1966

Medicare Parts A&B become effective: “Thus with a stroke of the pen the elderly acquired hospital benefits, the hospitals acquire cost reimbursement for these benefits, the Blue Cross Association [chosen as intermediary by 90% of hospitals] was precipitated into prominence as a major national organization (since the national contract was to be with the association, with subcontracting to local plans), and the Joint Commission [of Accreditation of Hospitals] was given formal government recognitions. “Simultaneously, through the implementation of federally subsidized Medicaid programs in the various states, the poor, like the elderly, were brought into the ‘mainstream’ of medicine. In theory, at least, most Americans might now be fully insured. . . . Medicare was a catalyst, testing the organizational resilience and the social altruism of the voluntary enterprise – testing, that is, its essential character. But some lines of development were already evident. Medicare and Medicaid together were to support the voluntary over the governmental hospital system. They affirmed the central importance of the hospital in American medicine, but left to individual hospitals the translation of this importance into networks and systems. There was little to push hospitals much beyond their exciting space-age image on TV. The altruistic aspects of voluntarism remained appealing, as did the continuing strategic connotations: freedom of action, political immunity local initiative, and noninterference of government in caring for the sick. But maintaining voluntarism carried the paradox of voluntary controls, if strong government controls were to be avoided, as well as opportunities for voluntary initiative” (Stevens II, 281-282).