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In recent years, bitter partisan disputes have erupted over Medicare reform. Democrats and Republicans have fiercely contested issues such as prescription drug coverage and how to finance Medicare to absorb the baby boomers. As Jonathan Oberlander demonstrates in The Political Life of Medicare, these developments herald the reopening of a historic debate over Medicare's fu In recent years, bitter partisan disputes have erupted over Medicare reform. Democrats and Republicans have fiercely contested issues such as prescription drug coverage and how to finance Medicare to absorb the baby boomers. As Jonathan Oberlander demonstrates in The Political Life of Medicare, these developments herald the reopening of a historic debate over Medicare's fundamental purpose and structure. Revealing how Medicare politics and policies have developed since Medicare's enactment in 1965 and what the program's future holds, Oberlander's timely and accessible analysis will interest anyone concerned with American politics and public policy, health care politics, aging, and the welfare state.


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In recent years, bitter partisan disputes have erupted over Medicare reform. Democrats and Republicans have fiercely contested issues such as prescription drug coverage and how to finance Medicare to absorb the baby boomers. As Jonathan Oberlander demonstrates in The Political Life of Medicare, these developments herald the reopening of a historic debate over Medicare's fu In recent years, bitter partisan disputes have erupted over Medicare reform. Democrats and Republicans have fiercely contested issues such as prescription drug coverage and how to finance Medicare to absorb the baby boomers. As Jonathan Oberlander demonstrates in The Political Life of Medicare, these developments herald the reopening of a historic debate over Medicare's fundamental purpose and structure. Revealing how Medicare politics and policies have developed since Medicare's enactment in 1965 and what the program's future holds, Oberlander's timely and accessible analysis will interest anyone concerned with American politics and public policy, health care politics, aging, and the welfare state.

30 review for The Political Life of Medicare

  1. 4 out of 5

    Nathanael Roy

    The political life of medicare follows the trajectory of Medicare as both policy and especially politics. Oberlander describes Medicare inception in 1965 when the framers believed it would naturally expand over time. He also gives us the period of consensus from 65-95 when reforms mostly involved maintenance of financing and cost with every move being bipartisan and the only expansion being quickly reversed. Finally, he views the 1995 battle for privatization and radical reforms by Republicans i The political life of medicare follows the trajectory of Medicare as both policy and especially politics. Oberlander describes Medicare inception in 1965 when the framers believed it would naturally expand over time. He also gives us the period of consensus from 65-95 when reforms mostly involved maintenance of financing and cost with every move being bipartisan and the only expansion being quickly reversed. Finally, he views the 1995 battle for privatization and radical reforms by Republicans in the wake of the Clinton health plan to be a major breaking point in the politics of Medicare. Oberlander argues throughout the book that this breaking point moved Medicare from a space of consensus where discussions of Medicare rarely broke out in the public sphere and that in this new era these fights are now more routine. This isn't an argument that public fights about underlying philosophies of medicare and radical restructuring would lead to radical changes in policy but the implication did seem to be that changes would become more likely. At the time of the book, the restructuring that happened involved the creation of a "part c" of medicare at the time called Medicare + Choice in 1997. This was a couple of years after the Republicans failure to get their attempted Medicare reform into law. At the time, the performance of Medicare + Choice was less than stellar. With the expansion coming with a tighter regulation of costs in Medicare and then a downturn in 2001 that led to a decline in the recent favorable winds that had gone into the sails of managed care. In fact, with the perhaps exception of Kaiser Permanente managed care would also decline in the consumers view for at least the next decade as patients found the added constraints and administration of managed care to be burdensome. Oberlander speaks of contemporary politics of yet another medicare reform that was central to the election of 2000. This involved drug benefit expansion (would pass in 2003 in the form of reforming Medicare + Choice into Medicare Advantage) and indeed this would consume the next 4 years of healthcare policy and politics culminating in the part D benefits expansion in 2006. This is a prescient book I believe as it demonstrates Oberlander's recognition that he was in the middle of a period where Medicare politics had exploded on the center stage of American domestic politics and would remain there into even today. From 1995 until 2010 hardly a 4 year election cycle would pass without some fairly major change in Medicare was fought over or enacted. As I write this the Speaker of the House Paul Ryan began his political life within the period Oberlander writes about, coming in 1999 and staking Medicare reform and privatization as his claim of interest. It looks near certain that Paul Ryan will have lost this very public debate over Medicare. The expansion of medicare managed care into the system has been lackluster to the point where advantage plans are not even available throughout a great deal of the country. On the other hand, the opposite reaction to the Republican plan, the view toward expansion of benefits has had pretty major successes with medicare part d and some additional expansion and financing through the ACA. Since publication, expansion hasn't had wins in every category. Oberlander speaks in his book about the politics of long-term care being an especially large split between elites and the public. This has continued to be the case as the only attempt at expansion of long-term care was Ted Kennedy's CLASS act in the ACA which whithered and died a few short years after becoming law before it could even start being enacted. If anyone is interested in the history of Medicare this book may be both indispensable and insufficient. Oberlander writes in a way that was very accessible to me and outlines both the politics and some of the policy well. Unfortunately, like many books on health politics and policy in the United States written in the last couple of decades it is drastically behind the times because healthcare has moved at such a swift pace. Yet I believe Oberlander is perhaps one of the books that I have read that does a pretty good job of tracing the roots of that swift pace and is very conscious of why that is.

