Medicare's Future: Fact, Fiction, and Folly
Theodore R. Marmor
Yale School of Management
Gary J. McKissick
affiliation not provided to SSRN
American Journal of Law & Medicine, Vol. 26, Nos. 2 & 3, July 2000
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
Date posted: August 9, 2000