Kimberly J. Morgan and Andrea Louise Campbell
- Published in print:
- 2011
- Published Online:
- January 2012
- ISBN:
- 9780199730346
- eISBN:
- 9780199918447
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199730346.003.0006
- Subject:
- Political Science, American Politics
Chapter six explores the consequences of delegated governance through an analysis of Medicare administration in general, and of key elements of the 2003 MMA—the Medicare Advantage program and the ...
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Chapter six explores the consequences of delegated governance through an analysis of Medicare administration in general, and of key elements of the 2003 MMA—the Medicare Advantage program and the Part D drug benefit. Although delegated governance has been politically expedient—enabling the passage and growth of government programs in an anti-government political climate—such expediency has frequently come at the cost of good governance. Outsourcing program responsibilities to non-state actors does not appear to produce more efficient or effectively-run government. Moreover, when the delegation occurs in a way that brings commercial actors into a program, this creates potential hazards (e.g. marketing abuses, fraud) that require oversight by a muscular political agency. Yet, the same hostility towards government that drives the decision to delegate governance in the first place also impedes the growth of an effective oversight body. As a result, various program failures arise that are frequently blamed on government officials who have never been sufficiently empowered to deal with these problems.Less
Chapter six explores the consequences of delegated governance through an analysis of Medicare administration in general, and of key elements of the 2003 MMA—the Medicare Advantage program and the Part D drug benefit. Although delegated governance has been politically expedient—enabling the passage and growth of government programs in an anti-government political climate—such expediency has frequently come at the cost of good governance. Outsourcing program responsibilities to non-state actors does not appear to produce more efficient or effectively-run government. Moreover, when the delegation occurs in a way that brings commercial actors into a program, this creates potential hazards (e.g. marketing abuses, fraud) that require oversight by a muscular political agency. Yet, the same hostility towards government that drives the decision to delegate governance in the first place also impedes the growth of an effective oversight body. As a result, various program failures arise that are frequently blamed on government officials who have never been sufficiently empowered to deal with these problems.
Kimberly J. Morgan and Andrea Louise Campbell
- Published in print:
- 2011
- Published Online:
- January 2012
- ISBN:
- 9780199730346
- eISBN:
- 9780199918447
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199730346.003.0007
- Subject:
- Political Science, American Politics
Chapter seven examines the impact of the MMA on politics, drawing upon original panel survey data to explore claims that market-based social provision can change mass attitudes about privatizing ...
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Chapter seven examines the impact of the MMA on politics, drawing upon original panel survey data to explore claims that market-based social provision can change mass attitudes about privatizing social programs. As the chapter shows, the new design of Medicare, with private entities providing the Part D and Medicare Advantage benefits, has not changed attitudes about the role of the state versus the market in health care, and nor has it undermined feelings of group consciousness and solidarity among seniors. Moreover, the Republican Party made few gains in ownership of issues like prescription drugs, Medicare, or health care in general after passage of the reform. However, the party did achieve “issue preemption,” in that it effectively solved the prescription drug issue and pushed it off the political agenda. The legislation also effectively demobilized the public around the prescription drug issue, offering a “good enough” policy that undercut efforts to improve the benefit or institute a directly governed alternative within Medicare. The MMA also created new constituencies protective of their programs. By demobilizing public demand for reform while also mobilizing commercial stakeholders, the MMA is generating a self-reinforcing logic that is difficult to challenge, absent unanticipated instability in the new Medicare marketplace or a fiscal emergency.Less
Chapter seven examines the impact of the MMA on politics, drawing upon original panel survey data to explore claims that market-based social provision can change mass attitudes about privatizing social programs. As the chapter shows, the new design of Medicare, with private entities providing the Part D and Medicare Advantage benefits, has not changed attitudes about the role of the state versus the market in health care, and nor has it undermined feelings of group consciousness and solidarity among seniors. Moreover, the Republican Party made few gains in ownership of issues like prescription drugs, Medicare, or health care in general after passage of the reform. However, the party did achieve “issue preemption,” in that it effectively solved the prescription drug issue and pushed it off the political agenda. The legislation also effectively demobilized the public around the prescription drug issue, offering a “good enough” policy that undercut efforts to improve the benefit or institute a directly governed alternative within Medicare. The MMA also created new constituencies protective of their programs. By demobilizing public demand for reform while also mobilizing commercial stakeholders, the MMA is generating a self-reinforcing logic that is difficult to challenge, absent unanticipated instability in the new Medicare marketplace or a fiscal emergency.
