MEDICARE AND MEDICAID AT 50: America’s Entitlement Programs in the age of affordable care (Oxford University Press, 2015)

the past, present, and future of U.S. health policy

a panel discussion among distinguished contributors to the volume, including (left to right) Ted Marmor, Jonathan Oberlander, Judith Feder, Keith Wailoo, Sara Rosenbaum, and Uwe Reinhardt — panel discussion sponsored by the National Academy of Social Insurance (video below)

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Contributors to Medicare and Medicaid at 50 discuss the past, present, and future of health care programs and U.S. health care.

"THE ERA OF BIG GOVERNMENT: WHY IT NEVER ENDED" (Keith Wailoo, excerpt from chapter 12 -- Medicare and Medicaid at 50: America's Entitlement Programs in the Age of Affordable Care): "Facing the Republican takeover of Congress in January 1995, President Bill Clinton conceded that 'the era of big government is over." With the defeat of his ambitious national health insurance plan a few months earlier and the subsequent Republican takeover of Congress, Clinton's declaration seemed to draw the curtain on 30 years of federal activism in health reform. The mid-1990s promised to bring a dire thirtieth anniversary for Medicare and Medicaid. Yet, within a year, the Republican-controlled Congress itself was embracing healthcare reform and expansion. By 1997, it had passed (and Clinton had signed) a new Children's Health Insurance program. Six years later, in 2003, Clinton's successor, Republican George W. Bush, would be the architect of another expansion -- a new prescription drug benefit for Medicare recipients. And then Bush's successor, Democrat Barack Obama, would continue the trend by using Democratic control of both houses of Congress in 2010 to push through the Affordable Care Act (ACA) by the thinnest of margins. In truth, then, 20 years of big government activism followed Clinton's concession. It was also the case that both parties, often regardless of ideology, have embraced expansion and so-called bigger government... Medicare and Medicaid have expanded despite enduring anti-government rhetoric and serious threats of retrenchment over the past five decades, and particularly since the rise of the political Right... Even Ronald Reagan -- who famously announced in his 1981 inaugural address, 'in the present crisis, government is not the solution to our problems, government IS the problem' -- would oversee growth in both programs... To understand the apparent paradox, we must distinguish between political rhetoric, on one hand, and the pragmatics of governance, on the other... The surprising durability of these programs under both Democratic and Republican stewardship speaks to a complex relationship between Americans of all political persuasions and their big government..." READ MORE.