ABSTRACT
This chapter examines the background of the landmark reform legislation establishing the Medicare and Medicaid programs. It considers the implementation of the programs. The chapter draws on some lessons from the experience with Medicare and Medicaid. Economic demand becomes the basis for use, creating inequities in access to health care, whereas equity would require that health need be the primary determinant of use. The Wagner-Murray-Dingell bills embodied the view—supported by Truman’s advisors, the labor movement, and public opinion polls—that financial means should not determine a person’s access to health care. In 1977, Medicare paid for 44 percent of all health care costs for the aged; another 14 percent were met by Medicaid and 7 percent by private insurance. Between 1966 and 1977, total health care spending per person sixty-five and over increased nearly four times while the patients’ direct payments increased only two times.
