Why have the pro-competition and managed care movements been successful?
Throughout the 50 years since Medicare began, Congress never seriously considered that Medicare could be extended to all Americans nor did they consider reducing the eligibility age of Medicare to below 65. This pattern was present even when national health insurance was at the top of the national agenda. When Medicare began in 1965, this was not what the original advocates had anticipated. They believed and saw Medicare as being a system of health insurance which would eventually end up covering Americans all over the country.
The managed care movement is what helped in marginalizing support for the expansion of Medicare through its influence on the national health insurance proponents. Potential proponents of Medicare expansion were persuaded to pursue another reform strategy. Insurance companies which were practicing managed care were seen as more efficient than was Medicare. Managed care thus kept the idea of Medicare for all off the agenda of Congress mostly by inducing potential proponents of Medicare expansion to be in support of managed care rather than on the expansion of the traditional program of Medicare.
Due to the rise of the pro-competition movement, another impediment could be seen as arising to the expansion of Medicare. It did so by strengthening upon the believe that competition which took place between health insurance firms could be increased mostly by the elimination of tax subsidies for insurance and by shifting costs onto the patients and such competition would help in making the health care sector one which is more efficient than Medicare could be. However since the movement appealed mostly to conservatives who weren’t in support of universal coverage to begin with, the impact on the debate concerning Medicare expansion was less direct albeit powerful.
One question which can be raised is why have the pro-competition and managed care movements been successful in influencing the political elite both outside and inside of Congress? The answer to this is two-fold in nature. Firstly, both the movements have managed in acquiring economic power in comparison to the supporters of the expansion of Medicare. And secondly, both these movements have clothed their diagnosis and solutions to this health care problem in rhetoric which causes listeners to overlook the unproven assumptions which actually form the basis of these diagnosis and solutions. This has caused both the movements in presenting their solutions in an idealized fashion and by oversimplifying forms and has compared their forms to Medicare. Thus, over the years, these movements have managed to develop a culture which doesn’t acknowledge the discrepancy which exists between the evidence present and the basis of their assumptions.
The willingness of these movements to be compared to the real-world Medicare program along with their idealized proposals is what has helped in contributing further to their ability of keeping the option of expanding Medicare off the agenda. It has also contributed towards them not having the ability to address the problems which affect the health care system in America- problems which consist of a high rate of uninsured people, rising costs and barriers to care for those insured.