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CALIFORNIA STATE UNIVERSITY, LOS ANGELES
DEPARTMENT OF POLITICAL SCIENCE
POLS 587, Seminar: Politics of Aging
Theme: Social Security and Medicare Reform
Fall, 2007: Wednesday nights, 6:15 p.m. until 10:00 p.m., E&T A-531
Instructor: Professor J. Theodore Anagnoson. Office: E&T A529 (fifth floor). (323) 343-2245.
Office Hours: All office hours are by appointment – make appointments by emailing me.
Tuesdays 5-6:30 p.m.
Wednesdays 8-9 a.m. and 5-6 p.m.
Thursdays 8-9 a.m.
Purpose – The purpose of this course is to explore the various options for Medicare and Social Security reform, as
well as the politics involved and the implications of the various policy options. When the course is over, you will
have a thorough understanding of the programs, their operations and design, and the various options available.
Course Description – In general, we will focus on the following topics:
 Demographics, public opinion, income, poverty of older Americans
 Politics of older Americans -- interest group involvement, political participation, impact on legislatures.
 Politics and policy analysis of Social Security and Medicare.
Books and Materials – while most of the course is developed from web-based materials, there are two books:
 Diamond, Peter A., and Peter R. Orszag. Saving Social Security. Washington: Brookings, 2005 (revised
edition). $22.95 new. 0-8157-1837-6
 Oberlander, Jonathan. The Political Life of Medicare. Chicago: University of Chicago, 2003. 0-226-615960
Course Requirements
1.
Two oral reports. 10%.
A. Two oral reports on a policy issue or article associated with one of the programs. These are usually from
readings that are designated on the syllabus. In some cases, these may be the same as your term paper,
which means that the oral report on the last day can be a short update.
B. One oral report on your term paper topic; these will be given the last day of class.
C. All oral reports are to be done as PowerPoint presentations. Instructions on how to do this will be provided
in class.
2.
Term paper. General topic: Analysis of an Option for Changing/Reforming Social Security and/or Medicare.
40%.
 Length: 10-12 pages including the bibliography but not the cover page.
 Be sure to insert page numbers on your pages.
 Bibliography must consist of several items, not just a few.
 Items obtained from the Internet must be in the following form: Author. Title. Place, date. URL
3.
Final Exam. 40%. A take-home final consisting of one or two essay questions will be distributed at the Week
10 class. It will be due at the time of the final exam, one week later. You should write no more than 4-5 double
spaced pages on each question. There will be some question choice.
4.
Class participation – 10%. Don't be silent. Class participation is an important part of the learning process in
the course. Participation is not just what the discussion leaders do; it is the responsibility of all of us to make
worthwhile contributions to the class discussion, including asking questions. A good question is often the key to
obtaining good answers. Quality and quantity are both judged in assessing your classroom participation. You
will learn more if you ask questions and keep prodding both your fellow students and the instructor.
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Policies Relevant To This Class:
1. Policy on attendance -- attendance is not required, but classroom participation is an important part of your
grade (10%). You should therefore attend every class. For most students, there is a high correlation between
attendance and the amount learned and thus the grade. Very few students can attend only sporadically and
do well on exams and papers, especially in a class like this one.
2. Paper policies – Please note carefully:
 Papers must be typed.
 Policy on stylistic and grammatical errors is the same policy as is used in manufacturing Toyota
automobiles – the goal is perfection, with zero defects -- no spelling errors, no grammatical errors,
no awkward phrases, no wrong words. Use a spell check program, hire an editor…whatever works.
But in the end, produce the best paper you have ever written in your life.
 Papers should be well-edited and checked for spelling, punctuation, run-on sentences, agreement
between subject and verb, agreement among pronouns, tense and general sentence construction and
syntax.
 Do not use plastic folders for your paper. Use a title page with the title of the paper, your name,
and this course number, plus the date, and staple the whole package in the upper left.
 Use page numbers. If you wish to have your name or an identifier at the top of each page, use the
last four digits of your CIN.
 Late papers are not accepted. You have weeks ahead to plan your paper; if you miss class that
night and have not already turned in your paper, you get a zero.
 Use one of the several styles where you cite authors in the text, not in footnotes. For a guide to the
MLA and/or APA style, see the Library's APA or MLA style guides.
3. Academic Dishonesty / Cheating policy -- You need to do your own work. Collaborating with others
either in the class or outside it is ENCOURAGED when you are planning your papers, planning your poster,
and studying for exams. Forming study groups is often an effective way to study and to learn. But when you
write your paper, you need to work on your own.
