ABSTRACT
A vitally important reason for studying the historic background of enact a programs is that such knowledge can be used to adapt to emerging needs as well as understand what should be preserved. Medicare and Medicaid are among the most important institutions of our society and deeply rooted in tradition and law. The Medicare program is not organized to pursue such activities aggressively, with the delegation of initial coverage decisions to the carriers and a presumption of covering all approved, non experimental procedures. There was cause for celebration in the passage, finally, of national legislation dealing with universal categories of need—the elderly and the indigent. It got nearly universal participation by providers and, generally, a high level of continuing satisfaction despite a long history of increasingly intrusive regulatory reforms. Sustained efforts to amend Medicare began after the Carter presidency and the failure during that administration of efforts at hospital cost containment.
