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Getting to the Affordable Care Act

Published online by Cambridge University Press:  15 September 2017

Edward Berkowitz
Edward Berkowitz*
Affiliation:
George Washington University
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Type
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Information
Journal of Policy History , Volume 29 , Issue 4 , October 2017 , pp. 519 - 542
Copyright
Copyright © Donald Critchlow and Cambridge University Press 2017 

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Footnotes

This article originated as a talk given at the Institute for Health, Health Care Policy, and Aging Research on October 8, 2015, at Rutgers University. I am grateful to Professor David Mechanic for arranging the event. I also wish to make clear that the essay was written, peer reviewed, and rewritten while Barack Obama was still president and before it became evident that Donald Trump and the Republican Party would win the 2016 election. I would contend that, despite the change in the political landscape, the points made in the article remain relevant to the history of health-care policy, although that is up to the reader to decide.

References

NOTES

1. Michael Hash, Oral interview with Edward Berkowitz, 11 May 2015, 14, in “Insights from the Top: An Oral History of Medicare and Medicaid” (hereafter Oral History Project), available from Centers for Medicare and Medicaid Services and the National Academy of Social Insurance.

2. “Remarks by the President and Vice President at Signing of the Health Insurance Reform Bill,” 23 March 2010, White House Press Release.

3. Excellent books in this genre include Christy Ford Chapin, Ensuring America’s Health: The Public Creation of the Corporate Health Insurance System (New York, 2015); Derickson, Alan, Health Security for All: Dreams of Universal Health Care in America (Baltimore, 2005);Google Scholar Fungiello, Phillip J., Chronic Politics: Health Care Security from FDR to George W. Bush (Lawrence, Kans., 2005);Google Scholar Gordon, Colin, Dead on Arrival: The Politics of Health in Twentieth Century America (Princeton, 2003);Google Scholar Hoffman, Beatrix, Health Care for Some: Rights and Rationing in the United States Since 1930 (Chicago, 2012).CrossRefGoogle Scholar

4. Michael Hash Interview; Jacobs, Lawrence R. and Skocpol, Theda, Health Care Reform and American Politics: What Everyone Needs to Know, expanded ed. (New York, 2012), 50, 114–18.Google Scholar

5. Interview with Gail Wilensky, 27 April 2015, Oral History Project, 13.

6. Himmelfarb, Richard, Catastrophic Politics: The Rise and Fall of the Medicare Catastrophic Coverage Act of 1988 (University Park, Pa., 1995), 37–40, 73;Google Scholar Thomas Scully, Interview with Edward Berkowitz, 19 May 2015, Oral History Project; Dan Rostenkowski, Interview with Edward Berkowitz, CMS Oral History (hereafter CMS Interviews), 4 December 2002, 695–709, available at https://www.cms.gov/...cms/... (.)

7. Robert Berenson, Interview with Edward Berkowitz, 20 May 2015, 8, Oral History Project. The Clinton health-care initiative has produced the usual raft of academic and popular articles and books. For a sample, see Simon Haeder, F. and Weimer, David L., “Inching Toward Universal Coverage: State-Federal Health-Care in Historical Perspective,” Journal of Policy History 23 (2015): 759;Google Scholar Skocpol, Theda, Boomerang: Health Care Reform and the Turn Against Government (New York, 1997);Google Scholar Hacker, Jacob S., The Road to Nowhere: The Genesis of President Clinton’s Plan for Health Security (Princeton, 1997);Google Scholar Johnson, Haynes and Broder, David, The System: The American Way of Politics at the Breaking Point (New York, 1997).Google Scholar

8. Nancy-Ann Min Deparle, Interview with Edward Berkowitz, 2 April 2015, Oral History Project.

9. Johnson and Broder (The System, 94) cite a memo from Atul Gawande that this (the need for cost control and expanded coverage) was the conventional wisdom as early as the Clinton administration. Gawande called health care “at once our most ambitious and treacherous project.”

10. Kerry Weems, Interview with Edward Berkowitz, 27 May 2015, 15, Oral History Project; Herbert B. Kuhn, Interview with Edward Berkowitz, 6 May 2015, 17, Oral History Project.

11. Oberlander, Jonathan and Marmor, Theodore R., “The Road Not Taken: What Happened to Medicare for All?” in Medicare and Medicaid at 50: America’s Entitlement Programs in the Age of Affordable Care, ed. Cohen, Alan B., Colby, David C., Wailoo, Keith A., and Zelizer, Julian (New York, 2015), 56–57.Google Scholar A standard reference to the Truman experience is Monte Poen, Harry S. Truman Versus the Medical Lobby: The Genesis of Medicare (Columbia, Mo., 2014). The usual account focuses on public relations techniques that were successfully employed to defeat the Truman initiative. See David Greenberg, Republic of Spin: An Inside History of the American Presidency (New York, 2016), 214–21.

