Medicaid is a story worth telling, one rooted in Americanhistory and shaped by its culture and institutions. It hasdramatic interest, heroes and heroines, triumphs andtragedies. The authors make this story come alive forthe reader by providing a strongly connected narrative,detailed accounts of important policy changes, and extensiveuse of interviews with individuals close to events.They emphasize politics and policy along with history.History is important because Medicaid has developedincrementally, layer by layer, so that almost any provisionor activity needs a historical gloss to understand it. TheMedicaid program has been especially subject to outsidepolitical and policy influences: the state of the economy,trends in federalism, developments in health or welfareprograms, and the electoral cycle.A central theme of the book is that Medicaid is a "weakentitlement," one less established or effectively defendedthan Medicare or Social Security, but more secure thanwelfare or food stamps. Medicaid has the flexibility to adapt(or be adapted) as well as a capacity to defend incrementaland opportunistic gains. At the same time, the programlacks an effective mechanism for overall reform. It hasgrown enormously since its inception to become the largesthealth insurance system in the country, a source of perennialcomplaint and, most recently, of continuing crisis.The dual emphasis upon politics and policy is importantto make the arcane Medicaid program accessible tothe reader, and to distinguish policy grounded in facts andanalysis from partisan bombast and ideology. The result isan authoritative account and reference for those seekingto refresh a perspective or to look further.
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