At the age of 22 Josie Muscat became the youngest ever Member of Parliament in Malta. He had a difficult time in his Zabbar constituency during the turbulent political years of the 70s, but he always managed to get elected with ever-increasing majorities. The faith that the Cottonera people showed in him encouraged him to make certain proposals to Dom Mintoff, then prime minister of Malta, which he still believes were sound. In any case they helped to reopen the discussions between the PN and the MLP that eventually led to the restoration of a government based on a majority vote.

Dr Muscat disappeared from politics after that event and slowly built up his private practice. His belief in innovation, in the creative capacity of the individual led him to introduce many medical firsts in Malta, such as in vitro conception, underwater births, key-hole surgery, MRI, spiral CT and laser surgery among many others. He also created the St James Private Health Group which had its beginnings in his own residence in Zabbar and has mushroomed into an international entity enjoying a high reputation for private nursing care.

Not content with all this, he founded The Eden Foundation, a project that was dedicated to his daughter Nicole and all other people with intellectual disabilities. The Foundation was responsible for including children with disabilities in mainstream education and training them to obtain jobs in the open market, something that nobody believed was possible. Hundreds of young people have benefited from the preparation they had at The Eden Foundation to become contributing citizens.

Dr Muscat's return to politics was marked by the creation of Azzjoni Nazzjonali, a party whose ideology is intended to balance the left-leaning political parties in Malta.