The Health of the Welfare State

In the United States, the Federal government has so far limited itself to Medicare and Medicaid in terms of health service provision. Before the establishment of Medicare in the mid-1960s, medical delivery in the United States still retained a considerable degree of charity work by most physicians, with a heavy involvement of voluntary and philanthropic agencies in the operation of clinics and hospitals. With the introduction of Medicare, which supported a large proportion of medical and hospital costs for the elderly, and which was based on a fee-for-service system to doctors, medical purveyors and hospitals, there was a rapid rise in medical expenditures and medical delivery. Seemingly overnight, with rises in costs and volume, there was a diminution of charity and voluntary medical services.