Robert Ball and the Politics of Social Security (review)

Robert Ball, a smart, idealistic English major with a master's thesis in applied economics, entered government service in 1939, four years after the Social Security legislation; by the late 1940s, he was influential in the growing ranks of social security experts. Able, canny, politically attuned, inspiring, and urbane, Ball was the chief administrator of the U.S. Social Security program from 1953 through 1972, years that included the Medicare legislation. Ball continued to influence social security policy as a Washington-based consultant, organizer, national committee member, and political broker. In one of the last activities described in this book, Ball tapes a commercial for presidential candidate Al Gore, backing his views on social security and criticizing those of George W. Bush. Congressman Wilbur Mills, who orchestrated the initial design and passage of Medicare, described Ball as a "near-genius" (p. 217). Equally, one could see him as a brilliant politician in his own right. Edward Berkowitz portrays him as the consummate bureaucrat: an unobtrusive problem-solver, marshaling critical facts to sway debate, wringing consensus across conflicting groups, and making Medicare work. His general approach was "relentlessly reasonable" (p. 363).

The Social Security program was, of course, much more than Medicare. Cash payments were initially designed as an extension of labor benefits, with payroll taxes imposed in 1937 and the first pensions scheduled for 1942. Much of the debate about Social Security, and thus most of the action of this book, is about cash benefits and eligibility policies. In 1948, for example, discussions at the Advisory Council on Social Security included, among many other topics, the extension of coverage beyond industrial and commercial workers, for whom the act was designed, to workers in nonprofit institutions, including hospitals. Health insurance was off the agenda. Robert Ball was staff director, and wrote much of the report that led, in turn, to major expansions in the program through passage of the Social Security Amendments of 1950.

Medicare was the major task of the Social Security Administration between 1961 and 1967. As with other aspects of Social Security, Ball worked with Congress, individually and at hearings, and negotiated with stakeholders, including Blue Cross and the American Hospital Association, about the form the proposals would take. Important decisions about Medicare were made during regulation writing and implementation. Part A, the hospital part of Medicare, was compulsory, but Part B (medical services) was voluntary. The bureaucrats launched a major promotional campaign to sell Part B, achieving a 90 percent acceptance rate among Medicare beneficiaries by May 1966; launched civil rights policies; and negotiated contracts with private insurance carriers. The machinery of bureaucracy was remarkably efficient (as well described here), a model of what a civil service can do.

Berkowitz makes full use of Ball's extensive papers and of numerous interviews. Here is the thick context of legislative development in the United States. This is a book about hundreds of people who know each other, shift jobs but remain in touch, develop expertise (and Social Security expertise is arcane), and work within and beyond the various bureaucracies in which they are placed. Ball's networks include invaluable contacts and allies in Congress, highly placed congressional staff, foundation executives, and at least one president.

This is also a book about change. Berkowitz marks the early 1970s as the end of an era of liberal legislation on Social Security that began in 1950. In 1977 Medicare was shifted to a specialized health agency, weakening its bonds to Social Security. Technical expertise largely replaced the practical idealism of individuals such as Robert Ball. It is useful to be reminded that government can be effective, and that a brilliant bureaucrat can play a noble role.