The changing national policy system: complexity, Medicare, and implications for aging groups

Changes in congressional processes, health agendas, and competitive positions of physician and hospital groups in the 1980s have produced important setbacks for such group interests within Medicare. Though united and successful in opposing Carter's 1977-79 hospital cost-containment proposals, these groups were subjected to severe new limits on hospital reimbursements under the 1982 budget reconciliation act. Thereafter, problems in protecting their interests continued or increased. Disagreements among hospital groups (e.g., the American Hospital Association and the former Federation of American Hospitals) surfaced over the Prospective Payment System introduced in 1983. In 1984, Congress instituted a freeze on physicians' Medicare fees despite AMA opposition. This projected narrow self-interest, thus decreasing the AMA's credibility. Further cost restrictions were imposed in 1985-86 budget acts. The problems of these organizations indicate that if aging groups are to protect their own stake in Medicare in the new political context, they must be particularly concerned with unity, credibility, and long-term perspectives.