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The Evolution of Medicare: Challenges, Responses, and Prospects
Glied S., Frank R., Lui B.
Q1
Abstract
The Medicare program has provided a near-universal source of health care coverage for America's elderly since 1965. Over its 60-year history, the program has evolved to cover a greater share of the population and pay for an increasing share of the nation's health care bills. As Medicare has grown, so too have its challenges. The traditional Medicare program has failed to keep pace with a rapidly changing health care sector and demographic shifts. Constrained by its own benefit design, Medicare has allowed privately-contracted health plans (Medigap, Medicare Advantage) to provide much needed yet inadequate remedies to the program's shortcomings. After briefly recounting Medicare's origins, we discuss how the program's founding statutes have hindered its ability to respond to new and growing challenges along the dimensions of cost-sharing, cost containment, and benefit design. We then propose a three-pronged approach to reforming Medicare's benefit structure. We argue that a simplified enrollment process, a single benefit that brings together the program's constituent parts (Part A, Part B, and Part D), and a new organizational structure for care delivery based on the program's experience with Accountable Care Organizations (ACOs), will together create a robust foundation that can sustain the Medicare program into the future.
Consequences of Medicare Advantage for Beneficiaries and Politics: Revisiting The Delegated Welfare State
Campbell A.L., Morgan K.J.
Q1
Abstract
The Delegated Welfare State (Morgan and Campbell 2011) explored the causes and possible consequences of the 2003 Medicare reform boosting private managed care plans in the delivery of Medicare benefits. In this paper, we review scholarship on beneficiary experience (access, costs, outcomes) and political feedbacks arising from the delegated governance reform to evaluate whether predictions about consumer behavior and policy entrenchment have manifested. We find that beneficiary experiences and satisfaction do not differ significantly between Medicare Advantage and traditional Medicare, and MA plans’ managed care techniques have cut per beneficiary spending. However, MA remains costlier to the federal government, per beneficiary, because of the outsized payments received by plan providers. Officials have failed to rectify these overpayments because of policy feedback effects – the empowerment of lobbying groups with a stake in the program and beneficiary support for it. Growing dependence on private plans to deliver health insurance for a large and politically influential constituency, senior citizens, has rendered government officials and elected politicians reluctant to imperil this market and the happiness of beneficiaries.
Medicare in Treacherous Markets: From Community Bake Sales to Private Equity
Morone J.A.
Q1
Abstract
Medicare's 60th birthday marks a shocking milestone for social democrats: More than half of all beneficiaries are signed up with private insurance plans that routinely deny payments. This paper flips the focus from the government program itself to the broader health care markets in which Medicare operates. I show how Medicare has lived through four very different health market eras. Each involves new kinds of medical institutions, new financial logics, and new thinking about what markets are and what role they ought to play in the program. First, during the long battle over Medicare, government programs and markets were (quite mistakenly) viewed as simple opposites. Second, in the 1970s, a new view emerged: Competition between HMOs would provide enrollees choice of providers, enhancing quality and lowering costs. Third, in the 1980s, Republicans pressed market choices into Medicare – drawing on rhetorical images from a bygone era; as conservatives were imagining medical markets, corporations arrived, asserted vast controls over medicine, and redirected consumer choice itself -- from selecting health providers to picking between insurance plans. Finally, beginning in the 2000s, private equity poured into health care and, once again, transformed the market. By Medicare's 60th birthday, enrollees found themselves in turbulent new era as health care in America was growing increasingly monetized.
Medicare at 60: A Popular Program Facing Challenges
Neuman T., Fuglesten Biniek J., Cubanski J.
Q1
Abstract
As Medicare approaches its 60th anniversary, it almost goes without saying that the program is both popular and successful. Medicare provides health insurance coverage to 67 million older adults and people with disabilities. Medicare is viewed favorably by Democrats, Republicans, and Independents. Medicare has also helped to extend life expectancy and, in conjunction with the Civil Rights Act of 1964, narrow disparities in care. It is a vital source of revenue for hospitals, physicians and other health care providers, and health insurers and is an essential component of health and retirement security in the U.S. These are among the reasons why Medicare is often considered a third rail in politics. Medicare also faces challenges stemming from the growing role of private plans, demographic shifts, and rising health care costs. This paper examines these challenges by focusing on three fundamental questions. First, what are the implications of the transformation that is taking place with private insurers playing a more dominant role in providing Medicare benefits? Second, what changes may be important to address the gaps in covered benefits and related affordability challenges? Third, how can Medicare be sustained to finance care for current and future generations?