Kimberly J. Morgan and Andrea Louise Campbell
- Published in print:
- 2011
- Published Online:
- January 2012
- ISBN:
- 9780199730346
- eISBN:
- 9780199918447
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199730346.003.0008
- Subject:
- Political Science, American Politics
Chapter eight explores the consequences of delegated governance and the market model for Medicare beneficiaries specifically and democratic citizens more generally. Although the MMA assumed that ...
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Chapter eight explores the consequences of delegated governance and the market model for Medicare beneficiaries specifically and democratic citizens more generally. Although the MMA assumed that seniors possessed the ability to choose among large numbers of competing alternatives, exit bad plans, and contest inadequate benefits, many Part D enrollees make poor initial choices and then fail to switch plans, thereby increasing costs for themselves and undermining the market logic behind the reform. And although seniors report high rates of problems with their prescription drug plans and low levels of satisfaction compared to those covered by other sources like the Veterans Administration or former employers, they profess favorability toward the prescription drug reform. The chapter concludes that recipients have responded to problems with their plans with loyalty (or passivity) rather than with exit or voice. More broadly, the chapter analyzes mechanisms of accountability and assesses the degree to which individuals can have their voices heard and when they operate as consumers facing for-profit businesses as opposed to citizens confronting public bureaucracies and elected officials.Less
Chapter eight explores the consequences of delegated governance and the market model for Medicare beneficiaries specifically and democratic citizens more generally. Although the MMA assumed that seniors possessed the ability to choose among large numbers of competing alternatives, exit bad plans, and contest inadequate benefits, many Part D enrollees make poor initial choices and then fail to switch plans, thereby increasing costs for themselves and undermining the market logic behind the reform. And although seniors report high rates of problems with their prescription drug plans and low levels of satisfaction compared to those covered by other sources like the Veterans Administration or former employers, they profess favorability toward the prescription drug reform. The chapter concludes that recipients have responded to problems with their plans with loyalty (or passivity) rather than with exit or voice. More broadly, the chapter analyzes mechanisms of accountability and assesses the degree to which individuals can have their voices heard and when they operate as consumers facing for-profit businesses as opposed to citizens confronting public bureaucracies and elected officials.
Eric Patashnik
- Published in print:
- 2012
- Published Online:
- October 2017
- ISBN:
- 9780691150734
- eISBN:
- 9781400841899
- Item type:
- chapter
- Publisher:
- Princeton University Press
- DOI:
- 10.23943/princeton/9780691150734.003.0010
- Subject:
- History, American History: early to 18th Century
This chapter examines the origins and consequences of Medicare's peculiar bifurcated structure, focusing on the role played by former House Ways and Means Committee chair Wilbur D. Mills. It shows ...
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This chapter examines the origins and consequences of Medicare's peculiar bifurcated structure, focusing on the role played by former House Ways and Means Committee chair Wilbur D. Mills. It shows that fiscal conservatism has been no less central to Medicare than the commitment to social insurance principles. The chapter first reviews the scholarly literature on Medicare finance and welfare state before discussing the logic of Mills's financing design. Three aspects of Medicare's legislative design are analyzed: the financing scheme chosen for Hospital Insurance; the financing scheme chosen for Supplementary Medical Insurance; and why Medicare's financing came to be divided in the first place. The chapter concludes with an assessment of recent Medicare reform proposals that featured competing financing approaches.Less
This chapter examines the origins and consequences of Medicare's peculiar bifurcated structure, focusing on the role played by former House Ways and Means Committee chair Wilbur D. Mills. It shows that fiscal conservatism has been no less central to Medicare than the commitment to social insurance principles. The chapter first reviews the scholarly literature on Medicare finance and welfare state before discussing the logic of Mills's financing design. Three aspects of Medicare's legislative design are analyzed: the financing scheme chosen for Hospital Insurance; the financing scheme chosen for Supplementary Medical Insurance; and why Medicare's financing came to be divided in the first place. The chapter concludes with an assessment of recent Medicare reform proposals that featured competing financing approaches.
Helen G. Levy
- Published in print:
- 2007
- Published Online:
- September 2007
- ISBN:
- 9780199230778
- eISBN:
- 9780191710971
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199230778.003.0008
- Subject:
- Business and Management, Pensions and Pension Management
This chapter asks how well Baby Boomers are protected against later-life health shocks. While exposure to such shocks is relatively high, the realization of risk appears unlikely and relatively ...
