Out of Balance: Medicare, Interest Groups, and American Politics

Medicare was born of interest group politics. The hostility of the American Medical Association (AMA)—the fiercest lobby in Washington from the 1930s to the 1960s—convinced advocates of public health insurance to start with the most vulnerable and difficult-to-insure segment of the population, the elderly. It also convinced Medicare’s advocates and early administrators to foreswear serious instruments for cost control that were in use in other rich democracies, such as fee schedules and restrictions on capital expenditures.