The Politics of Medicare

Discusses Medicare's emergence as a political issue and the responses it elicited within the federal government and American society

Theodore R. Marmor teaches politics and public policy in Yale University's management and law schools as well as in its political science department. Educated at Harvard and Oxford, Marmor has written widely about the politics of the modern welfare state, and has served on a number of governmental commissions and scholarly editorial boards.

Preface to the Second Edition

xi

Acknowledgments

xv

Preface to the First Edition

xix

Introduction

xxiii

PART I THE ORIGINS AND ENACTMENTS

1

(92)

The Origins of the Medicare Strategy

3

(20)

Twentieth-Century Medicine: The Paradoxes of Progress

3

(1)

Origins of the Government Health Insurance Issue

4

(2)

Universal Health Insurance Proposals in the Fair Deal

6

(4)

The Politics of Incrementalism: Turning toward the Aged

10

(1)

The Appeal of Focusing on the Aged

11

(4)

Focusing on Social Security Contributors

15

(2)

Pressure Groups and Medicare: The Lobbying of Millions

17

(6)

The Politics of Legislative Impossibility

23

(8)

Medicare under a Republican President

23

(2)

The Forand Bill versus the Welfare Approach

25

(2)

Kerr-Mills Bill of 1960

27

(4)

The Politics of Legislative Possibility

31

(14)

Medicare, 1961

31

(1)

The Obstacle Course in Congress: First Try with Ways and Means

32

(3)

The Sauthern Democrats

35

(3)

The Kennedy Administration versus the AMA

38

(3)

Medicare's Near Miss, 1964

41

(4)

The Politics of Legislative Certainty

45

(18)

The Impact of the Election of 1964

45

(1)

The Administration's Proposal: H.R. 1 and S. 1

46

(1)

The Ways and Means Committee and the House Take Action: January-April

47

(6)

H.R. 6675 Passes the Senate: April-July

53

(2)

Medicare Comes out of the Conference Committee: July 26, 1965

55

(1)

The Outcome of 1965: Explanation and Issues

56

(7)

Medicare and the Analysis of Social Policy in American Politics

63

(24)

Case Studies and Cumulative Knowledge

63

(1)

Conceptual Models and the Medicare Case

64

(1)

The Origins of Medicare: The Rational Actor Model

64

(3)

The Responses of Medicare, 1952-64: The Organizational Process Model

67

(2)

The 1965 Legislation: The Bureaucratic Politics Model

69

(2)

Processes and Policy in American Politics: The Case of Medicare

71

(9)

Medicare and the Character of American Social Policy

80

(7)

Legislation to Operation

87

(6)

PART II THE POLITICS OF MEDICARE: 1966-99

93

(100)

Medicare's Politics: 1966-90

95

(28)

The Origins of Medicare Revisited

95

(1)

The Politics of Accommodation: Medicare's Implementation and Subsequent Evolution from 1966 to 1970

96

(3)

The 1970s: Ineffectual Reforms and Intermittent Progress

99

(8)

The 1980s: The Challenge of the Reagan Era

107

(8)

Conclusion

115

(8)

The Politics of Medicare Reform in the 1990s: Budget Struggles, National Health Reform, and Shifting Conflicts

123

(28)

Introduction: The Changing Context of Medicare's Politics in the 1990s

123

(1)

Medicare and the 1992 Elections: The Reawakening of Concerns

124

(2)

A Negative Consensus on Health Reform

126

(9)

The 1995 Trustees' Report and Claims of Insolvency

135

(2)

From Legislative Impasse 1995-96 to Medicare ``Reform'' in 1997

137

(4)

The Medicare Reforms of 1997: Understanding the Politics of Balancing Budgets

141

(6)

Medicare Flip-Flop

147

(4)

The Ideological Context of Medicare's Politics: The Presumptions of Medicare's Founders versus the Rise of Procompetitive Ideas in Medical Care

151

(20)

Introduction

151

(1)

Medicare's Philosophical Roots: social Insurance and the Presumption of Expansion

152

(5)

The Rise of Procompetitive Ideas about Medical Care

157

(14)

Reflections on Medicare's Politics: Puzzles and Patterns

171

(22)

Introduction

171

(1)

Understanding Medicare's Politics: Patterns, Puzzles, and Explanatory Approaches

171

(2)

Structural Explanations and Medicare's Limited Evolution

173

(2)

Insider Politics, Medicare's Price Controls, and the Puzzles of the Reagan/Bush Era

175

(1)

Medicare 1995-99---Macro Politics and the Emergence of Unexpected Remedies

176

(3)

Conclusion

179

(4)

Medicare Scholarship: A Selective Review Essay

183

(10)

Glossary

193

(14)

References to Part I

207

(6)

References to Part II

213

(8)

Index

221

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The Politics of Medicare

Summary

Author Biography

Table of Contents

Supplemental Materials