Medicare at 60: Many Successes but More Work to Do
Garrett B., Holahan J., Zuckerman S.
Q1
Abstract
Enacted in 1965, Medicare enrolled its first beneficiaries in 1966. Medicare has provided access to health care for tens of millions of Americans aged 65 and older, as well as to younger individuals with disabilities. To mark its 60th anniversary, it is fitting to review Medicare's many accomplishments, as well as its problems, and highlight reforms that can extend and build on its legacy. The problems mainly relate to the financing challenges the program poses, for beneficiaries, taxpayers, and the federal budget, and the approach that has led to significant overpayments to private Medicare Advantage plans that now enroll over 50% of beneficiaries. This article reviews historic trends in enrollment and spending in Medicare, payment innovations the program created, how traditional Medicare has outperformed commercial insurers in controlling health care spending, and sources of overpayments in Medicare Advantage. Finally, the article highlights potential ways to fix Medicare's problems and promote its sustainability for future generations.
Introduction: Medicare at 60
Oberlander J.
Q1
The Last Korean Animation: Wonderful Days and the Aesthetics of Global Monopoly Capitalism
Gottesman Z.S.
Q1
Abstract
Wonderful Days (2003) was supposed to be the global breakthrough of Korean animation. After decades of government neglect and labor-intensive outsourcing work, the film aspired to show the world Korea's new technical prowess in animation, combining 2-D, 3-D, and miniatures in a new “Multi-Type Layer Animation.” Funded by the Korean government and Samsung's post–Asian financial crisis venture capital fund, the film also promised a new government-corporate Korean economic model in which creative labor and free-flowing finance capital would replace heavy industries and state planning. Instead, the film was a box office disaster commercially and critically, resulting in it becoming the last thematically complex, high-budget, feature-length Korean animation. What do these results tell us about the limits of its aspirations? This essay argues that the film's failure represents South Korean animation's defeat by American and Japanese monopoly capitalism. It then analyzes contradictions in the film's aesthetics and narrative to show the incompatibility of these countries’ postindustrial, ecoutopian ideology with persistent Korean manufacturing dependency and proletarian politics. The essay finally interrogates the consequences of Korean labor for thinking about transnational animation production beyond categories of success and failure determined by the nation-state and capitalism's global hierarchy of labor.
Contributors
Q1
The Cultural Politics of Asian Life in Carl Mydans's Photojournalism of Tule Lake and Yosu-Sunchon
Lim J.
Q1
Abstract
This article turns to two pieces of photojournalism in Life magazine by Carl Mydans to illuminate the visual economy of American militarism. By juxtaposing the photographs of the Tule Lake Japanese American incarceration camp and those of the Yosu-Sunchon rebellion in US-occupied Korea, the article explores the visual representations of military violence in these photographs with an eye to how US military violence was rendered civilized in comparison to the savage violence of Koreans. The visual repertoire of Asian lives in the photographs ranges from what the article calls “endurable life” to “liminal life” based on the photographed subject's receptiveness to Cold War racial liberalism and its governmentality. While Mydans's photojournalism of Tule Lake and Yosu-Sunchon precede the outbreak of the Korean War, the article suggests that the photographs of Asians under US militarism in the years leading up to 1950 show the conditions of the American public's reception of Korean War photographs, which Susan Sontag in 1973 characterized as “unanimous in its acquiescence to the Korean War.”
Face Masks for the Ancestors: Everyday Life and Death during the COVID-19 Pandemic in Urban Hanoi
Hüwelmeier G.
Q1
Abstract
This essay examines the everyday life and death of residents in urban Hanoi during the fourth wave of the pandemic in the summer of 2021. The article considers how city dwellers developed manifold creative strategies to deal with government requirements and argue that part of the population developed tactics of survival to circumvent prescribed rules in coping with the pandemic. But it wasn't just the living who were affected by the virus. The dead are believed to live on in the afterlife, and hence the essay also illustrates popular religious practices performed to protect ancestors from infection. Since customary respect for the deceased involves burning paper votive replicas, new items in the form of face masks and vaccine kits began circulating online. This not only sheds light on people's efforts to ensure that ancestors feel safe in the hereafter but shows how ritual artifacts and practices reflect and refract political, economic, and health concerns to bridge life and death.
China's Feminist Gap: Edges, Nearness, and Distance in Women's Arts
Claypool L.
