Poor People's Medicine

"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 "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 *

Jonathan Engel is Associate Professor and Chair of Public and Healthcare Administration at Seton Hall University.

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 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 Notes 253 Bibliography 289 Index 303