Chapter

Administering the Delegated Welfare State

Kimberly J. Morgan and Andrea Louise Campbell

in The Delegated Welfare State

Published in print October 2011 | ISBN: 9780199730346
Published online January 2012 | e-ISBN: 9780199918447 | DOI: http://dx.doi.org/10.1093/acprof:oso/9780199730346.003.0006

Series: Studies in Postwar American Political Development

Administering the Delegated Welfare State

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Chapter six explores the consequences of delegated governance through an analysis of Medicare administration in general, and of key elements of the 2003 MMA—the Medicare Advantage program and the Part D drug benefit. Although delegated governance has been politically expedient—enabling the passage and growth of government programs in an anti-government political climate—such expediency has frequently come at the cost of good governance. Outsourcing program responsibilities to non-state actors does not appear to produce more efficient or effectively-run government. Moreover, when the delegation occurs in a way that brings commercial actors into a program, this creates potential hazards (e.g. marketing abuses, fraud) that require oversight by a muscular political agency. Yet, the same hostility towards government that drives the decision to delegate governance in the first place also impedes the growth of an effective oversight body. As a result, various program failures arise that are frequently blamed on government officials who have never been sufficiently empowered to deal with these problems.

Keywords: medicare; overnance; contracting out; Medicare Advantage; Medicare Part D

Chapter.  11658 words. 

Subjects: US Politics

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