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The Political Life of Medicare (American Politics and Political Economy) Paperback – June 1, 2003

ISBN-13: 978-0226615967 ISBN-10: 0226615960 Edition: 1st

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The Political Life of Medicare (American Politics and Political Economy) + The Politics of Medicare: Second Edition (Social Institutions and Social Change) + The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry
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Product Details

  • Series: American Politics and Political Economy Series
  • Paperback: 224 pages
  • Publisher: University Of Chicago Press; 1 edition (June 1, 2003)
  • Language: English
  • ISBN-10: 0226615960
  • ISBN-13: 978-0226615967
  • Product Dimensions: 9 x 6.1 x 0.6 inches
  • Shipping Weight: 12.8 ounces (View shipping rates and policies)
  • Average Customer Review: 4.8 out of 5 stars  See all reviews (4 customer reviews)
  • Amazon Best Sellers Rank: #979,370 in Books (See Top 100 in Books)

Editorial Reviews


“This book combines in-depth personal interviews, historical dat (Choice)

"A brilliant little book, combining a grasp of programmatic and political detail sure to appeal to scholars of health policy with crisp prose and careful argument accessible to policymakers and most of Medicare’s beneficiaries. . . . Oberlander’s analysis is organized around three persistent tensions in Medicare politics: the gap between the program’s promise and its performance; the fiscal and administrative tug-of-war between private provision and public payment; and the political and actuarial dilemma of delivering ‘service’ benefits on a foundation of social insurance financing.  . . . The meat of the book tackles the post-1965 history of Medicare’s fragile consensus regarding program benefits, financing, and administration.”

(Colin Gordon Health Affairs)

“This is a very good (and very well written) book for anyone interested in US health politics."
(Robin Gauld Political Studies Review)

“Clearly, no one can claim to understand contemporary American politics and policymaking without understanding the Medicare program. Few scholars are more knowledgeable about Medicare politics than health policy expert Jonathan Oberlander. Combining rich, detailed narrative with acute political analysis, Oberlander offers an illuminating guide to Medicare’s evolution since the program’s creation in 1965. The book immediately takes its place as the best short monograph on Medicare’s political development, current status, and future prospects. . . . Well-organized, elegantly written, and jam-packed with sophisticated insights about the substance and process of U.S, policymaking, the book deserves to be read by anyone concerned with American national government, health-care politics, and the welfare state.”

(Eric M. Patashnik Perspectives on Politics) --This text refers to the Hardcover edition.

From the Inside Flap

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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14 of 14 people found the following review helpful By Raman on August 7, 2005
Format: Paperback Verified Purchase
Usually, I cannot get through books on the social sciences. They are too long for me, and their repetitive, unfocused writing style makes it hard to me to see how the author is structuring his or her arguments. This book, assigned by my political science professor as the best book on Medicare, is a welcome counterexample to that generalization. Jonathan Oberlander covers the political history of Medicare with clarity, gusto, and (most importantly for me) concision. The body of the text takes a mere 196 pages. The book is extensively annotated with 48 pages of notes. It is printed on good paper, has an attractive cover, and is well proofread and typeset.

The bulk of the book covers the history of Medicare from its inception in 1965 to the present. Oberlander's thesis throughout the book is that, after much political debate prior to its enactment, Medicare was ruled by a bipartisan legislative consensus from 1965-1995 which subsequently unraveled in Gingrich's Republican Congress. He analyzes the consensus by breaking it into three aspects - benefits, financing, and regulation - and showing how each aspect involved large changes in the program with little controversy over this thirty-year period. (Oberlander tends to dissect ideas into lists like this at every scale, so much of the book reads like a huge outline. While those accustomed to more fluid prose may find this style pedantic, it leaves no doubt as to how Oberlander's analysis is structured and contributes greatly to the book's clarity in my opinion.) After the three chapters on benefits, financing, and regulation, Oberlander has a short but terrific chapter debunking the application of various monolithic political theories to Medicare.
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3 of 3 people found the following review helpful By Stephen R. Laniel on August 31, 2009
Format: Paperback
Jonathan Oberlander's book is a great introduction to the practical politics of Medicare, and to the basic functioning of the program. I knew very little going in about Medicare, and felt obliged to learn: Medicare-for-all is held up as the goal toward which all health-insurance plans should converge, so it seems that I should understand what Medicare-for-just-the-elderly entails.

Medicare part A -- which reimburses hospitals -- is funded out of a dedicated tax amounting to 1.45% from employers and the same fraction from employees, whereas part B -- which reimburses doctors -- comes out of general revenues. Part A, therefore, can go bankrupt, whereas part B cannot. Part B is like the Department of Defense; no one ever talks about the DoD running out of money. In a sense, then, Medicare and Social Security are victims of their own fiscal responsibility. They cannot exceed their budgets.

The politics of Medicare are intimately tied up with this method of funding. Medicare has moved from crisis to crisis over the 40+ years of its existence, each crisis being precipitated by fiscal or demographic changes. People age, the young have fewer kids, recessions cut into tax revenues, etc. The debate over Medicare has always been crisis-driven, and always will be so long as it's funded out of a fixed fraction of payrolls.

This method of funding, and this series of crises, have also influenced the set of procedures that Medicare covers. There's always a tradeoff between expanding coverage and keeping the public fisc in check; that tradeoff is the fundamental tension at the heart of Medicare. Congress has consistently chosen to limit benefits rather than to expand Medicare's budget (and therefore increase the payroll tax).
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2 of 2 people found the following review helpful By Craig Bolon on April 2, 2010
Format: Paperback Verified Purchase
Jonathan Oberlander's book, The Political Life of Medicare, 2003, is in some ways complementary to Theodore R. Marmor's book, The Politics of Medicare, 1970, now in a second edition, 2000. Prof. Oberlander, of the University of North Carolina, did graduate studies with Prof. Marmor at Yale. The Oberlander book gives a briefer treatment of the development and enactment of Medicare but a fuller treatment of the political disputes over Medicare during the 1980s and 1990s.

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.

In 2003 Prof. Oberlander predicted a health-care reform "option to build on the current mixed system of care by expanding public coverage in combination with new subsidies for private insurance" [The politics of health reform, Health Affairs, March, 2003, at [...]]. That is the approach finally taken in 2010. The article predicts such an approach will fail to control costs and predicts a system involving individual insurance mandates "is unlikely to sit well with conservatives who are opposed to federal intrusion into individual liberties," indeed the current focus of opposition.

In March, 2010, Prof. Oberlander offered his assessment of the current health-care reform plan [A vote for health care reform, New England Journal of Medicine, at [...]].
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