  2. 4 out of 5

    Shuhua Bloom

    This book can really inspire big ideas. How to stay away from political bias, focus on evidence-based approach to analyze Medicare; utilize Medicare’s practical purposes and structure; our country’s health span versus life span - what is Medicare’s future ...

  3. 4 out of 5

    Frank Stein

    The best history out there of the evolution of Medicare politics from the 1960s to the 1990s. Although I disagree with some of his conclusions, Oberlander offers succinct and clear stories on how Medicare benefits and financing have changed, and how they haven't. Oberlander's main contention is that from 1965 to 1995, Medicare operated under a "politics of consensus," and that most minor changes to the system were the result of expert critiques and bureaucratic squabbles rather than national deba The best history out there of the evolution of Medicare politics from the 1960s to the 1990s. Although I disagree with some of his conclusions, Oberlander offers succinct and clear stories on how Medicare benefits and financing have changed, and how they haven't. Oberlander's main contention is that from 1965 to 1995, Medicare operated under a "politics of consensus," and that most minor changes to the system were the result of expert critiques and bureaucratic squabbles rather than national debates. The Prospective Payment System instituted in 1983 was created as part of a bipartisan effort to limit surging cost growth in the hospitalization system (and pushed by Reagan administration HHS Secretary Richard Schweiker), as was the Resource Based Relative Value System in 1989 (which was pushed by Democratic Representative Pete Stark and signed by President Bush). The very obscurity of these terms demonstrates how they were instituted under the political radar. That all changed in 1995, when the Republican takeover of Congress, and a new "funding crisis" that showed the Medicare Part A trust fund would be depleted in five years, led to the government shutdown and an intense new debate about vouchers instead of fee-for-service in the Medicare system. Yet even this led to a bipartisan compromise of sorts in the Balanced Budget Act of 1997, which limited cost growth like the Republicans wanted, and created a limited voucher program in Medicare Plus. Medicare debate entered the public arena again, but the sides were closer than many admitted. Even the 2000 election featured both Presidents campaigning on adding a prescription drug benefit to Medicare. Only the details differed, but each side made grandiose claims about the benefits of their plan and also made apocalyptic rhetoric about the dangers of the other side's. As Obamacare and the two recent Ryan budgets show, Oberlander is right that the age of Medicare consensus is over and that the age of mutual "Mediscares" is upon us. What Oberlander doesn't consider, however, is that the inexorable growth in Medicare spending, to the point where it now constitutes almost 5% of U.S. GDP, is the main driver changing a politics of consensus into a politics of division.

  4. 5 out of 5

    Lindsay

    Pros: Very readable. Unlike other textbook-type books, I was able to read this one completely through and rather quickly. The history section I found to be especially strong. The organization is suburb. He chooses to break down the politics into 3 areas and then tie them together in the last two chapters. Although I found the last to chapters to be the most interesting, but strength of the book is really in the middle three. Cons: Through no fault of the author this book is already a bit outdate Pros: Very readable. Unlike other textbook-type books, I was able to read this one completely through and rather quickly. The history section I found to be especially strong. The organization is suburb. He chooses to break down the politics into 3 areas and then tie them together in the last two chapters. Although I found the last to chapters to be the most interesting, but strength of the book is really in the middle three. Cons: Through no fault of the author this book is already a bit outdated. Additionally, I felt that he did not strive to draw overall conclusions, but rather beat down everyone else theory. This is fine as an argument style, but it felt like a bit of a cop out at some points. Book ends with the statement that Medicare is 'back where it started,' this feels a bit weak given that he spends considerable time on how everything changed in the early/mid 1990's. Notes: This is a politics not policy book, which I enjoyed. I am not a pol-sci student, but one of public health, and this was especially important for my understanding. Also, as with most Medicare/Medicaid books it is left-ward leaning. I tend to agree, but I can see how this might be frustrating to those who are not. Overall: I would recommend for those starting on the subject. It's a quick (<200 pages) read that gives a solid overview. A good read, but certainly not a stand alone on the subject.

  5. 4 out of 5

    Todd

    I learned a lot of interesting things about how the history of Medicare has driven its current form (like why End Stage Renal Disease is covered under Medicare). It's only 200 pages so it gives you just enough info on how the politics drove Medicare.

  6. 4 out of 5

    Carl

    Not sure who this will interest besides students of health policy, but I learned some valuable lessons about Medicare's development.

  7. 4 out of 5

    George Hagstrom

  8. 5 out of 5

    John

  9. 4 out of 5

    Chad A.

  10. 4 out of 5

    Willie

  11. 5 out of 5

    Teri Rose

  12. 4 out of 5

    Jeff Marr

  13. 5 out of 5

    Chris Hokanson

  14. 4 out of 5

    Alyssa Lucas

  15. 4 out of 5

    Mark Johnson

  16. 4 out of 5

    Colin

  17. 5 out of 5

    M Laug

  18. 4 out of 5

    Zachary

  19. 4 out of 5

    Elizabeth

  20. 5 out of 5

    Randa Allam

  21. 5 out of 5

    Chip Bowman-Zamora

  22. 5 out of 5

    Peter Critchlow

  23. 5 out of 5

    A Yergey

  24. 5 out of 5

    John Suddath

  25. 4 out of 5

    Hallie

  26. 5 out of 5

    Chris

  27. 5 out of 5

    Brooke

  28. 4 out of 5

    Lisa | Read Between the Spines

  29. 4 out of 5

    Phillip Singer

  30. 5 out of 5

    David R

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