Why Radiology is Not Part of Medicare Part A

This History of Radiology and
Julian Hardman, MD
John H. Stroger Hospital, Chicago
Rise of Medicare
• In the 1940s, the idea of national hospital insurance
seriously showed up on the congressional agenda in
bills by Murray, Wagner and Dingell
• All of the early congressional bills included radiology
as a hospital based service rather than a service
provided by independent physicians
• With the election of John Kennedy and Lyndon
Johnson in the 1960s, Medicare seemed sure to be
Rise of Medicare
• The American College of Radiology realized that it
had to stop radiology from being perceived as a
service provided by the hospital, and rather a service
provided by physicians
• In 1963 the ACR president Jack Carroll testified
before a congressional committee that including
radiology as a hospital service would destroy the
field of radiology
Rise of Medicare
• In 1964 it was apparent that Medicare was going to be
pushed through Congress
• The Medicare legislation in its current form was going to
cover radiology in hospitals rather than in physician offices
• In January 1965 the executive committee of the ACR met with
Karl Mundt who was a conservative senator
• He advised the committee to hire a lobbyist to get radiology
written out of the bill as Medicare was sure to pass through
Congress in 1965
• Who to Hire???
Lobbying Effort
• One month later, the ACR hired a former Democratic
congressman, J. T. Rutherford who taught the ACR
how to lobby Congress in that era
Lobbying Effort
• There were two targets of the lobbying effort:
– Represenative Wilbur Mills of Arkansas who was the chairman of the
house Ways and Means Committee
– Senator Paul Douglas of Illinois who was the chair of the Senate
Finance Committee
• Rep. Mills supported the view of the ACR while Sen. Douglas
and President Johnson did not
• There was a letter writing campaign and visits to Washington
DC from radiologists and patients all of which was
orchestrated by the ACR
• The AMA proposed Eldercare which was renamed
Medicare Part B by Rep. Mills
• This greatly helped the cause of radiologists as it was
more palatable to move radiology instead of exclude
it from Medicare
• Bill passed the House with radiology as a medical
service (Medicare Part B) despite pressure from
President Johnson
• In the Senate however, Senator Douglas moved
radiology back into a hospital service (Medicare Part
• In the conference committee, the ACR had to hope Rep. Mills
could hold his ground and in addition, they had to change the
mind of one senator
• The hero was Dr. Wynton Carroll from Shreveport, LA who
was treating the mother of Senator Russell Long for cancer
• Dr. Carroll convinced Sen. Long that radiology should be
treated as a medical service
• Radiology officially became part of Medicare part B
Medicare Part A vs Part B
• Medicare part A is hospital insurance that
helps cover inpatient care in hospitals, skilled
nursing facility, hospice, and home health
• Most people don’t pay a Part A premium
because they paid Medicare taxes while
Medicare Part A vs Part B
• Medicare part B helps cover medicallynecessary services like doctors' services,
outpatient care, durable medical equipment,
home health services, and other medical
• If you have Part B, you pay a Part B premium
each month. Most people will pay the
standard premium amount.
• If not for the efforts of the ACR, radiology would
have been a part of Medicare part A.
• Thus, radiology would only have been covered by
Medicare via hospital payments and private insurers
would have eventually followed Medicare’s lead,
essentially making radiologists hospital employees.
• Radiologists would have become salaried employees
of the hospitals, and radiology would probably not
be the same as it is today.

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