As American medical radiology grew in the early decades in the nineteenth century, the most common x-ray bases in larger cities were diagnostic and therapeutic sections in common hospitals. Before the training of radiology in the 1930s, several hundred US physicians had taken up the new concept in hospitals that had equipped basic x-ray systems. For most aspiring radiologists, their location was in a hospital and most of their compensation came from their hospital. Some radiologists had private offices in medical arts buildings and billed patients directly.
All of these patterns prevailed into the 1960s when the American Hospital Association (AHA) encouraged the Democratic majority of the US Congress to pass a new requirement for government payment for hospital service for age 65 Social Security beneficiaries. That action came after the 1960 election of a Democratic majority in the Congress and the election of John F. Kennedy as president and Lyndon B. Johnson as vice president.
In the early AHA legislation, only hospital service was to be covered. The American Medical Association (AMA) had opposed the hospital pitch. However, in the language of the hospital proposal, the services of radiology, pathology, and anesthesiology were specified as hospital services involving the medical specialists. When American College of Radiology (ACR) leaders read the draft language, they were upset at the notion that no radiologists would be compensated for any patients except for the elderly patients who were admitted to hospitals.
Bill Stronach, the ACR executive director, approached the AMA managers and Washington lobbyists to ask if they would try to remove radiology (and perhaps the other medical specialties) from the draft proposal. The AMA could not do that, he was told. If the ACR was intent to get a change, it would need to hire a lobbyist to attempt to get them out of the draft legislation.
In November 1963, just before President Kennedy was killed and Vice President Johnson became the president, the ACR had testified before a congressional committee hearing to express its concern. Then, in January 1965, Congress began to act on what was termed Medicare.
The congressional House of Representatives had designated its House Ways and Means Committee, led by Arkansas Representative Wilbur Mills, to take the responsibility of Medicare. The ACR leaders decided to hire a lobbyist and went to Washington to interview a former Texas congressman, J. T. “Slick” Rutherford. Several Arkansas radiologists had already contacted Representative Mills and he had encouraged radiologists oppose the hospital proposal. When the House of Representatives enacted a Medicare law, radiology was defined as an independent physician.
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