• Enduring truths

    [T]he federal government’s role in the financing of personal health services is one of the small class of public issues that can be counted on to activate deep, emotional, and bitter cleavages between what political commentators call “liberal” and “conservative” pressure groups. In the press, commentators felt compelled to write blow-by-blow descriptions of pressure group harangues and congressional responses. Within the Congress, clusters of Republicans and conservative southern Democrats allied to oppose “government medicine” and to declare ware against this “entering wedge of the Socialized State.”

    One has to read very closely to recognize this is not a description of the 2009-2010 debate over the ACA. Rather, it’s a description of the debate during the run-up to the 1965 passage of Medicare, as documented by Theodore Marmor in 1970 (page 17). His book, The Politics of Medicare, has since been updated and reprinted. I’m reading it now.

    Marmor continues,

    The president of the AMA captured the mood of Medicare’s critics in testifying before the Ways and Means Committee in 1963; hospital insurance for the aged, he said, was not “only unnecessary, but also dangerous to the basic principles underlying our American system of medical care.”

    I know the AMA was a different organization then than now. Nevertheless, if its membership in the 1960s could have anticipated the world as we now know it, with Medicare, I doubt many would prefer one without hospital insurance for the aged. Same goes for the other critics whose mood the then-AMA president captured.

    Reading stuff like this makes me wonder if interest groups even represent their own interests. It’s also interesting to contemplate the one-time strong resistance to Medicare by physicians juxtaposed against their urging of overrides and corrections to the Medicare physician pay schedule updates (the SGR). I guess paying physicians more is not unnecessary, dangerous, or against the basic principles underlying our system of medical care.*

    * In truth the SGR system has a virtue. However, I agree with doctors that it should be fixed. Actually, the entire way in which physicians are paid by Medicare should be updated. Some ideas here and here.

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