Entitlement Politics describes partisan attempts to shrink the sie of government by targeting two major federal health care entitlements. Efforts to restructure or eliminate entitlements as such, and to privatie and decentralie programs, along with more traditional attempts to amend and reform Medicare and Medicaid have radically transformed policymaking with respect to these programs. However, they have failed to achieve fundamental or lasting reform.

Smith combines historical narrative and case studies with descriptions of the technical aspects and dynamics of policymaking to help the consumer understand how the process has changed, evaluate particular policies and outcomes, and anticipate future possibilities. His account intentionally goes at some length into the substance of the programs, the policies that are involved, and the views of different protagonists about the major issues in the dispute. One unhealthy consequence of politiciing Medicare and Medicaid policy has been to separate public debate from the technical and organiational realities underlying issues of cost containment or program structure. Smith considers this development unfortunate, since it leaves even informed citiens unable to evaluate the claims being made. Ironically, strife over Medicare has complicated the political and policy issues in American life. Only a serious and genuine bipartisan effort bringing forth the best efforts of both political parties--and some of the best industry leaders and policy experts in the field--is likely to achieve genuine reform.

The more people and parties know about the history, politics, and policies of these programs, the better our prospects for devising workable, equitable, and lasting solutions. This volume leads the way toward that understanding.

David G. Smith is Richter Professor Emeritus of Political Science at Swarthmore College and has been a student of health policy since 1965. Among his books is an earlier study of health policy, Paying for Medicare.

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