Poor People′s Medicine

Medicaid and American Charity Care since 1965

Poor People′s Medicine

Book Pages: 344 Illustrations: Published: February 2006

Author: Jonathan Engel

History > U.S. History, Medicine and Health > Public Health and Health Policy, Politics > Public Policy

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.


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

“[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

“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

“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

“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 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

“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

“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

“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 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

“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 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

“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

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


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Author/Editor Bios Back to Top

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

Table of Contents Back to Top
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
Sales/Territorial Rights: World

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Additional InformationBack to Top
Paper ISBN: 978-0-8223-3695-2 / Cloth ISBN: 978-0-8223-3683-9
Publicity material