The Organization of Personal Health Services

In 1965, while approving Medicare, Congress reflected the prevailing view that such a program should not be used to alter arrangements for medical care. The whole intent was to assure payment for services; even to tinker with the system of health care delivery was looked upon as undesirable. The Medicare legislation specified: “Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any . . . control over . . . the manner in which medical services are provided . . .”1 Now, just six years later, it seems difficult to understand how Congress could have been persuaded that essentially only more money was needed to improve health care for the elderly, or for that matter any segment of the population, and that no attention to organization was needed. In 1971, several major health care proposals on the national scene reflect a directly opposite view; for example, the proposals by President Nixon, Senator Kennedy and the American Hospital Association. President Nixon in his 1971 health message to Congress, after discussing the inflationary rise in health care costs, continued:2