Poor People's Medicine

Engel Jonathan Engel

Description

Poor People's Medicine is a detailed history of Medicaid since its beginning in 1965. Federally aided and state-operated, Medicaid is the single most important source of medical care for the poorest citizens of the United States. From acute hospitalization to long-term nursing-home care, the nation's Medicaid programs pay virtually the entire cost of physician treatment, medical equipment, and prescription pharmaceuticals for the millions of Americans who fall within government-mandated eligibility guidelines. The product of four decades of contention over the role of government in the provision of health care, some of today's Medicaid programs are equal to private health plans in offering coordinated, high-quality medical care, while others offer little more than bare-bones coverage to their impoverished beneficiaries.Starting with a brief overview of the history of charity medical care, Jonathan Engel presents the debates surrounding Medicaid's creation and the compromises struck to allow federal funding of the nascent programs. He traces the development of Medicaid through the decades, as various states attempted to both enlarge the programs and more finely tailor them to their intended targets. At the same time, he describes how these new programs affected existing institutions and initiatives such as public hospitals, community clinics, and private pro bono clinical efforts. Along the way, Engel recounts the many political battles waged over Medicaid, particularly in relation to larger discussions about comprehensive health care and social welfare reform. Poor People's Medicine is an invaluable resource for understanding the evolution and present state of programs to deliver health care to America's poor.

Sujets

• Charities
• Sociologie, société et politique
• USA
• Charitable organization
• États-Unis

Informations

• Publié par: Duke University Press
• Date de parution: 22 février 2006
• Nombre de lectures: 0
• EAN13: 9780822387633
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Poor People’s Medicine

Poor People’s Medicine

Medicaid and American Charity Care since 1965

j o n at h a n e n g e l

D U K E U N I V E R S I T Y P R E S S

2 0 0 6

D U R H A M & L O N D O N

∫2006 Duke University Press

All rights reserved

Printed in the United States of America on acid-free paper$

Designed by Rebecca M. Giménez

Typeset in Minion by Keystone Typesetting, Inc.

Library of Congress Cataloging-in-Publication Data appear

on the last printed page of this book.

in memory of my father

Contents

1

2

3

4

5

6

7

8

9

10

11

12

Preface

ix

Antecedents: Poverty and Early Poverty Care Programs

Precursors to Medicare and Medicaid

28

War on Poverty and the Genesis of Medicaid

Hard-to-Reach Groups

Redefining Health

92

69

44

Charity Care and Comprehensive Reform under Nixon

Health Planning and Community Medicine in the 1970s

Health and Welfare Reform in the Carter White House

Block Grants and the New Federalism

163

1

107

123

144

Recovering the Cuts, Managed Care, and Comprehensive Reform

Managed Medicaid,aids, and the Clinton Health Bill

Afterword

Notes

253

244

Bibliography

Index

303

289

209

184

Preface

This is a story of ambivalence, for no other word better describes e√orts at charity medical care in the United States over the past half-century. Unwilling to wholly abandon the poor to private charities and municipal relief e√orts, but at the same time unwilling to provide full access to the private health system through a fully funded state insurance program, the nation has provided health insurance to the poor, coupled with an array of loosely coordinated community health centers, public hospitals, and neighborhood health clinics. The result has been imperfect, and fre- quently unsatisfactory, yet the e√ort has also produced startling suc- cesses. America’s poor today live nearly as long as the nonpoor, survive infancy at rates approaching those of the population at large, and use private physicians and hospitals at least as much as the privately insured do. Even as they complain, accurately, of being shunted to a second-tier medical system, the poor are granted access to some of the best hospitals and physicians in the country. Moreover, by most any measure the system has improved continu- ously for forty years. Starting with the legislation which created the mod- ern Medicaid program in 1965, the nation has increased federal subsidies to the states which administer the Medicaid programs, implemented new early screening and care programs, expanded eligibility, and subsidized services unimaginable at the time of the program’s construction. Dental,