Q1
Abstract
What does it mean to make art in a space that lies on the fault lines of geopolitical boundaries and gender discourses? This article explores the work of Chinese women artists who are alive to the complexities and ambiguities of their position and art practices in between. It asks after the feminist nature of that gap space as the condition for dispersal of identity and the emergence of embodied and affective meaning. How does the work of art work to bring the feminist gap into the beholder's presence? How do we as beholders enter into the feminist gap through our encounters with it? And why might ways of seeing that are shaped by these women's experiences as visual artists and their cultural understandings of feminism end up mattering to us all?
Heterogenesis and the Affective Economies of Catastrophes
Hai P.
Q1
Abstract
An emergent duo nan xing bang 多难兴邦 (catastrophes give rise to a stronger national community) discourse sets out appropriating major catastrophes befalling the disparate peoples in China into a totalizing signifying chain of national resilience and solidarity. Literary works and films assist this statist drive as they generate a common affective economy of suffering and national overcoming, not only to elicit the emotional labor of sympathy for those affected but also to nationalize the experiences of distraught individuals and specific localities. Closely reading two recently published literary treatments of the 1960 famines and the little-known 1920 Haiyuan earthquake, respectively, this article shows that literature could also participate in “rescuing history from the nation” by fully accentuating catastrophes’ role in fracturing landscapes, disrupting the myth of political cohesion, and, above all, dissenting from the narration of a unified, ascendant national community. The article uses a methodology of the Deleuzian heterogenesis in constituting the radical particularism in the two texts. It argues that the method of heterogenesis is most effective in questioning nationalism's reliance on homogeneity as its imaginative end.
Archive of the Missing: Speculative Visions and the Terms of Social Repair in Transnational Adoption
Kim H., Kim Y.R.
Q1
Abstract
This article examines Kate-hers RHEE's Noh-Chim (Missing) and Deann Borshay Liem's In the Matter of Cha Jung Hee, two films that employ the missing as a key motif to understand their personal adoption misinformation. In our close observation of these works, the article sees the missing as both a method and framework with which to imagine a vision of repair amid the debris of violence in the transnational adoption practice and archives. Both RHEE and Liem's experimental engagement with the search—the search for the missing—uncovers intercalated dimensions of archival violence—biopolitical, administrative, and rhetorical. Via artistic expression, each work disrupts the nationalistic and naturalistic narrative of search and reunion and offers speculative analytics via which to imagine the connections and visions from the missing. Drawing upon their brilliant aesthetic analysis of the missing, this article extrapolates the unexpected, ephemeral, encounter, entanglement, and empathy as a new horizon for ethics and politics of repair in transnational adoption practice.
Editor’s Note
Tu W.
Q2
The Indian Question in Afrocentric Politics
Shankar S.
Q2
Abstract
For African-Indian relationships, the idealism of Afro-Asian solidarity did not often match realities on the ground, which were volatile and rapidly changing from the 1940s. This essay explores how Idi Amin's expulsion of Asians was embedded in a racial calculus that had a history beyond Uganda in 1972, in the context of ongoing struggles for African independence, Pan-Africanism, the Cold War, and religious nationalism in the Middle East. The Indian question in Africa was a political and sociocultural one—emblematic of division and partition based on ethno-religious and cultural difference and hierarchy—and not simply an economic one for Africans. The Ugandan expulsion was complex and not a single event but one made in multiple registers, as wider continental African perspectives reveal.
Uneasy Solidarities
Rao V.V.
Q2
Mapping and Forgetting
Jaguaribe B.
Q2
Abstract
Centered on the mapping of the Brazilian state of Mato Grosso, this essay explores the relations between cartography, national imaginaries, and personal archives. Undertaken in 1917 by the Rondon Commission during the period of the First Republic (1889–1930), the making of the map spanned decades of Brazilian history, as it was finally published in 1952 during Getúlio Vargas's democratic presidency. Its making entailed the exploration of the vast Brazilian hinterlands, the transformation of Indigenous peoples, and the shaping of the lives of the explorers, guides, and cartographers engaged in the enterprise. Since its beginning, the making of the map was directed by Cândido Mariano da Silva Rondon's close collaborator, the military cartographer and chief of the cartography section of the Rondon Commission, Francisco Jaguaribe. As Jaguaribe was the author's paternal grandfather, the effort of mapping what was then the immense terrain of Mato Grosso became embedded in the memorial archives of her family. The author envisions the map as a material object, as a repertoire of imaginaries, a monument, ruin, and allegory. In narrating its saga, the author seeks to entwine personal lives with national projects, individual/collective oblivion with national erasure, and mapping with experiences of creation and destruction.
