The Politics of Medicare (Social Institutions and Social Change Series)

Theodore R. Marmor's book, The Politics of Medicare, 1970, second edition, 2000, is in some ways complementary to Jonathan Oberlander's book, The Political Life of Medicare, 2003. Prof. Marmor, at Yale, supervised the graduate studies of Prof. Oberlander of the University of North Carolina. The Marmor book gives a briefer treatment of the political disputes over Medicare during the 1980s and 1990s but a fuller treatment of the development and enactment of Medicare.Both books consider the Clinton administration's attempt at health care reform in 1993 and 1994 and the Medicare cuts in the Balanced Budget Act of 1997. Both stop short of prescription drug coverage in 2003 and Congressional postponements of Medicare cuts in 2003 through 2008 (once each), 2009 (twice) and 2010 (once so far). Neither book analyzes the arbitrary structure of the cuts nor predicts their postponement.Prof. Marmor explains Medicare, in comparison with other national health-care programs, through determination to structure earned benefits rather than social welfare: limited to people aged 65 and over but without a means test and financed by regressive payroll taxes. He shows how critical features such as lack of cost controls were political adaptations. The primary architects, Rep. Wilbur Mills and Wilbur Cohen, later HEW Secretary, believed that use of payroll taxes rather than general revenue would counter inflationary pressures. Perhaps they did over some years, but Prof. Marmor shows that hospital charges, already rising rapidly, quickly took an even steeper course (Figure 6.1).Of interest in the aftermath of 2010 health-care reform is Prof. Marmor's picture of the months after Medicare enactment. He shows opponents failed to sustain their focus. Medical professionals became absorbed in details of organizing the program. That is unlikely to be the pattern for 2010, when implementation of care was largely delayed four years. Once again the structure of a health-care program was dominated by politics: the delay was critical to lower costs in early years, a concern without parallel in Medicare. Medical professionals became deeply concerned over pending cuts in payments, also without parallel. Political potentials following enactment of 2010 health-care reform therefore differ substantially from those in 1965.Other comparisons are noted by Don Wolfensberger, Health care reform and the Medicare analogy, Woodrow Wilson Center, September, 2009, at [...] Profs. Marmor and Oberlander also published an outline of recent prospects for health-care reform [Health reform: the fateful moment, New York Review, August, 2009, at [...]]. Perhaps after the many controversies over 2010 health-care reform settle, Prof. Marmor will write a sequel to his 1970 book, taking advantage of his deep knowledge about how Medicare developed and evolved.

A well written synopsis of the actors involved in the time leading up to the Passage of the medicare and medicaid acts. Great historical perspective and as it was written over 40 years ago it has lots of first hand insight and knowledge of the persons involved in the decision making

As we enter another Presidential Political campaign, where the issues of saving Medicare, Medicaid, and Social Security will be hotly debated, this is an important book that documents the history of the Medicare program from the 1930's to the ultimate passage of the program in 1965. Professor Marmor is uniquely qualified to bring life to the events. It should be read by all who will want to understand how we "got where we are", and perhaps give insight to ways to make these important social programs more vibrant in the 21 st century

The first edition of The Politics of Medicare, reprinted in part for the second edition, provides an engaging analytical structure for understanding the complex forces of governments and politics. While studying under the author, a gifted political scientist, years ago, the first edition was a cornerstone in our studies of healthcare politics and programs in the United States. The book equips the reader with the tools and knowledge to understand political forces well beyond the Medicare program.The analysis of Medicare in the 1990s, found in the current volume, is excellent. This is an ideal time to read or reread the book since Medicare program changes will face our new President and the newly elected or reelected members of our House of Representatives and Senate during 2001. This fall I read the second edition and found the book very informative and enjoyable.