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This chapter asks how well Baby Boomers are protected against later-life health shocks. While exposure to such shocks is relatively high, the realization of risk appears unlikely and relatively little wealth is at risk. Almost one-quarter of the original Health and Retirement Study cohort was uninsured at some point in the six-year window before Medicare eligibility, but only 2% had an uninsured hospitalization in this window. Moreover, the amount at stake for the median uninsured person is relatively low. Since many in this age bracket approach old age in poor financial shape, lack of assets may be a larger problem than lack of health insurance. Policies aimed at preventing poverty among the elderly may be more important than policies to expand health insurance coverage among those on the verge of retirement.Less
This chapter asks how well Baby Boomers are protected against later-life health shocks. While exposure to such shocks is relatively high, the realization of risk appears unlikely and relatively little wealth is at risk. Almost one-quarter of the original Health and Retirement Study cohort was uninsured at some point in the six-year window before Medicare eligibility, but only 2% had an uninsured hospitalization in this window. Moreover, the amount at stake for the median uninsured person is relatively low. Since many in this age bracket approach old age in poor financial shape, lack of assets may be a larger problem than lack of health insurance. Policies aimed at preventing poverty among the elderly may be more important than policies to expand health insurance coverage among those on the verge of retirement.
Kimberly J. Morgan and Andrea Louise Campbell
- Published in print:
- 2011
- Published Online:
- January 2012
- ISBN:
- 9780199730346
- eISBN:
- 9780199918447
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199730346.003.0005
- Subject:
- Political Science, American Politics
Chapter five examines the passage of the Medicare Modernization Act of 2003—a major social policy reform that delegates responsibility for a Medicare prescription drug benefit to commercial firms. ...
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Chapter five examines the passage of the Medicare Modernization Act of 2003—a major social policy reform that delegates responsibility for a Medicare prescription drug benefit to commercial firms. The chapter argues that the Republican Congressional leadership used this form of delegated governance to reconcile competing electoral and free-market aims. Republicans faced intense pressure to address popular demands for a drug benefit but needed a policy that furthered long-term goals of marketization or even privatization of federal entitlements. To help build support for the reform, the Republican leadership enlisted interest group allies like the pharmaceutical and insurance industries, and they delegated powers to private actors with these groups in mind. They also used administrative design as a way to reconcile the competing preferences of conservatives worried about the creation of a vast new entitlement and mass public demand for a universal benefit. The result was a complex system of delegated governance, an extraordinarily complicated piece of legislation designed to meet the desires of many different factions.Less
Chapter five examines the passage of the Medicare Modernization Act of 2003—a major social policy reform that delegates responsibility for a Medicare prescription drug benefit to commercial firms. The chapter argues that the Republican Congressional leadership used this form of delegated governance to reconcile competing electoral and free-market aims. Republicans faced intense pressure to address popular demands for a drug benefit but needed a policy that furthered long-term goals of marketization or even privatization of federal entitlements. To help build support for the reform, the Republican leadership enlisted interest group allies like the pharmaceutical and insurance industries, and they delegated powers to private actors with these groups in mind. They also used administrative design as a way to reconcile the competing preferences of conservatives worried about the creation of a vast new entitlement and mass public demand for a universal benefit. The result was a complex system of delegated governance, an extraordinarily complicated piece of legislation designed to meet the desires of many different factions.
Robyn Muncy
- Published in print:
- 2014
- Published Online:
- October 2017
- ISBN:
- 9780691122731
- eISBN:
- 9781400852413
- Item type:
- book
- Publisher:
- Princeton University Press
- DOI:
- 10.23943/princeton/9780691122731.001.0001
- Subject:
- Political Science, American Politics
Josephine Roche (1886–1976) was a progressive activist, New Deal policymaker, and businesswoman. As a pro-labor and feminist member of Franklin D. Roosevelt's administration, she shaped the founding ...
