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The Shadow Welfare State: Labor, Business, and the Politics of Health Care in the United States, by Marie Gottschalk. Ithaca, NY: ILR Press of Cornell University, 2000, 288 pp., $45 cloth, $18.95 paper.
The Politics of Medicare (2nd edition), by Theodore R. Marmor. New York: Aldine De Gruyter, 2000, 228 pp., $35.95 cloth, $16.25 paper.
Among the world's advanced industrialized democracies, the United States stands out in the degree to which a significant proportion of its population lacks health insurance. Analysts have persistently sought to fathom the political origins of this circumstance, the demise of the Clinton health plan in the early 1990s recently attracting attention. However, more basic insight into this persistent social problem requires a longer historical perspective. In this regard, Marie Gottschalk and Theodore Marmor have peered through different lenses to provide lucid, insightful, and often provocative analyses of key dimensions of health care politics and policy since World War II. Marmor targets Medicare, the United States' primary venture into a "social insurance" approach to health care, while Gottschalk examines the private safety net and the behavior of organized labor and business in the medical arena.
Marmor anchors his work in the politics of the policy process-both the grand ideological politics of legislative decision as well as the highly technical, but nonetheless critically important, politics of more incremental policy evolution. With slight editing, the first part of this second edition replicates Marmor's earlier book (1973), which assayed the forces in play during the Truman, Eisenhower, Kennedy, and Johnson administrations leading to the passage of Medicare in July 1965. It is no small tribute to that earlier volume that I found it to be well worth rereading after more than two decades. The second part of Marmor's book breaks new ground as he reviews the politics of Medicare (most of it a kind of complex, insider politics) from the program's inception through the 1990s. After providing a historical overview of key developments, he dissects the ideological context of Medicare politics, the political puzzles that the program presents, and the relevance of political science for policy analyses focused on Medicare.
Marmor's book possesses many strengths. He conveys how broader political factors have shaped Medicare politics, explicating in particular three general forces-declining trust in government,...