Vladeck B C
Mount Sinai School of Medicine, New York City, USA.
Health Aff (Millwood). 1999 Jan-Feb;18(1):22-36. doi: 10.1377/hlthaff.18.1.22.
Medicare spends more than $200 billion a year; the politics surrounding the Medicare program cannot be fully understood without an adequate appreciation of that fact. An understanding of the political economy of Medicare is perhaps best achieved by thinking along three dimensions: (1) Medicare as redistributive politics; (2) Medicare as special-interest politics; and (3) Medicare as distributive politics. Seeing the extent to which Medicare policies flow from these political processes makes clear that Medicare reform and broader political reform are, at some level, inseparable and indistinguishable.
医疗保险每年支出超过2000亿美元；如果不能充分认识到这一事实，就无法完全理解围绕医疗保险计划的政治因素。对医疗保险政治经济学的理解或许最好从三个维度来思考：（1）医疗保险作为再分配政治；（2）医疗保险作为特殊利益政治；（3）医疗保险作为分配政治。认识到医疗保险政策在多大程度上源于这些政治过程，就会清楚地看到医疗保险改革与更广泛的政治改革在某种程度上是不可分割且难以区分的。