12. See, for example, Berkowitz, Edward and DeWitt, Larry, “Social Security from the New Deal to the Great Society: Expanding the Public Domain,” Conservatism and American Political Development, ed. Glenn, Brian J. and Teles, Steven M. (New York, 2009), 53–85.CrossRefGoogle Scholar

13. Berkowitz, Edward, “The Historical Development of Social Security in the United States,” in Social Security in the 21st Century, ed. Kingson, Eric and Schulz, James (New York, 1997), 22–38.Google Scholar

14. Christopher Howard, The Hidden Welfare State: Tax Expenditures and Social Policy in the United States (Princeton, 1997).

15. Zelizer, Julian E., Taxing America: Wilbur D. Mills, Congress, and the State, 1945–1975 (New York, 1998), 212–54;Google Scholar Berkowitz, Edward, Mr. Social Security: The Life of Wilbur J. Cohen (Lawrence, Kans., 1995), 215–22;Google Scholar Woods, Randall B., Lyndon Johnson, the Great Society, and the Limits of Liberalism (New York, 2016).Google Scholar

16. Cohen, Wilbur J. “Reflections on the Enactment of Medicare and Medicaid,” Health Care Financing Review, 1985Google Scholar Annual Supplement, 6; Wilbur Cohen to the President, 2 March 1965, Box 83, Wilbur Cohen Papers, Wisconsin State Historical Society, Madison. For a different view of this development and for an excellent overview of presidential health-care politics, see Blumenthal, David and Marone, James A., The Heart of Power: Health and Politics in the Oval Office (Berkeley, 2009).Google Scholar

17. Olson, Laura Katz, Introduction to The Politics of Medicaid (New York, 2010)Google Scholar; Smith, David G. and Moore, Judith G., Medicaid Politics and Policy, 2nd ed. (New Brunswick, 2015), chaps. 1 and 2.Google Scholar

18. Robert Ball to Karl deSchweinitz, 3 January 1963, Robert Ball Papers, Wisconsin State Historical Society.

19. Wilbur Cohen to Joseph Califano, 19 January 1968, Box 95, Cohen Papers; Ball, Robert, “Is Medicare Worth the Price?” US News and World Report, 21 July 1969CrossRefGoogle Scholar, copy available in Ball Papers.

20. Berkowitz, Edward and DeWitt, Larry, The Other Welfare: Supplemental Security Income and U.S. Social Policy (Ithaca, 2013), 38–42.Google Scholar

21. Blumenthal and Morone, The Heart of Power, 392–93.

22. Robert J. Myers with Richard L. Vernaci, Within the System: My Half Century in Social Security (Winsted, Conn., 1992).

23. W. R. Williamson, Statement of W. R. Williamson, in transcript of Advisory Council meeting, 21 October 1938, in Record Group 47, Records of the Social Security Administration, Box 13, National Archives, 59; Wilbur J. Cohen to Arthur Altmeyer, 13 October 1938, Record Group 47, File 025, Box 10; Derthick, Martha, Policymaking for Social Security (Washington, D.C., 1979), 170–82.Google Scholar

24. Califano, Joseph A. Jr., Governing America: An Insiders Report from the White House and the Cabinet (New York, 1981), 43–45.CrossRefGoogle Scholar

25. Sundquist, James, The Decline and Resurgence of Congress (Washington, D.C., 1980);Google Scholar Zelizer, Julian E., On Capitol Hill: The Struggle to Reform Congress and Its Consequences (New York, 2004), 154.Google Scholar

26. Oliver, Thomas R., Lee, Philip R., and Lipton, Helene L., “A Political History of Medicare and Prescription Drug Benefit,” Milbank Quarterly 82 (2004): 283–354.CrossRefGoogle Scholar

27. Interview with Thomas Scully, 28. I have based much of my account of this incident and taken all of the quotations from this interview. The chapter on the Medicare Modernization Act in Blumenthal and Morone, The Heart of Power, 385–408, is also useful, as is Morgan, Kimberly J. and Campbell, Andrea, The Delegated Welfare State: Medicare, Markets, and the Governance of Social Policy (New York, 2011).Google Scholar

28. Scully interview, 31.

29. Carey, Mary Agnes, “Retiring Medicare Actuary Reflects on the Politics of Health Care,” Kaiser Health News, 28 January 2013Google Scholar; “The Foster Affair,” editorial, New York Times, 13 July 2004; “Mysterious Fax Adds to Intrigue over Drug Bill,” New York Times, 17 March 2004; “Inquiry Confirms Top Medicare Official Threatens Actuary over Drug Benefits,” New York Times, 6 July 2004; “Senate Democrats Claim Medicare Chief Broke Law,” New York Times, 18 March 2004; “Requesting the President and Directing the Secretary of Health and Human Services Provide Certain Documents to the House of Representatives Relating to Estimates and Analysis of the Cost of the Medicare Drug Legislation,” 7 October 2004, House Report-108-754.

