Commentary Medicare’s Politics

This special section of articles on Medicare’s politics is, for a veteran of the subject like myself, both warmly welcome and mildly puzzling. It is welcome because the writing reflects a reality sharply different from the political analysis of medical care generally available during my early career in academic life, 1956–1966. During that decade, medical care was the object of social science’s interest in sociology, not political science or economics particularly. To be sure, health economics came to flourish as a field from the 1960s onward. But at Medicare’s birth in 1965, political scientists writing about the subject could be counted on the fingers of one hand. In this issue of JHPPL, by contrast, we have a set of thought-ful, accomplished scholars writing about Medicare’s politics, addressing a much larger audience of scholars interested in the subject. Moreover, the articles themselves reflect considerable scholarly investment in Medicare, its administrative history, its programmatic features today, the disputes about its present state, and the future of its reform. This set of articles mildly puzzles in one sense. As is all too true in social-science scholarship generally, cumulative knowledge remains a distant aim rather than a contemporary reality. As will be clear in my comments about individual articles, the scholarship here does not reflect a settled understanding of Medicare’s history. Nor do the authors con-verge about Medicare’s recent experience with “reform ” or its prospects for expansion or transformation, although all are interested in the lat-ter topic. Whether one should expect more common ground — especiall