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

by Morgan, Kimberly J.; Campbell, Andrea Louise

• ISBN13: 9780199730353
• ISBN10: 0199730350
• Format: Paperback
• Copyright: 2011-10-14
• Publisher: Oxford University Press

Summary

Why are so many American social programs delegated to private actors? And what are the consequences for efficiency, accountability, and the well-being of beneficiaries?The Delegated Welfare Stateexamines the development of the American welfare state through the lens of delegation: how policymakers have repeatedly avoided direct governmental provision of benefits and services, instead turning to non-state actors for the governance of social programs. More recent versions, such as the Medicare Part D prescription drug program, delegate responsibility to consumers themselves, who must choose from an array of private providers in social welfare marketplaces. Utilizing a case study of Medicare, along with the 2009-10 health care reform, authors Andrea Campbell and Kimberly Morgan argue that the prevalence of delegated governance derives from fundamental contradictions in American public opinion. Americans want both social programs and small government, leaving policy makers in a bind. In response, they contract out public programs to non-state actors as a way to mask the role of the state. Such arrangements also pull in interest group allies--the providers of these programs--who help pass policies in a political landscape fraught with obstacles. Although delegated governance has been politically expedient, enabling the passage and growth of government programs in an anti-government political climate, it raises questions about fraud, abuse, administrative effectiveness, and accountability. Social welfare marketplaces also suffer due to the difficulties individuals have in making choices about the benefits they need. In probing both the causes and consequences of delegated governance,The Delegated Welfare Stateoffers a novel interpretation of both American social welfare politics and the nature of the American state.

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	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 Monpropit 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 CONCLUSIO
Crafting the Medicare Modernization Act of 2003	p. 107
Delegated Governance In The MMA	p. 108
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 of 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
Cconclusion	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
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