Primary Education Topic:
Policy and Advocacy
Other Education Topics:
Healthcare & Aging
Leadership in Aging
Legal & Ethical Issues
On the evolution of the older adult lobby, and the proliferation of narrow interest groups that threaten Medicare’s future.
By Jacob S. Hacker
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.