Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-26T09:22:20.939Z Has data issue: false hasContentIssue false
  • English
  • Français

The Struggle for the Soul of Medicare

Published online by Cambridge University Press:  01 January 2021

Bruce C. Vladeck
Get access Rights & Permissions [Opens in a new window]

Extract

Not so very long ago - in historical terms - the politics of Medicare were thought to be stable and well-established. Medicare’s 1965 enactment culminated an epochal political battle that spanned fifteen years and involved mass mobilization, millions of dollars in lobbying expenditures (including the development of such techniques as “grass-roots lobbying” and targeted direct mail), and bitter partisan controversy. By the late 1980s those seemed to be distant birthing pains long since overshadowed by the program’s robust health and popularity. Medicare politics had devolved into a model of pluralist “normalcy” in which a relatively specialized and autonomous group of subject-matter experts in the federal bureaucracy, the Congress, and affected interest groups largely made policy by negotiating among themselves, primarily on issues of provider reimbursement. Even the extraordinary events involving the 1988 enactment of the “Medicare Catastrophic Coverage Act” legislation (which, among other things, established good coverage for prescription drugs), and the ensuing public firestorm that led to its partial repeal in 1989, could be seen as an aberrational deviation from a more placid pattern.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 32 , Issue 3 , Fall 2004 , pp. 410 - 415
Copyright
Copyright © American Society of Law, Medicine and Ethics 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

The classic political history is still R. Harris, A Sacred Trust (New York: New American Library, 1966).Google Scholar
Oberlander, J., The Political Life of Medicare (Chicago: University of Chicago Press, 2003): at 4–7 et. passim.Google Scholar
Id., at 1–4, 157ff.Google Scholar
See “Toplines: The Kaiser Family Foundation/Harvard School of Public Health National Survey of the Public's Views on Medicare,” (Washington: The Kaiser Foundation, 2003), at <http://www.kff.org/Medicare/loader.ctm?url=/commonspot/security/getfile.ctm&PageID=14304> (last visited June 30, 2004). (last visited June 30, 2004).' href=https://scholar.google.com/scholar?q=See+“Toplines:+The+Kaiser+Family+Foundation/Harvard+School+of+Public+Health+National+Survey+of+the+Public's+Views+on+Medicare,”+(Washington:+The+Kaiser+Foundation,+2003),+at++(last+visited+June+30,+2004).>Google Scholar
For an empirical examination of this view, see Wilensky, H.L., The Welfare State and Equality: Structural and Ideological Roots of Public Expenditures (Berkeley, University of California Press): xi–xvi. et passim.; for a more theoretical statement, see Dahrendorf, R., Life Chances. Approaches to Social and Political Theory (Chicago: University of Chicago Press, 1979).Google Scholar
Marmor, T.R., The Politics of Medicare (Chicago: Aldine, 1973): 20–23.Google Scholar
Pear, R., “Frist Expects Congress to Try to Expand Health Coverage,” New York Times, February 7, 2004, 7:5.Google Scholar
2004 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplemental Insurance Trust Funds (Washington: March 23, 2004): 22–31.Google Scholar
Id.Google Scholar
See “The Budget and Economic Outlook: Fiscal Years 2005–2014,” by Holtz-Eakin, D., Director, Congressional Budget Office, before the Committee on the Budget, U.S. House of Representatives, January 27, 2004, at <http://www.cbo.gov/showdoc.cfm?index=4988&sequence=0> (last visited June 30, 2004).Google Scholar
Moon, M. and Storeygard, M., “Solvency or Affordability? Ways to Measure Medicare’s Health,” prepared for the Henry J. Kaiser Family Foundation, March, 2002.Google Scholar
For example, see Woolhandler, S., Campbell, T., and Himmelstein, D.U., “Costs of Health Care Administration in the United States and Canada,” New England Journal of Medicine 349 (2003): 768–775.CrossRefGoogle Scholar
See Economic Report of the President (Washington: Government Printing Office, 2004): 194ff.Google Scholar
Rice, T., The Economics of Health Reconsidered, 2nd ed. (Chicago: Health Administration Press/Academy Health, 2003): 164–166.Google Scholar
Cooper, B.S. and How, S., “Medicare’s Future: Current Picture, Trends, and Medicare Prescription Drug Improvement & Modernization Act of 2003 – Selected Charts,” The Commonwealth Fund, Updated February 24, 2004, at <http://www.cmwf.org/programs/medfutur/medicarechtpk_debate_659.pdf> (last visited June 28, 2004): at 20, author’s calculations.+(last+visited+June+28,+2004):+at+20,+author’s+calculations.>Google Scholar
Id., at 22.Google Scholar
Id., at 18.Google Scholar
Id., at 14.Google Scholar
National Academy of Social Insurance, Financing Medicare’s Future: Final Report of the Study Panel on Medicare’s Long Term Financing — Restructuring Medicare for the Long Term Project (Washington, DC: National Academy of Social Insurance, 2000): at 23 et passim.Google Scholar
Cooper, B.S. and Vladeck, B.C., “Perspective: Bringing Competitive Pricing to Medicare,” Health Affairs 19, no. 5 (2000): 49–54.CrossRefGoogle Scholar
See, for example, the issue of Health Affairs 10, no. 4 (1991) — the closest thing the health policy community has to its own L’Osservatore Romano, entitled, “Managed Care: Key to Health Insurance Reform?”.Google Scholar
Vobejda, B. and Harris, J.F., “Democrats Pounce on GOP Medicare Comments,” Washington Post, October 27, 1995 at A4.Google Scholar
See Peterson, M.A., “Introduction: Politics, Misperception, or Apropos,” Journal of Health Politics, Policy and Law 24 (October, 1999): 873–886; the introduction is to a special issue devoted to “The HMO Backlash.”CrossRefGoogle Scholar
Aaron, H.J. and Reischauer, R.D., “The Medicare Reform Debate: What Is the Next Step,” Health Affairs 14, no. 4 (1995): 8–30.CrossRefGoogle Scholar
Oberlander, , supra note 2, at 187.Google Scholar
P.L. 108–173, “The Medicare Prescription Drug, Improvement, and Modernization Act of 2003,” Section 801.Google Scholar