Entitlement Politics: Medicare and Medicaid, 1995-2001

by Smith,David G.

• ISBN13: 9780202307190
• ISBN10: 0202307190
• Format: Nonspecific Binding
• Copyright: 2002-11-30
• Publisher: Routledge

Summary

Entitlement Politics describes partisan attempts to shrink the size of government by targeting two major federal health care entitlements. Efforts to restructure or eliminate entitlements as such, and to privatize and decentralize programs, along with more traditional attempts to amend and reform Medicare and Medicaid have radically transformed policymaking with respect to these programs. However, they have failed to achieve fundamental or lasting reform. Smith combines historical narrative and case studies with descriptions of the technical aspects and dynamics of policymaking to help the consumer understand how the process has changed, evaluate particular policies and outcomes, and anticipate future possibilities. His account intentionally goes at some length into the substance of the programs, the policies that are involved, and the views of different protagonists about the major issues in the dispute. One unhealthy consequence of politicizing Medicare and Medicaid policy has been to separate public debate from the technical and organizational realities underlying issues of cost containment or program structure. Smith considers this development unfortunate, since it leaves even informed citizens unable to evaluate the claims being made. Ironically, strife over Medicare has complicated the political and policy issues in American life. Only a serious and genuine bipartisan effort bringing forth the best efforts of both political parties--and some of the best industry leaders and policy experts in the field--is likely to achieve genuine reform. The more people and parties know about the history, politics, and policies of these programs, the better our prospects for devising workable, equitable, and lasting solutions. This volume leads the way toward that understanding. David G. Smith is Richter Professor Emeritus of Political Science at Swarthmore College and has been a student of health policy since 1965. Among his books is an earlier study of health policy, Paying for Medicare.

Table of Contents

Acknowledgments	vii
Introduction	1	(12)
Notes	11	(2)
Historical Background	13	(26)
Medicare and Medicaid-Initial Legislation	13	(3)
Medicare: Reform Efforts	16	(4)
Medicare and the Contemporary World	20	(4)
Medicaid: Perennial Issues and Reform Efforts	24	(15)
Notes	35	(4)
Medicaid and the Balanced Budget Act of 1995	39	(32)
Background and Early Moves	40	(4)
Budget Resolution	44	(9)
Budget Reconciliation	53	(18)
Notes	66	(5)
Medicare---1995	71	(76)
Preparing the Way	73	(9)
The Democrats Counter	82	(10)
The Medicare Preservation Act	92	(30)
Denouement	122	(25)
Notes	137	(10)
A Year of Transition---1996	147	(26)
The Three-Part Reconciliation	148	(7)
The Health Insurance Portability and Accountability Act	155	(10)
Reflections	165	(8)
Notes	167	(6)
Medicare and Medicaid, 1997	173	(70)
The Context of Events in 1997	174	(3)
The Budget Resolution: Setting Strategic Limits	177	(10)
The Budget Reconciliation	187	(36)
The Conference	223	(8)
Some Accomplishments	231	(12)
Notes	235	(8)
Implementation	243	(86)
Background	244	(3)
Medicare Implementation	247	(48)
Medicaid and SCHIP	295	(21)
Design and Construction	316	(13)
Notes	319	(10)
Old Business and New	329	(40)
Managed Care Reform and Patients' Bills of Rights	331	(12)
Beyond the Balanced Budget Act: Rhetoric and the Future	343	(26)
Notes	363	(6)
Postscript	369	(14)
Appendix	383	(12)
A. BBA 97: Table of Contents	383	(3)
B. HCFA (CMA): Activities and Organization	386	(9)
Glossary	395	(10)
Bibliography	405	(12)
Index	417