1. The term is Harold L. Wilensky's; see his The Welfare State and Equality: Structural and Ideological Roots of Public Expenditures (Berkeley: University of California Press, 1975).

This account draws largely but not exclusively on the following sources. Recent general accounts of public policy with respect to medical care include: Lawrence D. Brown, Politics and Health Care Organization: HMOs as Federal Policy (Washington, D.C.: Brookings, 1983); Karen Davis, National Health Insurance: Benefits, Costs, and Consequences (Washington, D.C.: Brookings, 1975); Alain Enthoven, Health Plan: The Only Practical Solution to the Soaring Cost of Medical Care (Menlo Park, Calif.: Addison-Wesley, 1980); and Paul Starr, The Social Transfor - soft

mation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982).

Recent but more specific accounts include: Henry J. Aaron and William B. Schwartz, The Painful Prescription: Rationing Hospital Care (Washington, D.C.: Brookings, 1984); Martha Derthick, Policymaking for Social Security (Washington, D.C.: Brookings, 1983) chaps. 15 and 16; Paul T. Menzel, Medical Costs, Moral Choices: A Philosophy of Health Care Economics in America (New Haven: Yale University Press, 1983); and Ann Shola Orloff and Theda Skocpol, "Why Not Equal Protection? Explaining the Politics of Public Social Welfare in Britain and the United States, 1880s-1920s," paper presented at the 1983 annual meeting of the American Sociological Association, Detroit, September 2.

Older but still useful general accounts include: Daniel S. Hirschfield, The Lost Reform: The Campaign for Compulsory Health Insurance in the United States from 1932 to 1943 (Cambridge: Harvard University Press, 1970); Roy Lubove, The Struggle for Social Security, 1900-1935 (Cambridge: Harvard University Press, 1968); and Theodore R. Marmor, The Politics of Medicare (Chicago: Aldine, 1973).

On the consequences of Medicare see Henry R. Brehm and Rodney M. Coe, Medical Care for the Aged: From Social Problem to Federal Program (New York: Praeger, 1980); and Stephen Davidson and Theodore R. Marmor, The Cost of Living Longer: National Health Insurance for the Elderly (Lexington, Mass.: D.C. Heath, 1980). On the consequences of Medicaid see Karen Davis and Cathy Schoen, Health and the War on Poverty: A Ten-Year Appraisal (Washington, D.C.: Brookings, 1978), chaps. 1, 2, 4, 6, and 7.

For statistics on Medicare see Congressional Budget Office, Changing the Structure of Medical Benefits: Issues and Options (Washington, D.C.: Congressional Budget Office, 1983); and selected issues of the Social Security Bulletin . [BACK]

2. Crusade is an appropriate term in light of Samuel Huntington's description of this period as one of "creedal passion"; see his American Politics: The Promise of Disharmony (Cambridge: Harvard University Press, 1981). [BACK]

3. See Carleton B. Chapman and John M. Talmadge, "The Evolution of the Right-to-Health Concept in the United States," in Maurice B. Visscher, ed., Humanistic Perspectives in Medical Ethics (Buffalo, N.Y.: Prometheus, 1972), pp. 72-134, especially pp. 94-103. [BACK]

4. Hirschfield, Lost Reform , passim. [BACK]

5. See Davis and Schoen, Health and the War on Poverty , chap. 5. [BACK]

6. Marmor, Politics of Medicare , pp. 14-16. [BACK]

7. Marmor, Politics of Medicare , pp. 25 and 53. On the extension of continue

social security to disabled workers, see Derthick, Policymaking , chap. 15. [BACK]

8. Brown, Politics and Health Care , pp. 195-96. [BACK]

9. For a comparison of various proposals see Davis, National Health Insurance , chap. 5; and Davidson and Marmor, Cost of Living Longer , chap. 5. [BACK]

10. Other beneficiaries include railroad retirement recipients, persons receiving social security disability payments, and some kidney dialysis patients. For most of these persons the criterion of effort is still applicable. [BACK]

