ABSTRACT
In 2009 members of Congress returning to their districts to hold town hall meetings encountered a new force: the Tea Party. One of the placards that became emblematic of these contentious meetings read: “Take your government hands off my Medicare.” In part, this sentiment was nothing new. For decades, elected officials had learned a difficult lesson: any attempt to reform the large entitlement programs for the elderly could carry a high political cost. It was not without reason that Social Security was commonly described as the “third rail of American politics.” Touch it, and you will die. But this placard was important for another reason. It revealed the ironic contours of public policy. As one survey revealed, 40 percent of Medicare beneficiaries and 44 percent of Social Security recipients reported that they had not used a government program. 1 This was a product of implementation and design. Many of Medicare’s benefits are delivered through third parties, like insurance companies. And Social Security had been explicitly designed to appear as a form of insurance. Each worker had his or her own account and, it appeared, could spend retirement drawing on a lifetime’s savings. Program participants could denounce government while enjoying its support. They could criticize welfare without recognizing that they were some of the chief beneficiaries of the welfare state. All of this would make the politics of reform quite complex.
