Synopses & Reviews
In
The Delegated Welfare State, the first book in the
Oxford Studies in Postwar American Political Development series, Andrea Campbell and Kimberly Morgan tackle the federal government's increasing propensity in recent times to outsource governmental functions to the private sector. They use the Medicare Modernization Act of 2003, under which insurance companies assumed many policy implementation responsibilities, as their central example, but their argument extends far beyond that single episode. They also consider the government's reliance on private security forces in Iraq, its use of for-profit entities to provide social services, and its outsourcing of construction oversight in federal disaster zones to private companies.
The book's primary aim is to show how 'delegated governance' works as a method to overcome opposition to expanded government intervention by awarding private interests a stake in public programs. The authors' show that it is not just conservatives who favor the approach. Liberals rely on it as well in order to build broad political coalitions around social programs (and to avoid the charge of big-government liberalism). Despite the approach's popularity, they contend that there are significant long-term costs. Delegated governance hampers the growth of state capacity, increases the power of private interests in policymaking, and reinforces public cynicism about public sector corruption and favoritism. The Bush administration certainly accelerated the shift toward delegated governance, but the impulse precedes that administration and will surely impact policymaking in the Obama administration. This book explains what delegated governance is, how it works, and the significant costs that it exacts on the American polity.
Review
"The Delegated Welfare State masterfully explains health care policy, welfare reform, and--ultimately--how American government really works. Fresh, powerful, elegant, deeply researched, and highly recommended."-James A. Morone, Professor of Political Science and Urban Studies, Brown University, and author of The Democratic Wish and co-author of The Heart of Power
"Medicare is all over the news these days--and the controversies can be mystifying. How can Republicans oppose cuts in Medicare spending, but still want to abolish the basic structure in favor of private vouchers? What did Democrats do with Medicare in the recent health reform legislation, and why? Answers to these puzzles are found in this excellent dissection of the 'delegated welfare state.' This is an important book, not just for scholars and students, but also for journalists, policymakers, and members of the educated public."*--Theda Skocpol, Professor of Government and Sociology, Harvard University, and co-author of Health Care Reform and American Politics
"A major contribution to our understanding of American politics and the welfare state. Morgan and Campbell expertly use Medicare to explore how and why the private sector is given authority over public programs, and the problems that delegated governance creates."--Jonathan Oberlander, Professor of Social Medicine and Health Policy and Management, University of North Carolina-Chapel Hill, and author of The Political Life of Medicare
Synopsis
Why are so many American social programs delegated to private actors? And what are the consequences for efficiency, accountability, and the well-being of beneficiaries? The Delegated Welfare State examines the development of the American welfare state through the lens of delegation: how policymakers have avoided direct governmental provision of benefits and services, turning to non-state actors for the governance of social programs. Utilizing case studies of Medicare and the 2009-10 health care reform, Morgan and Campbell argue that the prevalence of delegated governance reflects the powerful role of interest groups in American politics, the dominance of Congress in social policymaking, and deep contradictions in American public opinion. Americans want both social programs and small government, leaving policy makers in a bind. Contracting out public programs to non-state actors masks the role of the state and enlists private allies who push for passage. Although delegated governance has been politically expedient, enabling the growth of government programs in an anti-government political climate, it raises questions about fraud, abuse, administrative effectiveness, and accountability. In probing both the causes and consequences of delegated governance, The Delegated Welfare State offers a novel interpretation of both American social welfare politics and the nature of the American state.
About the Author
Kimberly J. Morgan is Associate Professor of Political Science at George Washington University.
Andrea Louise Campbell is Associate Professor of Political Science at Massachusetts Institute of Technology.
Table of Contents
Chapter One. IntroductionThe Concept of Delegated Governance
The Case Study of Medicare
The Methodology and Organization of This Book
Chapter Two. Exploring the Delegated Welfare State
Conceptualizing the Delegated Welfare State
What Does the Delegated Welfare State Look Like?
A Cross-National Perspective on Delegated Governance
Why Did the Delegated Welfare State Emerge in the US?
Does It Matter How Social Programs Are Administered?
Conclusion
Chapter Three. Medicare and the Delegated Welfare State in the Post-War Era
The Emergence of the Delegated Welfare State
Delegating the Governance of Medicare
Conclusion
Chapter Four. The Rise of the Market Reform Movement
The Complex Politics of Welfare State Privatization
The Free Market Movement in Health Care
The Politics of Marketization
Conclusion
Chapter Five. Crafting the Medicare Modernization Act of 2003
Delegated Governance in the MMA
The Political Context: Polarization, Electoral Competition, and Partisan Conflict
Program Design: The Turn to Delegated Governance
Passing the MMA in 2003
The Politics of Delegated Governance
Chapter Six. Administering the Delegated Welfare State The Cases of Medicare and the 2003 Medicare Modernization Act
Delegated Governance in Traditional Medicare: A Mixed Picture
Creating a Social Welfare Marketplace: The 2003 MMA
Conclusion
Chapter Seven. The Delegated Welfare State and Policy Feedbacks
The Feedbacks That Haven't Happened (Yet)
The Feedbacks that Did Happen: Public Demobilization and Issue Preemption
Conclusion
Chapter Eight. Citizens, Consumers, and the Market Model
Consumers and the Requirements of the Market Model
Senior Consumers and Part D Decisionmaking
Part D Effectiveness and Senior Welfare: Mixed Evidence
Vulnerable Populations and Redistribution Issues
Conclusion
Chapter Nine. Conclusion: Delegated Governance, Past, Present, and Future
Implications for Thinking about the American State
The 2009-2010 Health Care Debate: A Fight about Governance
Appendix A. Data Sources
Interviews
MMA Panel Survey
Wisconsin Advertising Project Data
Appendix B. Supplementary Tables