 You must observe all the standard rules of attribution -- if you get an idea or a phrase or a quote or
a paraphrase or anything at all from another source, it needs to be acknowledged. Use the APA or
the MLA style with the author's name and the page number at the end of the sentence (Anagnoson
96). Then have a list of references at the end of the document. This includes ideas from your
friends (Andranovich, 2001).
Reference: Andranovich, Gregory. Conversation. 6/15/01.
Should you be found to plagiarize, misrepresent the source of your work, steal, borrow, and/or
collaborate in a dishonest way with others in completing your work, you will receive a failing
grade for that work and be reported to the Coordinator of Student Discipline for further
disciplinary action.
4. Communicating with the instructor: email is the most efficient. Our voice mail system garbles people's
voices, so if you leave a message, be sure to speak slowly and clearly.
5. Grading Policy – plus and minus grades are used in this class.
6. Cell Phones and Pagers -- please turn these off in class.
7. Reasonable Accommodations for Qualified Students with Protected Disabilities – please see me
privately if you fall into this classification.
Possible Paper Topics:
Social Security:
 The 1982-1983 commission, its recommended changes, what happened. Why was the commission
successful when others have not been successful?
 The 1994-1996 Commission on Social Security - what did this commission recommend, why, why not
successful?
There are basically four viable sets of plans.
1. President Bush’s proposals. These came from
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i. The Bush Commission of 2001, and
ii. His effort in 2005 to coax the Congress into enacting individual accounts.
2. The Schieber-Shoven plan, as updated to 2006. From Schieber, Sylvester J., and John B.
Shoven. The Real Deal, The History and Future of Social Security. New Haven: Yale
University Press, 1999. For the updated plan, see
http://www.eller.arizona.edu/docs/ppt/2005/Shoven_Restoring_Social_Securitys_Solvency.ppt
3. Diamond/Orszag incremental proposals. These have a history, as the 1983 commission’s
proposals were also incremental, as were Bob Ball’s proposals on the 1994-96 commission,
and the proposals from various groups. We will do these in class from the book and readings.
4. Voluntary individual accounts (added on to the existing Social Security system). These are
sometimes considered something completely different, but they are an effort to augment Social
Security for the future.
Another possibility is to compare Social Security with another system. Some possibilities:
1. Galveston, Texas withdrew from Social Security – there is a literature on some cities and
towns that have done that. You can do that alone or with the next alternative.
2. Governmental bodies, all state and local, that were never members of Social Security. In this
area, the most well-known examples are the City and County of Los Angeles.
3. Sweden – instituted private accounts at the peak of the stock market. You can imagine what
happened.
4. Chile – the favorite example for the conservatives – interesting implementation and design
problems.
5. Britain – we have a couple of oral reports that cover Britain that will get you started.
6. Other European nations. There are three recent books out that cover various European
nations.
Medicare:
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4.
5.
6.
Medicare Catastrophic Coverage Act (MCCA) of 1988.
Medicare + Choice – the 1997 reform to produce more alternatives than just HMOs to
traditional fee-for-service Medicare.
Medicare Advantage – the retitling of the “Medicare + Choice” alternatives in the 2003
Medicare Modernization Act. Each of the following alternatives would be a possible term
paper topic:
i. Medicare HMOs and the history of managed care in Medicare.
ii. Medicare Preferred Provider Organizations (PPOs), Private Plans, and the other plans
authorized in the 2003 Medicare Modernization Act.
Private medical savings accounts -- Steve Forbes' proposal.
A defined contribution plan or “premium support” – Chaffey-Breaux Plan (Medicare
Commission, 3/99).
Incremental changes to the current system. We will do these in class.
Papers are due the 11th week, final exam week, on the date of the final exam, by 6:15 p.m. in my office.
Relevant Web Sites: These are valuable for your papers and/or presentations.
1.
The agencies that run the programs we are looking at:
 The Social Security Administration -- provides introductory material, statements of administration policy
proposals, and the Trustees’ reports -- www.ssa.gov. The Trustees’ reports have the basics of when the programs
(SS and Medicare) will run out of money, but they also analyze many reform ideas.
 The Centers for Medicare and Medicaid Services – like the SSA, they provide a lot of introductory material,
also statements of current administration policy proposals -- www.cms.gov, also www.medicare.gov
2.
