Medicare features an unusually complex financing design. The Hospital Insurance Trust Fund pays f... more Medicare features an unusually complex financing design. The Hospital Insurance Trust Fund pays for Part A of Medicare (hospital stays), while the Supplementary Medical Insurance Trust Fund finances Part B (doctor visits,outpatient care, and certain home health services). At a time when Medicare policy is generating debate, this article takes a new analytical look at the origins and consequences of the program's peculiar bifurcated structure. Addressing historians of the U.S. welfare state as well as contemporary health policy reformers, the article focuses on the crucial role of legendary Ways and Means Committee chair Wilbur Mills in Medicare's enactment in 1965. The central theme of the article is that fiscal conservatism and a commitment to budgetary restraint constitute important elements of Medicare's original political understanding. Contrary to analysts who argue that Medicare's financing design has produced “perverse” effects, we argue that it has served a v...
The policy feedback literature developed in an era in which the level of polarization and the int... more The policy feedback literature developed in an era in which the level of polarization and the intensity of party competition were far lower than today. These background conditions narrowed the scope of many policy debates and facilitated the consolidation of programmatic expansions after their enactment. As a result, the feedback literature emphasized the ways that new policies build supportive constituencies and become entrenched. While the core insight that policies can generate major political repercussions remains solid, American political development (APD) scholars should pay greater attention to the role of negative feedback processes and backlash politics in an era of disunity. Based on a review of New York Times articles mentioning policy backlash between 1960 and 2019, I show that the 2010s was a period of heightened countermobilization. Backlash forces have diffused from civil rights into many other arenas—including health, trade, and immigration—due to partisan polarizati...
... Why would a democracy fail to enact and implement policies that serve the interests of a very... more ... Why would a democracy fail to enact and implement policies that serve the interests of a very large portion of the citizenry? As David L. Weimer and Aidan R. Vining point out, social scientists ―have yet to produce a theory of government failure as comprehensive or widely ...
As the new century begins, the Medicaid program is arguably at a political crossroads. Over the 1... more As the new century begins, the Medicaid program is arguably at a political crossroads. Over the 1980s and 1990s, policy makers enacted major expansions in Medicaid coverage, offering significant new health benefits to poor women and children and other constituencies. In elite rhetoric and political framing, Medicaid was increasingly cast as a broad-based social welfare entitlement of value to all Americans, including middle-class citizens. Some health care advocates began viewing Medicaid expansions as a potential path to achieving universal coverage in the United States. Yet Medicaid remains a means-tested program that has been repeatedly threatened with policy retrenchment. In this essay, we scrutinize Medicaid's current status and future possibilities from a historical-institutional perspective by tracing its complex evolution since its enactment in the Social Security Amendments of 1965. Our core claim is that decisions made at the time of Medicaid's original adoption have fundamentally set the matrix for struggles over the program's unfolding development. We demonstrate that key ambiguities embedded in the 1965 act created largely unintended opportunities for policy entrepreneurs to broaden Medicaid's scale and scope as well as foreseeable vulnerabilities that must be overcome if Medicaid is to realize its full potential.
We conducted two national surveys of public opinion about comparative effectiveness research and ... more We conducted two national surveys of public opinion about comparative effectiveness research and the integration of findings from the research into clinical practice. The first survey found broad support for using research results to provide information, but less support for using them to allocate government resources or mandate treatment decisions. In addition, the public is willing to consider the use of financial incentives to encourage patients to choose cheaper treatments, if research demonstrates that they work as well as more expensive ones. The second survey found that support for comparative effectiveness research dropped in response to general debates about its consequences but that arguments against the research could be effectively countered by specific, targeted rebuttals.
Medicare features an unusually complex financing design. The Hospital Insurance Trust Fund pays f... more Medicare features an unusually complex financing design. The Hospital Insurance Trust Fund pays for Part A of Medicare (hospital stays), while the Supplementary Medical Insurance Trust Fund finances Part B (doctor visits,outpatient care, and certain home health services). At a time when Medicare policy is generating debate, this article takes a new analytical look at the origins and consequences of the program's peculiar bifurcated structure. Addressing historians of the U.S. welfare state as well as contemporary health policy reformers, the article focuses on the crucial role of legendary Ways and Means Committee chair Wilbur Mills in Medicare's enactment in 1965. The central theme of the article is that fiscal conservatism and a commitment to budgetary restraint constitute important elements of Medicare's original political understanding. Contrary to analysts who argue that Medicare's financing design has produced “perverse” effects, we argue that it has served a v...
The policy feedback literature developed in an era in which the level of polarization and the int... more The policy feedback literature developed in an era in which the level of polarization and the intensity of party competition were far lower than today. These background conditions narrowed the scope of many policy debates and facilitated the consolidation of programmatic expansions after their enactment. As a result, the feedback literature emphasized the ways that new policies build supportive constituencies and become entrenched. While the core insight that policies can generate major political repercussions remains solid, American political development (APD) scholars should pay greater attention to the role of negative feedback processes and backlash politics in an era of disunity. Based on a review of New York Times articles mentioning policy backlash between 1960 and 2019, I show that the 2010s was a period of heightened countermobilization. Backlash forces have diffused from civil rights into many other arenas—including health, trade, and immigration—due to partisan polarizati...
... Why would a democracy fail to enact and implement policies that serve the interests of a very... more ... Why would a democracy fail to enact and implement policies that serve the interests of a very large portion of the citizenry? As David L. Weimer and Aidan R. Vining point out, social scientists ―have yet to produce a theory of government failure as comprehensive or widely ...
As the new century begins, the Medicaid program is arguably at a political crossroads. Over the 1... more As the new century begins, the Medicaid program is arguably at a political crossroads. Over the 1980s and 1990s, policy makers enacted major expansions in Medicaid coverage, offering significant new health benefits to poor women and children and other constituencies. In elite rhetoric and political framing, Medicaid was increasingly cast as a broad-based social welfare entitlement of value to all Americans, including middle-class citizens. Some health care advocates began viewing Medicaid expansions as a potential path to achieving universal coverage in the United States. Yet Medicaid remains a means-tested program that has been repeatedly threatened with policy retrenchment. In this essay, we scrutinize Medicaid's current status and future possibilities from a historical-institutional perspective by tracing its complex evolution since its enactment in the Social Security Amendments of 1965. Our core claim is that decisions made at the time of Medicaid's original adoption have fundamentally set the matrix for struggles over the program's unfolding development. We demonstrate that key ambiguities embedded in the 1965 act created largely unintended opportunities for policy entrepreneurs to broaden Medicaid's scale and scope as well as foreseeable vulnerabilities that must be overcome if Medicaid is to realize its full potential.
We conducted two national surveys of public opinion about comparative effectiveness research and ... more We conducted two national surveys of public opinion about comparative effectiveness research and the integration of findings from the research into clinical practice. The first survey found broad support for using research results to provide information, but less support for using them to allocate government resources or mandate treatment decisions. In addition, the public is willing to consider the use of financial incentives to encourage patients to choose cheaper treatments, if research demonstrates that they work as well as more expensive ones. The second survey found that support for comparative effectiveness research dropped in response to general debates about its consequences but that arguments against the research could be effectively countered by specific, targeted rebuttals.
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