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

Why are so many American social programs delegated to private actors? And what are the consequences for efficiency, accountability, and the well-being of beneficiaries? The Delegated Welfare State examines the development of the American welfare state through the lens of delegation: how policymakers have repeatedly avoided direct governmental provision of benefits and services, instead turning to non-state actors for the governance of social programs. More recent versions, such as the Medicare Part D prescription drug program, delegate responsibility to consumers themselves, who must choose from an array of private providers in social welfare marketplaces.

Utilizing a case study of Medicare, along with the 2009-10 health care reform, authors Andrea Campbell and Kimberly Morgan argue that the prevalence of delegated governance derives from fundamental contradictions in American public opinion. Americans want both social programs and small government, leaving policy makers in a bind. In response, they contract out public programs to non-state actors as a way to mask the role of the state. Such arrangements also pull in interest group allies--the providers of these programs--who help pass policies in a political landscape fraught with obstacles. Although delegated governance has been politically expedient, enabling the passage and growth of government programs in an anti-government political climate, it raises questions about fraud, abuse, administrative effectiveness, and accountability. Social welfare marketplaces also suffer due to the difficulties individuals have in making choices about the benefits they need. In probing both the causes and consequences of delegated governance, The Delegated Welfare State offers a novel interpretation of both American social welfare politics and the nature of the American state.