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Josephine Roche (1886–1976) was a progressive activist, New Deal policymaker, and businesswoman. As a pro-labor and feminist member of Franklin D. Roosevelt's administration, she shaped the founding legislation of the U.S. welfare state and generated the national conversation about health care policy that Americans are still having today. This book offers Roche's persistent progressivism as evidence for surprising continuities among the Progressive Era, the New Deal, and the Great Society. The book explains that Roche became the second-highest-ranking woman in the New Deal government after running a Colorado coal company in partnership with coal miners themselves. Once in office, Roche developed a national health plan that was stymied by World War II but enacted piecemeal during the postwar period, culminating in Medicare and Medicaid in the 1960s. By then, Roche directed the United Mine Workers of America Welfare and Retirement Fund, an initiative aimed at bolstering the labor movement, advancing managed health care, and reorganizing medicine to facilitate national health insurance, one of Roche's unrealized dreams. This book uses Roche's dramatic life story as a unique vantage point from which to examine the challenges that women have faced in public life and to reassess the meaning and trajectory of progressive reform.Less
Josephine Roche (1886–1976) was a progressive activist, New Deal policymaker, and businesswoman. As a pro-labor and feminist member of Franklin D. Roosevelt's administration, she shaped the founding legislation of the U.S. welfare state and generated the national conversation about health care policy that Americans are still having today. This book offers Roche's persistent progressivism as evidence for surprising continuities among the Progressive Era, the New Deal, and the Great Society. The book explains that Roche became the second-highest-ranking woman in the New Deal government after running a Colorado coal company in partnership with coal miners themselves. Once in office, Roche developed a national health plan that was stymied by World War II but enacted piecemeal during the postwar period, culminating in Medicare and Medicaid in the 1960s. By then, Roche directed the United Mine Workers of America Welfare and Retirement Fund, an initiative aimed at bolstering the labor movement, advancing managed health care, and reorganizing medicine to facilitate national health insurance, one of Roche's unrealized dreams. This book uses Roche's dramatic life story as a unique vantage point from which to examine the challenges that women have faced in public life and to reassess the meaning and trajectory of progressive reform.
Julian E. Zelizer
- Published in print:
- 2012
- Published Online:
- October 2017
- ISBN:
- 9780691150734
- eISBN:
- 9781400841899
- Item type:
- book
- Publisher:
- Princeton University Press
- DOI:
- 10.23943/princeton/9780691150734.001.0001
- Subject:
- History, American History: early to 18th Century
In recent years, the study of American political history has experienced a remarkable renaissance. After decades during which the subject fell out of fashion and disappeared from public view, it has ...
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In recent years, the study of American political history has experienced a remarkable renaissance. After decades during which the subject fell out of fashion and disappeared from public view, it has returned to prominence as the study of American history has shifted its focus back to politics broadly defined. This book assesses its revival and demonstrates how this work not only illuminates the past but also helps us better understand American politics today. It considers the history of public policy and American conservatism as well as the politics of Medicare, campaign finance, troop withdrawal, and national security, among others. It also explores the interrelationships between democracy, taxation, and state-building, along with scandals in American politics.Less
In recent years, the study of American political history has experienced a remarkable renaissance. After decades during which the subject fell out of fashion and disappeared from public view, it has returned to prominence as the study of American history has shifted its focus back to politics broadly defined. This book assesses its revival and demonstrates how this work not only illuminates the past but also helps us better understand American politics today. It considers the history of public policy and American conservatism as well as the politics of Medicare, campaign finance, troop withdrawal, and national security, among others. It also explores the interrelationships between democracy, taxation, and state-building, along with scandals in American politics.
Timothy Stoltzfus Jost and Lawrence P. Casalino
- Published in print:
- 2010
- Published Online:
- May 2010
- ISBN:
- 9780195390131
- eISBN:
- 9780199775934
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195390131.003.009
- Subject:
- Law, Medical Law
This chapter proposes the adaptation of traditional Medicare to accommodate value-purchasing strategies, specifically medical homes and accountable care systems. It also examines legal barriers under ...
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This chapter proposes the adaptation of traditional Medicare to accommodate value-purchasing strategies, specifically medical homes and accountable care systems. It also examines legal barriers under the Medicare law and other federal and state laws to implementing these strategies.Less
This chapter proposes the adaptation of traditional Medicare to accommodate value-purchasing strategies, specifically medical homes and accountable care systems. It also examines legal barriers under the Medicare law and other federal and state laws to implementing these strategies.
Jill Quadagno
- Published in print:
- 2006
- Published Online:
- May 2012
- ISBN:
- 9780195160390
- eISBN:
- 9780199944026
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195160390.003.0003
- Subject:
- Sociology, Race and Ethnicity
This chapter studies trade unions and how they helped promote the emerging private health insurance system, showing that the trade unions also led the drive for Medicare and disability insurance. It ...
