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The Delegated Welfare StateMedicare, Markets, and the Governance of Social Policy$
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Kimberly J. Morgan and Andrea Louise Campbell

Print publication date: 2011

Print ISBN-13: 9780199730346

Published to Oxford Scholarship Online: January 2012

DOI: 10.1093/acprof:oso/9780199730346.001.0001

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Citizens, Consumers, and the Market Model

Citizens, Consumers, and the Market Model

(p.200) 8 Citizens, Consumers, and the Market Model
The Delegated Welfare State

Kimberly J. Morgan

Andrea Louise Campbell

Oxford University Press

Chapter eight explores the consequences of delegated governance and the market model for Medicare beneficiaries specifically and democratic citizens more generally. Although the MMA assumed that seniors possessed the ability to choose among large numbers of competing alternatives, exit bad plans, and contest inadequate benefits, many Part D enrollees make poor initial choices and then fail to switch plans, thereby increasing costs for themselves and undermining the market logic behind the reform. And although seniors report high rates of problems with their prescription drug plans and low levels of satisfaction compared to those covered by other sources like the Veterans Administration or former employers, they profess favorability toward the prescription drug reform. The chapter concludes that recipients have responded to problems with their plans with loyalty (or passivity) rather than with exit or voice. More broadly, the chapter analyzes mechanisms of accountability and assesses the degree to which individuals can have their voices heard and when they operate as consumers facing for-profit businesses as opposed to citizens confronting public bureaucracies and elected officials.

Keywords:   medicare, Medicare Part D, Medicare Advantage, consumer choice

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