Other government agencies with interesting information for the study of gerontology:
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U.S. Census Bureau – best quality data, excellent quality background material. See syllabus. www.census.gov –
use the Census Bureau’s search engine.
U.S. Congressional Budget Office – so correct that the Clinton administration at one point said that it would
use CBO’s projections rather than its own Office of Management and Budget. www.cbo.gov. Does many longrange budget projections.
Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services – my old
office was the Office of Health Policy, in ASPE. There is an Office of Aging, Disability, and Long-Term Care.
http://aspe.os.dhhs.gov. Also see the Department’s link to its many sources of information on aging at
http://www.hhs.gov/aging/index.html.
3.
Other places for policy analysis related to senior citizen issues and programs:
 AARP has a policy and research arm. http://www.aarp.org/research/
 Kaiser Family Foundation – www.kff.org and www.kffedu.org.
 The Medicare HICAP program in California – HICAP is the Health Insurance Counseling and Advocacy
Program. http://www.cahealthadvocates.org/about/hicap.html
 Urban Institute -- good analyses of Social Security and Medicare reform, recent papers on the impact of the
welfare reforms and immigration reforms on the social safety net in California and other states -- www.urban.org
 Brookings Institution -- www.brookings.edu
 Center on Budget and Policy Priorities -- unabashedly liberal in a conservative age –they have pages with all
of their comments on Medicare, Social Security, Medicaid, etc. http://www.cbpp.org.
 On the conservative end of things, see Heritage Foundation and Cato Institute (www.heritage.org and
www.cato.org) – like CBPP, they have pages with all of their ideas about health care, retirement, Social
Secuirty, etc.
4.
Other sources to link from:
 Committee on Health Politics -- note that the links page has a special section with introductory links for
students -- www.cohealthpolitics.org – The Committee is a group of political scientists interested in health
policy; I did their web page, and we included a special set of links for students.
 Aging Policy and Politics Group -- note that the links page has a special section with introductory links for
students -- www.silcom.com/~anag999/APPG.htm – Ditto.
Lecture/Discussion Schedule
Health Affairs articles may be obtained from the instructor or through the Library’s electronic databases.
1.
September 26, 2005. Introduction and overview.
 Overview of the syllabus.
 Working over the age of 90?
 Overview of the problem – why affording old age is a problem for our society – some causes, and some
effects.
2.
October 3. The basics. Topics
 Demographics, income, poverty, life expectancy, longevity.
 Senior citizen politics, including political participation among senior citizens.
 Pensions and their relationship to Social Security
Read:
U.S., Census Bureau. “The 65 Years and Over Population: 2000, a Census 2000 Brief.” By Lisa Hetzel and Annetta
Smith. Issued October, 2001. 8 pp. Download the document and bring a printed copy to class as we will go
over the tables: http://www.census.gov/prod/2001pubs/c2kbr01-10.pdf Bring this to class.
The Century Foundation. Public Policy in an Older America, a Century Foundation Guide to the Issues. New
York: The Century Foundation, 2006. Read pp. 1-16. You can download this from:
http://www.tcf.org/Publications/RetirementSecurity/AgingBasics.pdf
Oberlander, pp. 46-47, Tables 3.4-3.5. Bring this to class, or at least these two pages.
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Public Policy Institute of California. “The Age Gap in California Politics.” August 2005. Download from:
http://www.ppic.org/content/pubs/jtf/JTF_AgeGapJTF.pdf Bring this to class.
Gale, William G. and Peter R. Orszag. “Private Pensions: Issues and Options.” Washington, D.C.: The UrbanBrookings Tax Policy Center, Discussion Paper #9, April, 2003. Download from:
http://www.urban.org//UploadedPDF/310666_TPC-DP9.pdf
Reports:
Frey, William H. Mapping the Growth of Older America: Seniors and Boomers in the 21 st Century.
Washington, D.C.: The Brookings Institution, Metropolitan Policy Program, May 2007. Pp. 1-12. Download
from: http://www.brookings.edu/views/articles/200705frey.htm
Campbell, Andrea Louise. How Policies Make Citizens, Senior Citizen Activism and the American Welfare
State. Princeton, N.J.: Princeton University Press, 2003.
U.S., Congressional Budget Office. “Retirement Age and the Need for Saving.” Economic and Budget Issue Brief,
May 12, 2004. Download from: http://www.cbo.gov/ftpdocs/54xx/doc5419/05-12-RetireAgeSaving.pdf
Boyken, Grant. Funding the Golden Years in the Golden State, An Overview of Public Employee Post-Employment
Benefits and Recent Concerns About How to Provide and Pay for Them. April 2007. Report on pension trrnds
only. http://www.pebc.ca.gov/images/files/golden%20years.pdf
3.
