B C VLADECK : The political economy of Medicare

Published in Health Affairs, Vol 18, Issue 1, 22-36 Copyright © 1999 by Project HOPE

Medicare spends more than $200 billion a year ; the politics surrounding the Medicare program cannot be fully understood without an adequate appreciation of that fact. An understanding of the political economy of Medicare is perhaps best achieved by thinking along three dimensions : (1) Medicare as redistributive politics ; (2) Medicare as special-interest politics ; and (3) Medicare as distributive politics. Seeing the extent to which Medicare policies flow from these political processes makes clear that Medicare reform and broader political reform are, at some level, inseparable and indistinguishable.

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