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This chapter studies trade unions and how they helped promote the emerging private health insurance system, showing that the trade unions also led the drive for Medicare and disability insurance. It looks at the development of private health benefits and the events that led to the establishment of disability insurance and insurance for retirees. Finally, the chapter shows how those who supported medical insurance finally defeated the American Medical Association.Less
This chapter studies trade unions and how they helped promote the emerging private health insurance system, showing that the trade unions also led the drive for Medicare and disability insurance. It looks at the development of private health benefits and the events that led to the establishment of disability insurance and insurance for retirees. Finally, the chapter shows how those who supported medical insurance finally defeated the American Medical Association.
Jill Quadagno
- Published in print:
- 2006
- Published Online:
- May 2012
- ISBN:
- 9780195160390
- eISBN:
- 9780199944026
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195160390.003.0004
- Subject:
- Sociology, Race and Ethnicity
This chapter explains how the radical politics of the South were enacted within the health care system. It shows how the performance of Medicare gave federal officials the resources to enforce racial ...
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This chapter explains how the radical politics of the South were enacted within the health care system. It shows how the performance of Medicare gave federal officials the resources to enforce racial integration on southern hospitals. The chapter notes that racial discrimination was widespread in the health care system, and that the legal basis for racial segregation was derived from the Plessy v. Ferguson case. It introduces the Hill-Burton, which was aimed at rural and poor communities that did not have access to health care, discusses the civil rights challenge, and also shows how Medicare was implemented.Less
This chapter explains how the radical politics of the South were enacted within the health care system. It shows how the performance of Medicare gave federal officials the resources to enforce racial integration on southern hospitals. The chapter notes that racial discrimination was widespread in the health care system, and that the legal basis for racial segregation was derived from the Plessy v. Ferguson case. It introduces the Hill-Burton, which was aimed at rural and poor communities that did not have access to health care, discusses the civil rights challenge, and also shows how Medicare was implemented.
Jill Quadagno
- Published in print:
- 2006
- Published Online:
- May 2012
- ISBN:
- 9780195160390
- eISBN:
- 9780199944026
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195160390.003.0005
- Subject:
- Sociology, Race and Ethnicity
This chapter discusses how Medicaid and Medicare created uncontrollable inflation within the health care system, thus leading to a purchaser's revolt, first studying how the beneficiaries were ...
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This chapter discusses how Medicaid and Medicare created uncontrollable inflation within the health care system, thus leading to a purchaser's revolt, first studying how the beneficiaries were notified, before focusing on the implementation of Medicaid and of Parts A and B of Medicare. It also shows how costs were controlled in the health care sector.Less
This chapter discusses how Medicaid and Medicare created uncontrollable inflation within the health care system, thus leading to a purchaser's revolt, first studying how the beneficiaries were notified, before focusing on the implementation of Medicaid and of Parts A and B of Medicare. It also shows how costs were controlled in the health care sector.
Jill Quadagno
- Published in print:
- 2006
- Published Online:
- May 2012
- ISBN:
- 9780195160390
- eISBN:
- 9780199944026
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195160390.003.0007
- Subject:
- Sociology, Race and Ethnicity
This chapter shows how the failure of federal cost containment provoked corporate purchasers to experiment with their own methods for controlling costs, leading to managed care in the 1990s and ...
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This chapter shows how the failure of federal cost containment provoked corporate purchasers to experiment with their own methods for controlling costs, leading to managed care in the 1990s and triggering a huge conflict between insurers and physicians. The first section identifies the origins of the corporate revolt, and looks at the downsizing of the private welfare state. The chapter then studies the Medicare Catastrophic Coverage Act, which is considered as an irregularity in the history of Medicare, and ends with a section on the different piecemeal approaches in health care management.Less
This chapter shows how the failure of federal cost containment provoked corporate purchasers to experiment with their own methods for controlling costs, leading to managed care in the 1990s and triggering a huge conflict between insurers and physicians. The first section identifies the origins of the corporate revolt, and looks at the downsizing of the private welfare state. The chapter then studies the Medicare Catastrophic Coverage Act, which is considered as an irregularity in the history of Medicare, and ends with a section on the different piecemeal approaches in health care management.
