The Delegated Welfare State: Medicare, Markets, and the Governance of Social Policy

By Kimberly J. Morgan; Andrea Louise Campbell | Go to book overview

9
Conclusion
Delegated Governance, Past, Present, and Future

The goal of this book is to explore some of the ways in which the American welfare state delegates authority to private actors. It is well-known that the private sector plays a vital role in the delivery of social benefits and services. Many have also written about the indirect way in which American government often achieves its social policy objectives—using tax policy or regulation, for instance, as a way to prod private provision in lieu of direct government action. We have taken this line of inquiry a step further, examining how, even in what seem to be the most “public” of social programs, such as Medicare, considerable authority for the management and delivery of these programs has long been vested with non-state actors. Although many would assume that such practices are a product of neo-liberal political currents that have taken hold since the early 1980s, we instead find delegated governance to be a pervasive feature of the American welfare state, one that predates the coming to power of Ronald Reagan and other market-oriented conservatives. In fact, much of the growth of the American state in the post-1945 period has been achieved through the granting of governing authority over social programs to private entities.

To capture this phenomenon, we develop the concept of delegated governance: the delegation of responsibility for publicly funded social welfare programs to non-state actors. We use this general term to encompass several more specific forms of delegation. The form most common in the earliest development of social programs was one that assigned responsibility for program administration or service delivery to nonprofit organizations or publicly minded professionals. Here, the assumption was that profit motives were not always appropriate when it came to delivering social welfare programs and services, and thus many policy-makers preferred to rely on nonprofits or professionals—such as physicians—as essentially nongovernmental extensions of the government. In later years, however, a growing chorus of advocates favored introducing market competition into the delivery of public programs. This would shape two other variants of delegated governance—a marketized version that shifted governance to risk-bearing, for-profit entities and/or sought to introduce greater competition among all government

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