30. Louis Hays, Interview with Edward Berkowitz, 22 April 2015, Oral History Project, 6.

31. William Roper, Interview with Edward Berkowitz, 10 April 2015, Oral History Project, 23.

32. Mayes, Rick and Berenson, Robert A., Medicare Prospective Payment and the Shaping of U.S. Health Policy (Baltimore, 2006);Google Scholar Altman, Stuart and Shactman, David, Power, Politics, and Universal Health Care (Amherst, N.Y., 2011).Google Scholar

33. Michael McMullan, Interview with Edward Berkowitz, 26 May 2015, Oral History Project, 18.

34. Bruce Vladeck, Interview with Rick Mayes, 14 April 2002 (transcript courtesy of Rick Mayes); Rick Mayes, “The Origins, Development, and Passage of Medicare’s Revolutionary Payment System,” courtesy of the author, version published in Journal of the History of Medicine and Allied Sciences (2006).

35. Paul Rettig, Interview with Edward Berkowitz, 14 August 1995, CMS Oral History Collection.

36. Jacob S. Hacker, “From Servant to Master to Partner,” in Medicare and Medicaid at Fifty, ed. Cohen, Colby, Wailoo, and Zelizer, 275.

37. C. McClain Haddow, Interview with Edward Berkowitz, 8 June 2015, Oral History Project, 14.

38. Hsiao, William C., Braun, Peter, Dunn, Daniel, and Becker, Edmund R., “Resource-Based Relative Scale Values: An Overview,” Journal of the American Medical Association 260 (1980): 2347–52.Google Scholar

39. Henry Des Marais, Interview with Edward Berkowitz, 27 May 2015, Oral History Project, 8.

40. “Patient Protection and Affordable Care Act,” Public Law 111-148, 23 March 2010.

41. Smith and Moore, Medicaid Politics and Policy, 99; Derthick, Policymaking for Social Security.

42. Michael McMullan interview, 6; Kerry Weems interview, 17; William Toby, Interview with Edward Berkowitz, 26 June 2015, Oral History Project, 9.

43. McMullan interview, 29.

44. Klemm, John D., “Medicaid Spending: A Brief History,” Health Care Financing Review 22 (2000): 105.Google Scholar

45. Hoffman, Beatrix, Health Care for Some: Rights and Rationing in the United States Since 1930 (Chicago, 2012), 188;Google Scholar Laura Katz Olson, The Politics of Medicaid, 69–70.

46. Rice, T., Desmond, K., and Gabel, J., “The Medicare Catastrophic Coverage Act: A Post-Mortem,” Health Affairs 9 (1990): 77.Google Scholar

47. Klemm, “Medicaid Spending,” 108; Olson, Medicaid Politics, 73.

48. Judith Feder, “The Missing Piece: Medicaid, Medicare, and Long-Term Care,” in Medicare and Medicaid at Fifty, ed. Cohen et al., 57; Rashi Fein, “The Early Days of Medicare and Medicaid,” in Medicare and Medicaid at Fifty, ed. Cohen et al., 49; Olson, Medicaid Politics, 133–34, 26.

49. Feder, “The Missing Piece,” 255.

50. Olson, Medicaid Politics, 5.

51. U.S. House of Representatives, Historian’s Office, “Waxman, Henry Arnold,” http://history.house.gov/People/Listing/W/WAXMAN,-Henry-Arnold-%28W000215%29/.

52. Witte, Edwin, The Development of the Social Security Act (Madison, 1962), 80–81.Google Scholar

53. Huthmacher, J. J., Senator Robert Wagner and the Rise of Urban Liberalism (New York, 1968);Google Scholar Mayes, Rick, Universal Coverage: The Elusive Quest for National Health Insurance (Ann Arbor, 2004), 31–40;Google Scholar Smith and Moore, Medicaid Politics and Policy, Kindle edition, location 2619.Google Scholar

54. Klemm, “Medicaid Spending,” 109; Haeder and Weimer, “Inching Toward Universal Coverage,” 759; Smith and Moore, Medicaid Politics and Policy, Kindle edition, location 2908.

55. Michael Hash interview, 8; Herbert Kuhn interview, 6 May 2015, Oral History Project, 2; Thompson, Frank J., “Medicaid Rising: The Perils and Pitfalls of Federalism,” in Medicare and Medicaid at FiftyGoogle Scholar, ed. Cohen et al., 195; Starr, Paul, Remedy and Reaction: The Peculiar American Struggle over Health Care (New Haven, 2013), 71.Google Scholar

56. Goldstein, Amy, “Third ACA Sign-up to Focus on 10.5 Million Uninsured Americans,” Washington Post, 22 September 2015.Google Scholar

57. Rosenbaum, Sara and Westmoreland, Timothy M., “The Supreme Court’s Surprising Decision on the Medicaid Expansion: How Will the Federal Government and States Proceed?” Health Affairs 31 (2012): 1663–72Google Scholar, commenting on National Federation of Independent Business v. Sibelius; Levey, Noam A., “2 GOP Senators to Unveil Plan to Replace Obamacare,” Baltimore Sun, 19 May 2016, 9.Google Scholar

58. Roper interview, 18.

59. Herbert Kuhn interview, 19.

60. Roper interview, 22.

61. Tavenner interview, 13.