Kimberly J. Morgan and Andrea Louise Campbell
- Published in print:
- 2011
- Published Online:
- January 2012
- ISBN:
- 9780199730346
- eISBN:
- 9780199918447
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199730346.001.0001
- Subject:
- Political Science, American Politics
This book explores the delegation of authority over American social programs to private actors. In the development of the American welfare state, policy-makers have often avoided direct governmental ...
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This book explores the delegation of authority over American social programs to private actors. In the development of the American welfare state, policy-makers have often avoided direct governmental provision of benefits and services, turning instead to private actors for the governance of social programs. More recent versions of delegated governance seek also to create social welfare marketplaces in which consumers can choose from an array of private providers. This book examines both the reasons behind this persistent delegation of authority and the consequences. Focusing on the case study of Medicare—and, in particular, the 2003 Medicare Modernization Act—the book argues that fundamental contradictions in American public opinion help explain the prevalence of delegated governance. Americans want both social programs and small government, leaving policy-makers in a bind. To square the circle, policy-makers have contracted out public programs to non-state actors, including voluntary organizations and for-profit entities, as a way to mask the role of the state. Such arrangements also pull in interest group allies—the providers of these programs—who can help pass policies in a political landscape that is fraught with obstacles. Although delegated governance has been politically expedient, it has frequently come at the cost of effective administration and created problems of fraud and abuse. Social welfare marketplaces also suffer from the difficulties individuals have in making choices about the benefits they need. In probing both the causes and consequences of delegated governance, this book offers a novel interpretation of both American social welfare politics and the nature of the American state.Less
This book explores the delegation of authority over American social programs to private actors. In the development of the American welfare state, policy-makers have often avoided direct governmental provision of benefits and services, turning instead to private actors for the governance of social programs. More recent versions of delegated governance seek also to create social welfare marketplaces in which consumers can choose from an array of private providers. This book examines both the reasons behind this persistent delegation of authority and the consequences. Focusing on the case study of Medicare—and, in particular, the 2003 Medicare Modernization Act—the book argues that fundamental contradictions in American public opinion help explain the prevalence of delegated governance. Americans want both social programs and small government, leaving policy-makers in a bind. To square the circle, policy-makers have contracted out public programs to non-state actors, including voluntary organizations and for-profit entities, as a way to mask the role of the state. Such arrangements also pull in interest group allies—the providers of these programs—who can help pass policies in a political landscape that is fraught with obstacles. Although delegated governance has been politically expedient, it has frequently come at the cost of effective administration and created problems of fraud and abuse. Social welfare marketplaces also suffer from the difficulties individuals have in making choices about the benefits they need. In probing both the causes and consequences of delegated governance, this book offers a novel interpretation of both American social welfare politics and the nature of the American state.
Kimberly J. Morgan and Andrea Louise Campbell
- Published in print:
- 2011
- Published Online:
- January 2012
- ISBN:
- 9780199730346
- eISBN:
- 9780199918447
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199730346.003.0001
- Subject:
- Political Science, American Politics
This chapter provides an overview of how the American welfare state delegates authority to private actors through the contracting out of social programs and development of publicly-subsidized private ...
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This chapter provides an overview of how the American welfare state delegates authority to private actors through the contracting out of social programs and development of publicly-subsidized private welfare marketplaces. The chapter also provides a foretaste of the book’s arguments about the political forces that have led to these arrangements and the consequences of delegated governance. Finally, the chapter discusses the use of Medicare as a case study for this way of organizing social policy administration.Less
This chapter provides an overview of how the American welfare state delegates authority to private actors through the contracting out of social programs and development of publicly-subsidized private welfare marketplaces. The chapter also provides a foretaste of the book’s arguments about the political forces that have led to these arrangements and the consequences of delegated governance. Finally, the chapter discusses the use of Medicare as a case study for this way of organizing social policy administration.
Kimberly J. Morgan and Andrea Louise Campbell
- Published in print:
- 2011
- Published Online:
- January 2012
- ISBN:
- 9780199730346
- eISBN:
- 9780199918447
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199730346.003.0002
- Subject:
- Political Science, American Politics
This chapter develops the concept of delegated governance and applies it to the American welfare state. The chapter also places the American practice in historical, comparative, and cross-policy ...
