MEDICARE AND SENIORS

Medicare and Seniors

Abstract

Several articles have been written describing the political dynamics surrounding the enactment of Medicare in 1965. This paper expands the existing body of knowledge by comparing and contrasting two models of the policy process in an attempt to provide a more comprehensive and insightful account of the passage of Medicare enactment. The paper concludes that a synthesis of the two models provides the most realistic account of the historical events recorded in the literature.

Table of Content

Introduction4

Discussion and Analysis4

Two Competing Models of the American Policy Process4

The Health Belief Model8

Lack of Awareness9

Case Study Analysis: the enactment of Medicare10

Analyzing the Explanatory Power of Each Theoretical Model14

Conclusion15

References17

Medicare and Seniors

Introduction

The final Medicare act (officially part of the “Social Security Amendment of 1965”) was signed into law by President Lyndon Johnson on July, 30 1965 in Independence, Missouri. Based on the legislation, the federal government would, for the first time, provide hospitalization coverage for the elderly, operate a program of physicians insurance and subsidize medical assistance to the poor. Moreover, it extended Medicare coverage initially to the nearly three million seniors who were not eligible for Social security. In doing so, it served as the most significant piece of Welfare legislation since the New Deal. This paper will compare and contrast two theoretical models of the American policy process:

Pluralism—Interest Group Mobilization;

Theory of Punctuated Equilibrium—Agenda-setting and Issue Framing.

Initially, the paper will identify and elucidate the basic assumptions and perspectives underlying the two theories. In doing so, it will compare and contrast their fundamental assertions. Then, using a case study approach, the paper will analyze the process and decision to enact Medicare legislation in 1965, through the lens of each theoretical model. The paper will conclude with a discussion that addresses the explanatory power of each of the models in terms of the enactment of Medicare.

Discussion and Analysis

Two Competing Models of the American Policy Process

In the rational decision-making model presented by Dahl, individual behavior is interpreted as rational decision: individuals consciously formulate goals, gather information about alternative means to achieve them, evaluate the alternatives, and choose the one most likely to succeed. Related to this perspective on individual behavior is the assumption that information is neutral and unbiased. The rational ideal offers reason as the basis for government whereby groups, organizations and even whole societies can imitate the process of rational deliberation by individuals (Stone, 1988).

The basic unit of analysis in Pluralism is the interest group. Of particular concern is the ways in which interest groups rationally pursue their interests on behalf of their constituent base. In seeking out their interests they inevitably confront other opposing interests, with whom they ultimately establish some form of compromise. According to Dahl, it is within the “political stratum” that interest groups are able to voice their concerns and ultimately be heard. In fact, Dahl states that in many pluralistic systems, the “political stratum” is far from being closed or a static group. Rather, he says that it is easily penetrated because elections provide politicians ...