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The Political Life of Medicare

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.

288 pages | 3 line drawings, 23 tables | 6 x 9 | © 2003

American Politics and Political Economy Series

History: American History

Political Science: American Government and Politics, Public Policy


“This book combines in-depth personal interviews, historical data, and legislative records in an insightful case study of Medicare.  The 50-year history of this program is enlivened by a search for patterns based on theories from political science. . . . The book also explores new theories of path dependence and the roles of ideas in public policy in the US.”


"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

Table of Contents

1: Introduction
2: Medicare’s Roots
The Elusive Search for National Health Insurance
3: Going Nowhere
The Politics of Benefits
4: Going Broke
The Politics of Financing
5: The State Rises
The Politics of Regulation
6: Medicare Politics
Patterns and Explanations
7: The New Politics of Medicare

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