11. For details of coverage see Brehm and Coe, Medical Care for the Aged , pp. 59-63; or Davidson and Marmor, Cost of Living Longer , pp. 35-40. [BACK]

12. Brehm and Coe, Medical Care for the Aged , pp. 41-42. [BACK]

13. See Ivan D. Illich, Medical Nemesis: The Expropriation of Health Care (New York: Bantam, 1977). [BACK]

14. Guido Calabresi and Philip Bobbit, Tragic Choices (New York: Norton, 1978); Menzel, Medical Costs, Moral Choices , p. 138. [BACK]

15. Menzel, Medical Costs, Moral Choices , p. 82. [BACK]

16. Marmor, Politics of Medicare , pp. 67, 86, and 122-23. [BACK]

17. M. Kenneth Bowler, "Changing Politics of Federal Health Insurance Programs," PS 20 (Spring 1987):202-11. [BACK]

18. Starr, Social Transformation , bk. 2, chap. 5. [BACK]

19. Starr, Social Transformation , p. 311 and bk. 2, chap. 5. [BACK]

20. Davis and Schoen, Health and the War on Poverty , p. 97; Congressional Budget Office, Changing the Structure of Medical Benefits , pp. 11-12; Social Security Bulletin 51 (July 1988). [BACK]

21. See Enthoven, Health Plan , pp. 16-32; and Davis and Schoen, Health and the War on Poverty , p. 97. [BACK]

22. John Holahan and John L. Palmer, "Medicare's Fiscal Problems" (Washington, D.C.: Changing Domestic Priorities Project, Urban Institute, 1987). [BACK]

23. See Enthoven, Health Plan , pp. 27-28 and 105-6; and Bowler, "Changing Politics of Health Insurance." [BACK]

24. Enthoven, Health Plan , pp. 32-36. [BACK]

25. See Brehm and Coe, Medical Care for the Aged , pp. 68-77; and Menzel, Medical Costs, Moral Choices , pp. 120 and 138. [BACK]

27. Enthoven, Health Plan , pp. 82-89. [BACK]

28. Enthoven, Health Plan , pp. 84-88; and Brown, Politics and Health Care , pp. 377-82. [BACK]

29. Brown, Politics and Health Care . [BACK]

30. See Brown, Politics and Health Care , pp. 234 and 360. break [BACK]

31. On the need for regulation under competitive and current market conditions, see Brown, Politics and Health Care , pp. 228, 234, and 360; Enthoven, Health Plan , pp. 78-82. [BACK]

32. Brown, Politics and Health Care , p. 527; and Davis and Schoen, Health and the War on Poverty , pp. 212-13; and Davidson and Marmor, Cost of Living Longer , chap. 5. [BACK]

33. Davis and Schoen, Health and the War on Poverty , p. 92. [BACK]

34. Brehm and Coe, Medical Care for the Aged , pp. 63-64 and 95. [BACK]

35. These terms as well as accountability and acceptability —Medicare doing better on the latter—come from Brehm and Coe, Medical Care for the Aged , p. 130. [BACK]

36. Davis, National Health Insurance , p. 73. [BACK]

37. Davidson and Marmor, Cost of Living Longer , p. 12. [BACK]

38. "President Carter's National Health Plan Legislation: Detailed Fact Sheet" (Washington, D.C.: Department of Health, Education, and Welfare, June 12, 1979). [BACK]

39. But see Louise B. Russell, Is Prevention Better Than Cure? (Washington, D.C.: Brookings, 1986). [BACK]

40. Brehm and Coe, Medical Care for the Aged , pp. 79-81. [BACK]

41. Marmor, Politics of Medicare , p. 25. [BACK]

42. See particularly, Enthoven, Health Plan , pp. 105-6. [BACK]

43. Starr, Social Transformation , bk. 2, chap. 5, discusses this decline but has a glum view of it. [BACK]

44. Charles Lockhart, "Values and Policy Conceptions of Health Policy Elites in the United States, the United Kingdom, and the Federal Republic of Germany," Journal of Health Politics, Policy and Law 6 (Spring 1981):98-119, particularly pp. 103-5. [BACK]