Reforming medicare: The limited framework of political discourse on equity and economy (original) (raw)

Misrepresented Interests: Business, Medicare, and the Making of the American Health Care State

Studies in American Political Development, 2018

A belief that there is a pervasive and enduring adversarial relationship between business and the welfare state is shared widely across scholarly disciplines engaged in historical and comparative analysis of social politics. According to that view, each stage in the expansion of the American welfare state was a defeat for capitalists. Detailed evidence on the politics of health care, with special focus on the passage of Medicare in 1965, casts serious doubt on this dominant view about class politics, the welfare state, and the power of business. It shows that much of the literature takes a hazardous inferential leap from national business organizations’ official positions against reform to overconfident conclusions about actual business opinions. The literature also mistakenly discounts evidence of business support for moderate reforms as strategic camouflage of actual opposition designed to head off more radical ones. Extensive evidence reveals enormous division within business rat...

Medicare: Intentions, Effects, and Politics

Journal of Health Politics, Policy and Law, 2001

To rephrase a lyric by the Grateful Dead, what a short, strange trip it's been. Just six years ago the combination of the apparent immediate fiscal crisis in the trust fund for Part A of Medicare, anticipation of the Baby Boom's approaching retirement, and the largely unexpected arrival of active, conservative Republican majorities in Congress shot fundamental restructuring of Medicare to the top of the nation's political and legislative agendas. That theme carried through the often contentious work of the National Bipartisan Commission on the Future of Medicare, which in 1999 fell just one vote short of the supermajority required to recommend formally shifting from providing a package of defined benefits to giving checks to beneficiaries ("premium support") toward purchase of their choice of a qualified private health insurance plan in competition with "traditional Medicare." Many pages of this journal and others, as well as various special edited books, were devoted to assessments of the relative merits of different market-based models for Medicare. However, thanks to a continuing robust economy, the resulting welcome surge in revenues, and the surprisingly effective financial restraints imposed on Medicare provider payments by the bipartisan Balanced Budget Act of 1997, what looked like looming deficits for the health insurance trust fund starting as soon as next year has been pushed back more than two decades, according to the most recent report of the Medicare trustees (Board of Trustees 2000).

Privatization of Medicare: Toward Disentitlement and Betrayal of a Social Contract

International Journal of Health Services, 2004

An intense political battle is being waged over the future of U.S. Medicare. The 40-year social contract established with the nation's elderly and disabled is seriously threatened. The basic issue is whether Medicare will remain a universal entitlement program or be privatized and dismantled as an obligation of government. Faced with the growing costs of the Medicare program, changing demographics of an aging population, and long-term federal deficits, conservative interests are promoting further privatization of the program under the guise of increasing beneficiaries' choice and the claimed efficiency of the private marketplace. Following a historical overview of past efforts to privatize Medicare, this article reviews the track record of private Medicare plans over the last 20 years with regard to choice, reliability, cost containment, benefits, quality of care, efficiency, public satisfaction, and fraud. In all of these areas, privatized Medicare has performed less well than original Medicare. Based on the evidence, one has to conclude that privatization of Medicare is detrimental to the elderly and disabled, the most vulnerable groups in our society, and that the only winners in that transformation are private market interests. The intense political battle waged in recent years over adding a prescription drug benefit to Medicare has again brought out in the open polarized ideologic views that go way beyond the drug benefit itself. Finally passed by a slim majority in the U.S. Congress in November 2003, the Medicare Prescription Drug, Improvement and Modernization Act of 2003 ended up providing a confusing and meager drug benefit to Medicare beneficiaries while creating lucrative new markets for the pharmaceutical and insurance industries. The underlying issue-the uncontrolled escalation of drug prices and their unaffordability for millions of Americans-was

Secret Weapon: The “New” Medicare as a Route to Health Security

Journal of Health Politics, Policy and Law, 2007

Over the past twenty years, Medicare has been transformed from a single-payer insurer into a hybrid of complementary public and private insurance arrangements. Despite creating ongoing controversy, these changes have resulted in an ironic and largely overlooked strategic potential: Medicare's evolving hybrid form makes it the most promising vehicle for overcoming the historical obstacles to universal health insurance in the United States. To make this surprising case, we first explore the distinctive political dynamics of programs that, like today's Medicare, are hybrids of public and private arrangements. We then consider how these political dynamics might circumvent past barriers to universal health insurance. Finally, we discuss the strengths and weaknesses of alternative pathways through which Medicare could be expanded to promote health security.

Understanding Social Insurance: Fairness, Affordability, And The 'Modernization' Of Social Security And Medicare

Health Affairs, 2006

Americans have been urged for several decades to view Social Security and Medicare as political relics-both unaffordable and unfair in light of contemporary demographic and fiscal circumstances and the practices of modern financial markets and modern medicine. Proposals abound for "modernizing" both systems to emphasize choice, competition, and individual ownership. This paper contends that critics of Social Security and Medicare have misanalyzed the problems of both programs and are urging misdirected reforms. The critics, we argue, are often wrong factually and sometimes confused conceptually. More fundamentally, these critiques and proposals are either ignorant of or hostile to the fundamental logic of social insurance. [Health Affairs 25 (2006): w114-w134 (published online 21 March 2006; 10.1377/hlthaff.25.w114)]

The politics of health and social welfare in the United States

Ageing International, 2006

In their essay, Jack H. Knott and Robert E Rich provide an overview of the development of the private-public, segmented health care system in the United States. It then examines what the authors call the "politics of exceptions" as the original fee-for-service model of health insurance was radically altered by the introduction of managed care and other reforms. Knott and Rich examine health policy by analyzing political values and institutions, which allows them to assess the strengths and weaknesses of the health care system and serves as a basis for recommending politically feasible options for reform in the future.

Justice and fairness: a critical element in U.S. health system reform

The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics, 2012

The case for U.S. health system reform aimed at achieving wider insurance coverage in the population and disciplining the growth of costs is fundamentally a moral case, grounded in two principles: (1) a principle of social justice, the Just Sharing of the costs of illness, and (2) a related principle of fairness, the Prevention of Free-Riding. These principles generate an argument for universal access to basic care when applied to two existing facts: the phenomenon of "market failure" in health insurance and, in the U.S., the existing legal guarantee of access to emergency care. The principles are widely shared in U.S. moral culture by conservatives and liberals alike. Similarly, across the political spectrum, the fact of market failure is not contested (though it is sometimes ignored), and the guarantee of access to emergency care is rarely challenged. The conclusion generated by the principles is not only that insurance for a basic minimum of care should be mandatory but...