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This chapter develops the concept of delegated governance and applies it to the American welfare state. The chapter also places the American practice in historical, comparative, and cross-policy perspective, analyzing how the US differs from other countries, but also how delegated governance in the welfare state has evolved over time and differs across policy areas. Of particular interest is the shift over time from relying on non-profits to increasingly using for-profit actors and social welfare marketplaces to deliver publicly-funded benefits and services. The chapter also discusses the implications of these administrative arrangements for scholarly debates about how best to characterize bureaucratic power and authority in the United States.Less
This chapter develops the concept of delegated governance and applies it to the American welfare state. The chapter also places the American practice in historical, comparative, and cross-policy perspective, analyzing how the US differs from other countries, but also how delegated governance in the welfare state has evolved over time and differs across policy areas. Of particular interest is the shift over time from relying on non-profits to increasingly using for-profit actors and social welfare marketplaces to deliver publicly-funded benefits and services. The chapter also discusses the implications of these administrative arrangements for scholarly debates about how best to characterize bureaucratic power and authority in the United States.
Kimberly J. Morgan and Andrea Louise Campbell
- Published in print:
- 2011
- Published Online:
- January 2012
- ISBN:
- 9780199730346
- eISBN:
- 9780199918447
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199730346.003.0003
- Subject:
- Political Science, American Politics
This chapter examines the creation of Medicare in 1965 and explains why a delegated administrative structure was chosen for this program. Debates over the program are examined through the lens of ...
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This chapter examines the creation of Medicare in 1965 and explains why a delegated administrative structure was chosen for this program. Debates over the program are examined through the lens of larger conflicts over state-building in the post-1945 period. The chapter also compares the creation of Medicare to the development of two directly administered programs—Social Security and the Veterans Administration health care system. In contrast to these programs, which were created in the 1920 and 1930s, Medicare was forged at a time when an array of health care interest groups was present on the political scene and could exploit latent public antipathy toward government. To build a coalition around the new program, direct federal administration of Medicare program was abandoned in favour of contracting out to non-state actors. This chapter briefly follows the post-passage trajectory of Medicare administration and discusses how decisions about its governance affected program cost and quality.Less
This chapter examines the creation of Medicare in 1965 and explains why a delegated administrative structure was chosen for this program. Debates over the program are examined through the lens of larger conflicts over state-building in the post-1945 period. The chapter also compares the creation of Medicare to the development of two directly administered programs—Social Security and the Veterans Administration health care system. In contrast to these programs, which were created in the 1920 and 1930s, Medicare was forged at a time when an array of health care interest groups was present on the political scene and could exploit latent public antipathy toward government. To build a coalition around the new program, direct federal administration of Medicare program was abandoned in favour of contracting out to non-state actors. This chapter briefly follows the post-passage trajectory of Medicare administration and discusses how decisions about its governance affected program cost and quality.
Kimberly J. Morgan and Andrea Louise Campbell
- Published in print:
- 2011
- Published Online:
- January 2012
- ISBN:
- 9780199730346
- eISBN:
- 9780199918447
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199730346.003.0004
- Subject:
- Political Science, American Politics
This chapter examines the ideational and political movements advocating market-based forms of delegated governance since the 1970s. In part, the embrace of marketizing reforms reflected the ...
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This chapter examines the ideational and political movements advocating market-based forms of delegated governance since the 1970s. In part, the embrace of marketizing reforms reflected the refinement of ideas about the inefficient and oppressive nature of government as juxtaposed with the dynamism, efficiency, and liberating qualities of markets and individual choice. Some conservative and centrist policy-makers also believed the American state was inherently weak—a self-fulfilling prophecy given their longstanding resistance to building effective bureaucratic capacity at the federal level. In a context of rising health care costs, some policy-makers sought ways to make private insurers do the tough work of disciplining health care interests, delegating to these non-governmental authorities responsibility for meting out pain to medical providers. We trace this impulse through the push for allowing HMOs to administer Medicare benefits; the gathering enthusiasm for managed competition and the Clinton health care reform effort of 1993/94; proposals that emerged in the 1990s for complete Medicare voucherization; and the movement for Health Savings Accounts.Less
This chapter examines the ideational and political movements advocating market-based forms of delegated governance since the 1970s. In part, the embrace of marketizing reforms reflected the refinement of ideas about the inefficient and oppressive nature of government as juxtaposed with the dynamism, efficiency, and liberating qualities of markets and individual choice. Some conservative and centrist policy-makers also believed the American state was inherently weak—a self-fulfilling prophecy given their longstanding resistance to building effective bureaucratic capacity at the federal level. In a context of rising health care costs, some policy-makers sought ways to make private insurers do the tough work of disciplining health care interests, delegating to these non-governmental authorities responsibility for meting out pain to medical providers. We trace this impulse through the push for allowing HMOs to administer Medicare benefits; the gathering enthusiasm for managed competition and the Clinton health care reform effort of 1993/94; proposals that emerged in the 1990s for complete Medicare voucherization; and the movement for Health Savings Accounts.