Optimizing Mecca
Shah O.
Q2
Abstract
In the holy city of Mecca, crowds and numbers matter. A hadith or saying of the Prophet reports that when pilgrims number fewer than seven hundred thousand, angels will perform the rituals in their stead. One of the names of Mecca is umm al-zuhm or “Mother of Crowds.” Thinking about crowds in Mecca requires an alternate, Islamic genealogy of “the crowd.” But in contemporary Saudi Arabia, the crowd is becoming a resource in new ways. As part of the Vision 2030 national transformation plan, the Saudi government wants to intensify Mecca's crowds, increasing the annual number of pilgrims from eight million to thirty million. Under this plan, the holy city is to become a laboratory for new sciences and technologies of crowd management, logistics, and optimization. This article demonstrates how Mecca comes to be constitutive of these new crowd sciences. The author shows how a range of knowledges (both religious and more secular) compete and collaborate through the building of a massive hajj infrastructure (the Jamarāt Bridge) and its system of logistical optimization (tafwīj). While the author is generally interested in how Mecca comes to be useful for these new crowd sciences and technologies, he is particularly interested in how Islamic law is deployed as “optimization” and as a crowd management “solution.” These strategies of crowd efficiency and optimization not only transform the performance of ritual itself but also diminish the cosmopolitanism that undergirds the hajj and its knowledge worlds.
Expulsion as Decolonization
Serunkuma Y.K.
Q2
Abstract
Despite more than a hundred years in Uganda, ethnic Indian Ugandans have struggled to integrate into a space historically renowned for naturalizing visitors. As the Mabira Forest Protests of 2007 demonstrated, Indian-Ugandans have sustained the image of a ‘loathed exploitative settler’ among their native compatriots. Despite this image having a specific colonial history, this article contends that the persistence of anti-Indian sentiments—and the ire and violence—is not simply a “legacy of colonialism” or evidence of natives’ xenophobia. It is rather a product of closed Indian cultural practices, and state sanctioned economic privileging of Indian-Asian businessmen, which combine to effectively alienate the entire community from other Ugandans. If the 1972 Indian expulsion was understood through the lens of decolonization, the abundance of the conditions that led to 1972, renders another expulsion possible. To make these contentions, this article provides context on the nature and scale of anti-Asian public sentiments in Uganda by drawing on sources from the mainstream and popular media that narrate and analyze the often-suspicious economic dealings of prominent Indian-Ugandans. Prominent among others is the subject of “repossession” of expropriated Indian properties. The article revisits the 2007 Mabira Forest protests to demonstrate controversies, connections, and possibilities of re-expulsion as the ingredients of 1972 abound.
Port Cities, Creative Cities
Edwards B.T., Ksikes D.
Q2
Abstract
This essay describes a project launched by the authors in 2020 in multiple port cities. Part manifesto, part interim report, the essay advances three claims about the distinctiveness and potentialities of port cities. First, they share both positive and negative characteristics. On the negative axis, port cities struggle with environmental crisis, susceptibility to epidemics, and endemic forms of crime, poverty, and corruption. On the positive axis, they are distinguished by high levels of multilingualism, social relationality, cosmopolitanism, and creativity. Crossing both axes, water is a key force, as metaphor, energy, and threat. Second, port cities are typically exceptional to the nations to which they pertain, frequently occupying the status of a “minor” city in any given national or regional imaginary, even while part of colonial and postcolonial tensions. As such, they function as nodes across a global network of minor realms. Third, their capacity for resilience and their potential for survival in the face of existential challenges are derived from a concentration of “organic connectors.” The authors define the concept of the “organic connector” and argue for its role in positive social and cultural change. Having established this set of characteristics, the essay lays out a methodology for activist, collaborative research.
Vanishing Mediators
Kara T.
Q2
Abstract
The expulsion of Ugandan Asians in 1972 coincided with the formal and informal development of multiculturalism as state policy and as shibboleth, while their arrival in places like Canada and Britain accelerated or compelled its advance. In both contexts, Uganda's Asians as well as cognate communities from Kenya and Tanzania are often seen as one of multiculturalism's ostensible success stories, even though in Britain they have also become some of its most visible critics. This essay suggests that the history of the expulsion is intimately rather than only accidentally connected to that of multiculturalism. It traces the conceptual links between the colonial “multiracialism” that defined the contexts in East Africa from where the Asians were expelled and what is today called multiculturalism. It makes the case that both might be better understood in relation to the persistent problem of mediation, as well as the uncertain place of mediating groups themselves.
