Not long after the 1966 enactment of Medicare and Medicaid, evidence emerged that unscrupulous physicians and health care organizations were gaming the system. Research over the past 50 years shows that around 10 percent of the federal government’s annual cost for these programs is attributed to fraudulent claims or abuses where hospitals and treatments have been overused for undue provider profit. This article examines early congressional attention to this problem and describes lawmakers’ attempts to find legislative solutions to it. It historicizes the dilemma of balancing the ideological limits of government regulation with cultural assumptions about professional self-regulation, focusing on a major 1972 law, the Professional Standards Review Organization (PSRO) Act. The law launched a 10-year career for PSROs, physician-staffed peer-review boards designed to identify and sanction efforts to overcharge Medicare. The article contextualizes multiple actors’ concerns over cost containment and the crisis of faith in medical authority that persisted following failures to control professional malfeasance.

This article examines the divide within the Republican Party between business interests and conservative evangelicals during the debate over the Americans with Disabilities Act of 1990 (ADA). Business interests were able to build compromises by raising their concerns over practical matters such as costs. Conservative evangelicals advocated for changes due to their moral and ideological positions on homosexuality and HIV. Conservative evangelicals did not receive their desired changes because they constructed their concerns with public safety themes. This led to conservative evangelicals and their opponents talking past each other instead of addressing their concerns. The dynamics shown from the opposition of conservative evangelicals in the ADA debate demonstrate that their influence in elections did not lead to dominance within the Republican Party in shaping policy.

This article examines out-of-home placements in Denmark over a seven-decade period from 1905 to 1975. The Danish state delegated this responsibility to a, using the words of Kimberly J. Morgan and Ann Shola Orloff, “difficult-to-classify public-private hybrid,” the Children’s Welfare Boards (CWBs). These CWBs comprised private citizens selected by the municipality. The article shows how the CWBs acted as interpreters, mediators, and implementers of state policy at the street level while also functioning as the direct link between government and citizens. The findings reveal an inherent conflict between center and periphery in that the state’s nationwide regulations and bureaucratic practices, intended to apply to all citizens uniformly, were to be implemented by local units within municipalities that operated according to logics other than those of the state. The vase of variations in child out-placement practices shows the importance of examining local variations in studying the history of policy implementation.

Nineteenth-century seamen were subject to exploitation by boardinghouse keepers who recouped seamen’s debt by pocketing their advance wages from a future voyage. New York’s 1866 Act for the Better Protection of Seamen, the U.S. Shipping Commissioners Act of 1872, and the 1884 Dingley Act all purported to respond to this practice of “crimping,” but each of these acts simply allowed for new arrangements that continued to exact money from seamen. Even when corruption or collusion operated and were publicly known, such practices were tolerated because they continued to provide a steady supply of maritime labor, which promoted maritime commerce. This article considers the misleading political development of this legislation in the context of the early years of spoils reform.

This article examines the financial industry’s critical role in retargeting U.S. health policy goals of improving peoples’ health in the 1960s to those of expanding institutional wealth in the 1970s. Government collaborated with finance to support not-for-profit hospitals’ use of debt to build services that augmented capital and operated like for-profit businesses. Certificate of Need, hospital rate review, and national health planning programs came to assess hospital performance in terms of capital formation, returns on investment, and bond ratings. The regulatory programs helped gentrify medicine by reinforcing selective investment in lucrative, high-tech services that market specialty procedures to affluent populations in place of disease control, primary care, and general acute care for all. Their actions laid the groundwork for the 1980s finance industry coup, which employed market ideology to dominate health policy at the expense of equality, effectiveness, and public health governance.