Muriel R. Gillick
- Published in print:
- 2017
- Published Online:
- May 2018
- ISBN:
- 9781469635248
- eISBN:
- 9781469635255
- Item type:
- book
- Publisher:
- University of North Carolina Press
- DOI:
- 10.5149/northcarolina/9781469635248.001.0001
- Subject:
- Palliative Care, Palliative Medicine and Older People
Since the introduction of Medicare and Medicaid in 1965, the American health care system has grown in size and complexity. Muriel R. Gillick takes readers on a narrative tour of American health care, ...
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Since the introduction of Medicare and Medicaid in 1965, the American health care system has grown in size and complexity. Muriel R. Gillick takes readers on a narrative tour of American health care, incorporating the stories of older patients as they travel from the doctor’s office to the skilled nursing facility, and examining the influence of forces as diverse as pharmaceutical corporations, device manufacturers, and health insurance companies on their experience. A scholar who has practiced medicine for over thirty years, Gillick offers readers an informed and straightforward view of health care from the ground up, revealing that many crucial medical decisions are based not on what is best for the patient but rather on outside forces, sometimes to the detriment of patient health and quality of life. Gillick suggests a broadly imagined patient-centered reform of the health care system with Medicare as the engine of change, a transformation that would be mediated through accountability, cost-effectiveness, and culture change.Less
Since the introduction of Medicare and Medicaid in 1965, the American health care system has grown in size and complexity. Muriel R. Gillick takes readers on a narrative tour of American health care, incorporating the stories of older patients as they travel from the doctor’s office to the skilled nursing facility, and examining the influence of forces as diverse as pharmaceutical corporations, device manufacturers, and health insurance companies on their experience. A scholar who has practiced medicine for over thirty years, Gillick offers readers an informed and straightforward view of health care from the ground up, revealing that many crucial medical decisions are based not on what is best for the patient but rather on outside forces, sometimes to the detriment of patient health and quality of life. Gillick suggests a broadly imagined patient-centered reform of the health care system with Medicare as the engine of change, a transformation that would be mediated through accountability, cost-effectiveness, and culture change.
Julian E. Zelizer
- Published in print:
- 2012
- Published Online:
- October 2017
- ISBN:
- 9780691150734
- eISBN:
- 9781400841899
- Item type:
- chapter
- Publisher:
- Princeton University Press
- DOI:
- 10.23943/princeton/9780691150734.003.0001
- Subject:
- History, American History: early to 18th Century
This book offers fresh narratives about U.S. political history by focusing on policy, political institutions, and electoral politics. It argues that the field of American political history, once ...
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This book offers fresh narratives about U.S. political history by focusing on policy, political institutions, and electoral politics. It argues that the field of American political history, once marginalized, has been remade in vibrant fashion and now provides rich and original approaches and interpretations about America's political past. The book is divided into four thematic sections. Part I deals with the historiography of political history, and especially the intellectual underpinnings of the field and the multiple analytic foundations upon which it is built. Part II examines the challenges imposed by fiscal constraint in American politics, showing how policymakers were able to use innovative fiscal strategies such as Social Security and Medicare to build programs within such constraints. Part III considers the impact of the political process as it occurred in Congress, whereas Part IV explores how policy and politics intersected in the case of national security.Less
This book offers fresh narratives about U.S. political history by focusing on policy, political institutions, and electoral politics. It argues that the field of American political history, once marginalized, has been remade in vibrant fashion and now provides rich and original approaches and interpretations about America's political past. The book is divided into four thematic sections. Part I deals with the historiography of political history, and especially the intellectual underpinnings of the field and the multiple analytic foundations upon which it is built. Part II examines the challenges imposed by fiscal constraint in American politics, showing how policymakers were able to use innovative fiscal strategies such as Social Security and Medicare to build programs within such constraints. Part III considers the impact of the political process as it occurred in Congress, whereas Part IV explores how policy and politics intersected in the case of national security.
