly. Truman took up the mantle of healthcare reform and advocated for it vigorously as a part of his “Fair Deal.” Various bills were introduced around the idea of national health insurance, but they never garnered the necessary support. Roosevelt dropped comprehensive national health insurance out of fear of risking passage of the remainder of his New Deal reforms. They broke with the majority by arguing against group payment methods, and opposition groups seized onto this minority recommendation. The CCMC’s majority recommendations cited above were accompanied by a minority report written by dissenters within the committee. 5 The resistance to national health insurance was fierce, however, with lobbying groups including the American Medical Association strongly opposed out of concern that group payment would compromise physician autonomy. 2 Two decades later, around the time the CCMC completed its final report, the idea reemerged as a possible component of Social Security in Franklin Roosevelt’s New Deal. This notion of public health insurance had previously been advocated by Theodore Roosevelt in his run for a third term as a progressive, but never came to fruition after his loss to Woodrow Wilson. His description of this majority recommendation was that “medical costs should be placed on a group payment basis through insurance, taxation, or both.” 4 One of the most controversial of these recommendations was summarized in a reflection written by the CCMC’s Director of Study, I.S Falk, 25 years after the committee’s dissolution. ![]() 3 In its final report in 1933, the committee made several recommendations to address the evolving landscape of healthcare costs. This rise in costs was reflected in the work of a group formed in 1927 called the Committee on the Cost of Medical Care (CCMC). 1, 2 With this increasing complexity of care came a parallel increase in costs. Rather than long-term care of the chronically unwell, hospitals came to utilize ever advancing therapies to treat patients. With the introduction of various discoveries such as anesthesia and antiseptic surgery, hospital care was changing. Medicine was evolving rapidly in the second half of the nineteenth century.
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