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The Delegated Welfare StateMedicare, Markets, and the Governance of Social Policy$
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Kimberly J. Morgan and Andrea Louise Campbell

Print publication date: 2011

Print ISBN-13: 9780199730346

Published to Oxford Scholarship Online: January 2012

DOI: 10.1093/acprof:oso/9780199730346.001.0001

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Administering the Delegated Welfare State

Administering the Delegated Welfare State

The Cases of Medicare and the 2003 Medicare Modernization Act

(p.144) 6 Administering the Delegated Welfare State
The Delegated Welfare State

Kimberly J. Morgan

Andrea Louise Campbell

Oxford University Press

Chapter six explores the consequences of delegated governance through an analysis of Medicare administration in general, and of key elements of the 2003 MMA—the Medicare Advantage program and the Part D drug benefit. Although delegated governance has been politically expedient—enabling the passage and growth of government programs in an anti-government political climate—such expediency has frequently come at the cost of good governance. Outsourcing program responsibilities to non-state actors does not appear to produce more efficient or effectively-run government. Moreover, when the delegation occurs in a way that brings commercial actors into a program, this creates potential hazards (e.g. marketing abuses, fraud) that require oversight by a muscular political agency. Yet, the same hostility towards government that drives the decision to delegate governance in the first place also impedes the growth of an effective oversight body. As a result, various program failures arise that are frequently blamed on government officials who have never been sufficiently empowered to deal with these problems.

Keywords:   medicare, overnance, contracting out, Medicare Advantage, Medicare Part D

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