The Delegated Welfare State Medicare, Markets, and the Governance of Social Policy

by Morgan, Kimberly J.; Campbell, Andrea Louise

• ISBN13: 9780199730346
• ISBN10: 0199730342
• Format: Hardcover
• Copyright: 2011-10-14
• Publisher: Oxford University Press

Summary

InThe Delegated Welfare State, the first book in theOxford Studies in Postwar American Political Developmentseries, Andrea Campbell and Kimberly Morgan tackle the federal government's increasing propensity in recent times to outsource governmental functions to the private sector. They use the Medicare Modernization Act of 2003, under which insurance companies assumed many policy implementation responsibilities, as their central example, but their argument extends far beyond that single episode. They also consider the government's reliance on private security forces in Iraq, its use of for-profit entities to provide social services, and its outsourcing of construction oversight in federal disaster zones to private companies. The book's primary aim is to show how 'delegated governance' works as a method to overcome opposition to expanded government intervention by awarding private interests a stake in public programs. The authors' show that it is not just conservatives who favor the approach. Liberals rely on it as well in order to build broad political coalitions around social programs (and to avoid the charge of big-government liberalism). Despite the approach's popularity, they contend that there are significant long-term costs. Delegated governance hampers the growth of state capacity, increases the power of private interests in policymaking, and reinforces public cynicism about public sector corruption and favoritism. The Bush administration certainly accelerated the shift toward delegated governance, but the impulse precedes that administration and will surely impact policymaking in the Obama administration. This book explains what delegated governance is, how it works, and the significant costs that it exacts on the American polity.

Author Biography

KIMBERLY J. MORGAN is Associate Professor of Political Science at George Washington University. ANDREA LOUISE CAMPBELL is Associate Professor of Political Science at the Massachusetts Institute of Technology.

Table of Contents

List of Figures	p. ix
List of Tables	p. xi
Acknowledgments	p. xiii
Abbreviations	p. xv
Introduction	p. 3
The Concept of Delegated Governance	p. 4
The Case Study of Medicare	p. 10
The Methodology and Organization Of This Book	p. 13
Exploring the Delegated Welfare State	p. 18
Conceptualizing The Delegated Welfare State	p. 19
What Does The Delegated Welfare State Look Like?	p. 22
A Cross-National Perspective On Delegated Governance	p. 28
Why Did The Delegated Welfare State Emerge In The United States?	p. 35
Does It Matter How Social Programs Are Administered?	p. 48
Conclusion	p. 55
Medicare and the Delegated Welfare State in the Postwar Era	p. 56
The Emergence Of The Delegated Welfare State	p. 57
Delegating Social Welfare Delivery To The Nonprofit Sector	p. 63
Delegating The Governance Of Medicare	p. 66
Conclusion	p. 77
The Rise of the Market Reform Movement	p. 79
The Complex Politics Of Welfare State Reform	p. 80
The Free Market Movement In Health Care	p. 88
The Politics Of Market Reform	p. 94
Conclusion	p. 105
Crafting the Medicare Modernization Act of 2003	p. 107
Delegated Governance in The MMA	p. 108
The Political Context: Polarization, Electoral Competition, And Partisan Conflict	p. 112
Program Design: The Turn To Delegated Governance	p. 116
Passing The MMA In 2003	p. 132
The Politics Op Delegated Governance	p. 141
Administering the Delegated Welfare State: The Cases of Medicare and the 2003 Medicare Modernization Act	p. 144
Delegated Governance in Traditional Medicare: A Mixed Picture	p. 146
Creating A Social Welfare Marketplace: The 2003 MMA	p. 154
Conclusion	p. 165
The Delegated Welfare State and Policy Feedbacks	p. 168
Studying Feedbacks at The Mass Level: The MMA Panel Survey	p. 170
The Feedbacks That Have Not Happened (Yet)	p. 172
The Feedbacks That Did Happen: Public Demobilization and Issue Preemption	p. 190
Conclusion	p. 198
Citizens, Consumers, and the Market Model	p. 200
Consumers And The Requirements Of The Market Model	p. 201
Senior Consumers And Part D Decision-Making	p. 204
Part D Effectiveness And Senior Welfare: Mixed Evidence	p. 207
Vulnerable Populations And Redistributive Issues	p. 212
Conclusion	p. 216
Conclusion: Delegated Governance, Past, Present, and Future	p. 218
Implications For Thinking About The American State	p. 222
The Politics Of Entitlements: Off-Center Or Catering To The Mushy Middle?	p. 226
The 2010 Health Care Reform: More Delegated Governance	p. 227
Improving The Delegated Welfare State	p. 235
Data Sources	p. 237
Interviews	p. 237
Mma Panel Survey	p. 237
Wisconsin Advertising Project Data	p. 238
Supplementary Tables	p. 243
Notes	p. 253
Index	p. 299
Table of Contents provided by Ingram. All Rights Reserved.