Preface  ix

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 1970s  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

Notes  253

Bibliography  289

Index  303

"[A] thorough histor[y] of health care reform. . . ."—Joseph S. Ross, New England Journal of Medicine

“I suspect dissatisfied consumers of the health care system will find much ammunition here, and policymakers and health educators will certainly find the book indispensable. Engel has a knack for crafting a well-written story out of complex and sometimes arcane legislation. He never fails to see the forest for the trees, yet he is able to add ample supporting evidence and specific, detailed documentation when helpful and appropriate. Let us hope psychologists also find their way to this book; many will find it relevant.”—Grant J. Rich, Contemporary Psychology

“With financially-strapped states continually slashing Medicaid and the Internal Revenue Service now probing whether nonprofit hospitals are providing enough charity care, Jonathan Engel’s well-researched and well-written book, Poor People’s Medicine, couldn’t be more timely.”—Lucia Hwang, California Nurse

“Poor People’s Medicine is a welcome arrival in the health policy literature. Newcomers to its topics will get a valuable overview of both trees and forest, and seasoned analysts will find in it many rich insights to ponder and pursue.”—Lawrence D. Brown, Health Affairs

“Engel has written a finely balanced and judicious work on a contentious subject. He does not take shortcuts and does his best to fully convey the intricacies of health care debates. This book deserves a prominent place on the reading lists of health care and social welfare historians.”—T. Beito, Journal of American History

“A compelling writer, [Engel] integrates scholarship from public policy, political science, the medical professions, and sociology to craft an informative and thought-provoking analysis of this controversial topic.”—Grant J. Rich, PsycCritiques

“[R]eaders [can learn] a great deal from Engel’s analysis of legislative history, his vast knowledge of published public health data regarding Medicaid, his extensive grasp of institutional changes in healthcare delivery, and his reconstruction of the worldview and experiences of health experts, planners, and policymakers.”—David Herzberg, Reviews in American History

“Any reader of this book will be forced to reflect on whether there is any truly neutral competence and how ‘experts’ can be distinguished from ‘advocates.’. . . [The book] has many provocative observations, and it could be of interest to anyone who is involved in administering or advocating for health programs for the poor.”—Joseph White, Public Administration Review

“This book provides a detailed history of health care provision for poor people in the United States, focusing on the period from 1965, and the establishment of the Medicaid program.”—Patrick Carroll, American Journal of Sociology

“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.”—Harriet L. Komisar, JAMA

“This thoughtful, thorough, and well-written book contains much more than could be covered in this review. . . . This book should be the first resource for anyone seeking information on the history of Medicaid.”—William G. Rothstein, Journal of the History of Medicine

“With its wealth of details about the interface of Medicaid, charity care, health status, and health care reform, Poor People’s Medicine is a valuable resource for both the health policy enthusiast and the beginner.”—Sidney D. Watson, Journal of Health Politics, Policy and Law

“Engel carefully reviews the historical constructs of American charity care, with emphasis on the implementation and various changes in the Medicaid program since 1965. . . . This is a well-written, easy-to-understand work. Recommended. Graduate students and above; general readers.”—J. E Thompson, Choice

“Engel painstakingly sorts through the many tides of support and criticism with respect to charity care in the United States, providing the reader with not only a clear and comprehensive history, but also a unique policy study that has great significance for the current debate over health care reform.”—Robert J. McGrath, Inquiry

"[A] thorough histor[y] of health care reform. . . ."—Joseph S. Ross, New England Journal of Medicine

“I suspect dissatisfied consumers of the health care system will find much ammunition here, and policymakers and health educators will certainly find the book indispensable. Engel has a knack for crafting a well-written story out of complex and sometimes arcane legislation. He never fails to see the forest for the trees, yet he is able to add ample supporting evidence and specific, detailed documentation when helpful and appropriate. Let us hope psychologists also find their way to this book; many will find it relevant.”—Grant J. Rich, Contemporary Psychology

“With financially-strapped states continually slashing Medicaid and the Internal Revenue Service now probing whether nonprofit hospitals are providing enough charity care, Jonathan Engel’s well-researched and well-written book, Poor People’s Medicine, couldn’t be more timely.”—Lucia Hwang, California Nurse

“Poor People’s Medicine is a welcome arrival in the health policy literature. Newcomers to its topics will get a valuable overview of both trees and forest, and seasoned analysts will find in it many rich insights to ponder and pursue.”—Lawrence D. Brown, Health Affairs

“Engel has written a finely balanced and judicious work on a contentious subject. He does not take shortcuts and does his best to fully convey the intricacies of health care debates. This book deserves a prominent place on the reading lists of health care and social welfare historians.”—T. Beito, Journal of American History

“A compelling writer, [Engel] integrates scholarship from public policy, political science, the medical professions, and sociology to craft an informative and thought-provoking analysis of this controversial topic.”—Grant J. Rich, PsycCritiques

“[R]eaders [can learn] a great deal from Engel’s analysis of legislative history, his vast knowledge of published public health data regarding Medicaid, his extensive grasp of institutional changes in healthcare delivery, and his reconstruction of the worldview and experiences of health experts, planners, and policymakers.”—David Herzberg, Reviews in American History

“Any reader of this book will be forced to reflect on whether there is any truly neutral competence and how ‘experts’ can be distinguished from ‘advocates.’. . . [The book] has many provocative observations, and it could be of interest to anyone who is involved in administering or advocating for health programs for the poor.”—Joseph White, Public Administration Review

“This book provides a detailed history of health care provision for poor people in the United States, focusing on the period from 1965, and the establishment of the Medicaid program.”—Patrick Carroll, American Journal of Sociology

“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.”—Harriet L. Komisar, JAMA

“This thoughtful, thorough, and well-written book contains much more than could be covered in this review. . . . This book should be the first resource for anyone seeking information on the history of Medicaid.”—William G. Rothstein, Journal of the History of Medicine

“With its wealth of details about the interface of Medicaid, charity care, health status, and health care reform, Poor People’s Medicine is a valuable resource for both the health policy enthusiast and the beginner.”—Sidney D. Watson, Journal of Health Politics, Policy and Law

“Engel carefully reviews the historical constructs of American charity care, with emphasis on the implementation and various changes in the Medicaid program since 1965. . . . This is a well-written, easy-to-understand work. Recommended. Graduate students and above; general readers.”—J. E Thompson, Choice

“Engel painstakingly sorts through the many tides of support and criticism with respect to charity care in the United States, providing the reader with not only a clear and comprehensive history, but also a unique policy study that has great significance for the current debate over health care reform.”—Robert J. McGrath, Inquiry

“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

“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

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