ABSTRACT
This chapter examines the politics of Medicare's enactment and answered one particular set of questions. It explains the rather curious progression by which the primary and strategically narrow aim of "initially" providing federal hospital insurance for the elderly was at the last minute substantially expanded, with the approval of former opponents. The chapter illustrates the interplay of causal influences outside of Medicare and those more closely related to the program's organization and immediate constituencies. Without such understanding, Medicare's expansion of prospective reimbursement and tighter fee schedules during the Reagan-Bush era of the 1980s would be truly anomalous. A visitor from Canada who observed the fight over the Clinton health reform proposal in the early 1990s would, had she returned in 1995, been surprised by the advocacy of Republican legislative leaders for a system of vouchers in Medicare.
