In recent years, “Medicare for All” has become a rallying cry for the progressive left. Proposed and advocated most visibly by Senator Bernie Sanders, the program would establish a national government health care system, moving the U.S. away from its current employer-based health insurance system. However, this proposal, Edward Berkowitz reminds us in Making Social Welfare Policy in America, glosses over the administrative design and complex evolution of Medicare. Medicare has, since its inception, relied on private insurers and health care providers to administer the program, and over time, it has increased its use of market mechanisms through the addition of new plan options and competition. The program bears little resemblance to the government-administered vision proposed by Sanders and others.

Using the cases of Medicare, Social Security Disability Insurance (SSDI), and Aid to Families with Dependent Children (AFDC), Berkowitz explores the political dynamics and policy evolution of the modern American welfare state. Berkowitz, a historian, makes clear that he does not seek to formulate or test grand theories, but instead to engage with the complicated dynamics involved in the policymaking process for each of these important policies.

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