Medicare's Future: Fact, Fiction, and Folly

Posted: 9 Aug 2000

See all articles by Theodore R. Marmor

Theodore R. Marmor

Yale School of Management

Gary J. McKissick

affiliation not provided to SSRN


This article seeks to clarify the contemporary Medicare debate by providing, first, an historical perspective on Medicare's origin and development and, second, an understanding of the analytical damage done by an all-too-common style of Medicare policy analysis.

We have two central claims. First, we argue that the contemporary debate over Medicare reflects the program's distinctive political development, its generally low salience among the public, and the partisan rhetoric of politicians engaged in broader ideological battles. Emerging more of a political than a programmatic logic, Medicare's guiding social insurance philosophy was never fully articulated to the broader public. Moreover, its social insurance rationale has eroded over time, in part through piecemeal changes to the program. The public seems to have embraced Medicare with only a modest understanding of its functional form and remains largely ignorant of the program's real status or likely future. Moreover, the typically remote position Medicare occupies in public discourse feeds into the recurring atmosphere of crisis so easily stoked and exploited by partisans hoping to frame debate over Medicare to their ideological and electoral advantage.

Our second point is that the debate's confusions have been magnified by the lack of rigor with which many policy analysts have characterized the political context of Medicare reform. Because many policy analysts pay only cursory attention to the political analysis of Medicare's origins and recent developments, the fundamental issues at stake in the debate over Medicare's future are regularly obscured.

JEL Classification: I18

Suggested Citation

Marmor, Theodore Richard and McKissick, Gary J., Medicare's Future: Fact, Fiction, and Folly. American Journal of Law & Medicine, Vol. 26, Nos. 2 & 3, July 2000, Available at SSRN:

Theodore Richard Marmor (Contact Author)

Yale School of Management ( email )

135 Prospect Street
P.O. Box 208200
New Haven, CT 06520-8200
United States
203-432-3238 (Phone)

Gary J. McKissick

affiliation not provided to SSRN

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