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AbstractThis essay examines how Martha Derthick creatively combined history and political science to produce influential analyses of key public programs, such as Social Security.

On July 30, 1965, President Lyndon B. Johnson signed the Social Security Amendments of 1965 into law. With his signature he created Medicare and Medicaid, which became two of America's most enduring social programs. The signing ceremony took place in Independence, Missouri, in the presence of former President Harry S. Truman, as if to indicate that what President Truman and other Presidents before him had tried to get done had now been accomplished. Yet, for all of the appearance of continuity, the law that President Johnson approved differed in significant ways from the law that President Franklin D. Roosevelt would have passed in the thirties or President Truman would have signed in the forties. The very idea of national health insurance underwent a major transformation between the beginning of the century and 1965. Even as the passage of Medicare became assured late in 1964 and in 1965, the legislation remained fluid, with important matters related to consumer choice and the basic design of the program in constant flux.

On July 30, 1965, President Lyndon B. Johnson signed the Social Security Amendments of 1965 into law. With his signature he created Medicare and Medicaid, which became two of America's most enduring social programs. The signing ceremony took place in Independence, Missouri, in the presence of former President Harry S. Truman, as if to indicate that what President Truman and other Presidents before him had tried to get done had now been accomplished. Yet, for all of the appearance of continuity, the law that President Johnson approved differed in significant ways from the law that President Franklin D. Roosevelt would have passed in the thirties or President Truman would have signed in the forties. The very idea of national health insurance underwent a major transformation between the beginning of the century and 1965. Even as the passage of Medicare became assured late in 1964 and in 1965, the legislation remained fluid, with important matters related to consumer choice and the basic design of the program in constant flux.

Abstract. Mary E. Switzer (1901‐1972), a federal civil servant from 1921 to 1970, had a career which provides a case study of entrepreneurship within a bureaucracy. At first a staffer in progressive era social agencies, she became an assistant to Josephine Roche, well known advocate of government social programs. At first Switzer opposed federal health programs, believing that centralization of control would harm them. Then she became an advocate of federal aid to the local communities and health enterprises, with decentralized control over research and health services. Taking over vocational rehabilitation, she harmonized private and public power and at least managed to make a rehabilitation approach to social problems the cornerstone of President Eisenhower's domestic social welfare program. But the rehabilitation approach failed when applied to unemployment and poverty in general.

Intro -- Contents -- Preface -- Introduction -- Chapter 1. Congress Passes a Law, the Labor Movement Unites, and Walter George Retires -- Chapter 2. What Happened to the Disability Program and How Policy Makers Tried to Respond -- Chapter 3. Wilbur Mills, Wilbur Cohen, and Nelson Cruik shank Curate Medicare -- Chapter 4. The Consequences of Medicare from Accommodation to Regulation -- Chapter 5. The Continuing Consequences of Medicare: Choice and Prescription Drugs -- Chapter 6. The Welfare Reform Debate from JFK to Reagan -- Chapter 7. Clinton, Gingrich, and Welfare Reform in 1996 -- Conclusion -- Notes -- Index.