Lisbeth B. Schorr, Center for the Study of Social Policy
It was early 1965 when I sat in on a meeting that was one of a series deliberating the final touches of the legislation that would soon be enacted as Medicare. Those gathered that day were the Undersecretary of HEW, Wilbur Cohen, the Commissioner of Social Security, Robert Ball, a representative of the White House whose name I can no longer remember, and the director of social security for the AFL-CIO, Nelson Cruikshank.
Wilbur Cohen reported on his latest inconclusive negotiations with Wilbur Mills, chair of the House Ways and Means Committee. He also reported with considerable enthusiasm that someone at the White House had suggested a novel way to deal with one of the troublesome issues still outstanding: how to decide on the hospital benefit to be covered. Should the benefit consist of 15 days of hospitalization with no coinsurance and no deductible? 30 days with a 3-day deductible? 60 days with a larger deductible and coinsurance? The solution that the Undersecretary was now advancing was to provide the beneficiaries with a choice among each of these.
I remember vividly how the soft-spoken Commissioner of Social Security rose from his chair to announce, in the strongest voice I had ever heard him use, that he would refuse to administer such a benefit. He was unwilling to ask retirees, a significant segment of whom were in their 80s and 90s, to struggle with that kind of a choice. He was also convinced that the complexities of administering such a program would threaten the Social Security Administration’s 30-year commitment to making every encounter between government and beneficiary one that inspired confidence because it was clear, smooth, and self-evidently fair. The choice-of-benefits idea was never proposed again.
While I’m fully aware that those who are making choices about their health insurance today are a more heterogeneous group than the over-65 Social Security beneficiaries of 1965, and that the capacity to deal electronically with that kind of decision-making has vastly increased (though perhaps not quite enough), I still long for the voice of Robert Ball. With his unwavering focus on assuring every American with a high quality experience in dealing with government, he might have saved us from some of the disappointments we experienced this October.