Felicia E. Mebane - Medicare Politics: Exploring the Roles of Media Coverage, Political Information, and Political Participation

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HEALTH CARE POLICY IN THE UNITED STATES

edited by

JOHN G. BRUHN

PENNSYLVANIA STATE
UNIVERSITY-HARRISBURG

MEDICARE POLITICS

EXPLORING THE ROLES OF MEDIA COVERAGE, POLITICAL INFORMATION, AND POLITICAL PARTICIPATION

Felicia E. Mebane

First published 2000 by Garland Publishing, Inc.

Published 2018 by Routledge

2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN

52 Vanderbilt Avenue, New York, NY 10017

Fisrt issued in paperback 2018

Routledge is an imprint of the Taylor & Francis Group, an informa business

Copyright 2000 by Felicia E. Mebane

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

Notice:

Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.

Library of Congress Cataloging-in-Publication Data

Mebane, Felicia E.

Medicare politics : exploring the media coverage, political information, and political participation / Felicia e. Mebane.

p.cm.-- (Health care policy in the United States)

Includes bibliographical references and index.

ISBN 0-8153-3717-5 (alk. paper)

1. Medicare--Political aspects. 2. Medicare--Public opinion. 3. Public opinion--United States. I. Title. II. Series.

RA412.3M42 2000

368.42600973--dc21

00-042232

ISBN 13: 978-1-138-87474-9 (pbk)

ISBN 13: 978-0-8153-3717-1 (hbk)

To Mom and Dad

Contents

Since 1965, Medicare has been an integral part of the political landscape in the United States. Medicare is the major source of health insurance for older Americans, who play a key role in electoral politics, is popular with the American public, and is a sizable portion of the federal budget. Thus, to understand major Medicare policy decisions, one must understand the politics surrounding the Medicare program.

This book includes three studies that further illuminate various aspects of a key political determinant of Medicare policy: public opinion. , political participation and mobilization of older and younger Americans in 1996, when Medicare was a campaign issue, is compared with corresponding rates of participation and mobilization in 1992 and 1988.

All three studies apply political science models and methods to a major public health program in order to provide insights into Medicare policy decisions. The final chapter translates lessons learned into implications for future Medicare policy debates.

I am thankful to many people for helping me to realize the goal of writing this dissertation. I thank Robert J. Blendon, my mentor, for inspiring me to pursue research topics that are fascinating, meaningful, and somewhat unique. I thank Keith Reeves, Penny Feldman, and Doug Staiger for contributing myriad perspectives on politics, health policy, and methods for analysis to the development of these studies.

I am also indebted to friends/colleagues, notably John Benson, Karen Donelan, Ted Brader, Kristina Hanson, Kathleen ONeill, Nancy Beaulieu, Deborah Azrael, John T. Young, Pamela Berenbaum, Meredith Rosenthal, and David J. Cohen, who provided invaluable critiques and advice concerning numerous written and oral presentations of these ideas.

I am also thankful to everyone who provided me with data and financial support throughout the development of this manuscript. I thank Harvard University, the Agency for Health Care Policy and Research, Robert J. Blendon, Mollyann Brodie and the Henry J. Kaiser Family Foundation, and the Shorenstein Center at the Kennedy School of Government for providing these critical underpinnings for my research. I also thank Joan Curhan, Joe Newhouse, and other faculty and staff associated with the Ph.D. program in Health Policy for encouragement, advice, and guidance throughout the dissertation process.

Finally, I couldnt have earned this achievement without the love and support of family (Mom, Dad, Charlene, and Sheryl) and friends. Special thanks to the family of friends that I have developed within the Harvard community, especially my cohort (Amber Batata, Pam Berenbaum, Joanna Birckmayer, John Lavis, Meredith Rosenthal, and Jennifer Ruger), my Gov. 2000/2001 buddies, current and former members of Bobs group, Mollyann Brodie, and Haiden Huskamp.

TABLES

FIGURES

The impending swell in the ranks of older Americans and rising medical costs ensure that Medicare will attain a prominent position on the national policy agenda in the near future. Once again, Congressional leaders, the President of the United States, and other policymakers will have to confront policy issues that could require fundamental changes to the Medicare program.

A crucial determinant of whether or not Medicare policy proposals become legislation is public support for the proposal.1 As in previous Medicare policy debates, elected officials responsible for considering and implementing Medicare reform will use public opinion about reform proposals as support for their position or as a gauge of the likely political ramifications of their position.2 The influence of public opinion on policymakers decisions concerning changes to Medicare lead to the notion that factors influencing public opinion concerning Medicare are also important determinants of Medicare policy outcomes.

Media coverage is a key source of information about Medicare that affects public opinion and, indirectly, Medicare policy.3 For the millions of Americans who watch or read stories about Medicare, media influence their opinions about proposals to reform Medicare and the ability of political leaders to address Medicares problems by determining the information they receive about particular policy proposals and political leaders.4 Thus, in order to understand public opinion concerning Medicare during upcoming policy debates, proponents of Medicare reform proposals should have an understanding of what information about Medicare media convey to the public.

Based on the predominant method used for analyzing the content of media coverage, this study presents statistics describing coverage of the Medicare debates in 1995-96 that can be used as a benchmark for patterns in future coverage. The analysis also provides evidence of how changes in one aspect of media coverage, criticism of newsmakers, correlate with shifts in public opinion concerning Medicare. The study ends with an examination of factors that explain variation in the level of criticism in coverage.

The first section below begins with a brief summary of the political environment and proposals that were the focus of media coverage during the last major debate about Medicare reform. Next is a discussion explaining the importance of opinion toward political leaders and describing the shifts in opinion that are later linked with changes in media coverage. The subsequent sections discuss how media affect public opinion and the focus of this study. A discussion of the data and methods used follows, along with descriptions of key variables. The final two sections present the results and a discussion of the implications.

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