Synopses & Reviews
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.
“Medicaid is a vital program, and providing medical care to the poor is a critical issue in contemporary health policy, but there long has been a gap between Medicaid’s significance and academic attention to its historical evolution. There has not been nearly enough scholarship of the sort represented in Poor People’s Medicine, scholarship that sketches out the history of Medicaid, key changes in the program, and, crucially, the development of other medical care programs for the poor.”—Jonathan Oberlander, coeditor of The Social Medicine Reader, second edition
“As debate about Medicaid’s future rages in Washington, D.C., and state capitols around the country, Jonathan Engel’s book provides much-needed perspective on how our nation has provided health care to the poor over the years. As he shows, second-tier medicine for the poor and uninsured has been a stable feature of the American health care system, and efforts to close the gap between rich and poor cannot but face an uphill battle.”—Alan Weil, Executive Director, National Academy for State Health Policy
“The book reflects extensive research and abounds with details, and its descriptions of historic events are enlivened by quotations from concurrent observers. . . . There is plenty to learn from Poor People’s Medicine about the successes and shortcomings of our public policies toward making health care available to people who cannot otherwise afford it.”
A national and state-by-state history of public health options for the American poor.
About the Author
Jonathan Engel is Associate Professor and Chair of Public and Healthcare Administration at Seton Hall University.
Table of Contents
1. Antecedents: Poverty and Early Poverty Care Programs 1
2. Precursors to Medicare and Medicaid 28
3. War on Poverty and the Genesis of Medicaid 44
4. Hard-to-Reach Groups 69
5. Redefining Health 92
6. Charity Care and Comprehensive Reform under Nixon 107
7. Health Planning and Community Medicine in the 1970’s 123
8. Health and Welfare Reform in the Carter White House 144
9. Block Grants and the New Federalism 163
10. Recovering the Cuts, Managed Care, and Comprehensive Bill 184
11. Managed Medicaid, AIDS, and the Clinton Health Bill 209
12. Afterword 244