October 10. Social Security.
 The federal budget and the role of entitlements in the budget
 The development of Social Security
Read:
Antos, Joseph R. and Alice M. Rivlin. Restoring Fiscal Sanity, 2007. Washington, D.C.: Brookings, 2007. Chapter
1, Rising Health Care Spending, Federal and National. Download from:
http://www.brookings.edu/es/research/projects/budget/fiscalsanity2007.htm
Diamond and Orszag, Chapters 1-2
Gladwell, Malcolm. “The Risk Pool, What’s Behind Ireland’s Economic Miracle – and GM’s Financial
Crisis?” The New Yorker, August 28, 2006. Download from:
http://www.newyorker.com/archive/2006/08/28/060828fa_fact
Reports:
Penner, Rudolph and C. Eugene Steuerle. Stabilizing Future Fiscal Policy, It’s Time to Pull the Trigger. Washington,
D.C., Urban Institute, August 2007,. Pp. 1-25. Download from: http://www.urban.org/publications/411524.html
Ghilarducci, Teresa. “The End of Retirement.” Monthly Review, May 2006. Download from:
http://www.monthlyreview.org/0506ghilarducci.htm
4.
October 17. Social Security – Reform Efforts.
 The 1970s – the 1972 indexing and the 1977 reforms
 The 1980s – the 1983 reforms
 The 1990s – the 1994-96 commission
Read
Munnell, Alicia H. “The Declining Role of Social Security.” Boston: Center for Retirement Research at Boston
College, February, 2003, Number 6. Download: http://crr.bc.edu/images/stories/Just%20the%20Facts/jtf_6.pdf
Diamond and Orszag, Chapters 3-5
Sass, Steven, Alicia H. Munnell, and Andrew Eschtruth. The Social Security Fix-It Book. Boston: Center for
Retirement Research, Boston College, 2007. Download from: http://crr.bc.edu/. The document is 2 mb in size;
if too big for your computer connection, bring a jump drive to my office and I will download it for you.
Report:
 Report on the 2007 Social Security and Medicare Trustee’s Report. The trustee’s reports are located at:
http://www.ssa.gov/OACT/TR/
 Retirement system in Galveston, Texas (which withdrew from Social Security), City or County of LA (not
members of Social Security)
 New systems in Great Britain, Ireland, and Germany. Korczyk, Sophie. “Mandatory Employer Pensions in
Ireland, Germany, and the United Kingdom. Washington, D.C.: AARP, January 2007.. Download from:
http://assets.aarp.org/rgcenter/econ/2007_03_pension.pdf
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5.
October 24. Social Security reform plans.
 The Diamond-Orszag reform plan
 Other countries’ retirement systems: Britain, others.
 Incremental plans
Read:
Try your hand at Social Security reform by playing the Social Security Game at the American Academy of Actuaries
web site. Located at: http://www.actuary.org/socsec.asp Keep a record of your recommendation and we will
compare them in class.
Diamond and Orszag, Chapters 6-7.
American Academy of Actuaries. Issue Brief. Social Security Reform: Changes to the Benefit Formula and Taxation
of Benefits. October 2006. Download from: http://www.actuary.org/pdf/socialsecurity/reform_oct06.pdf
Reports:
 Sweden – AARP. Fact Sheet: Private Accounts in Sweden. 2005.
http://assets.aarp.org/rgcenter/econ/fs109_sweden.pdf
o Weaver, R. Kent. “Social Security Smorgasbord? Lessons from Sweden’s Individual Pension
Accounts.” Brookings Policy Brief, June, 2005. Can be downloaded from:
http://www.brookings.edu/comm/policybriefs/pb140.htm
 Chile – Williamson, John B. “An Update on Chile’s Experience with Partial Privatization and Individual
Accounts.” Washington, D.C.: AARP, December 2005. http://assets.aarp.org/rgcenter/econ/2005_19_chile.pdf
 Australia – Schulz, James. “Old Age Income Security: Australia Tries a Different Way.” Washington, D.C.:
AARP, December 2005. http://assets.aarp.org/rgcenter/econ/2005_21_australia.pdf
 Canada, Quebec. Meldelson, Michael. “Financing the Canada and Quebec Pension Plans.” Washington, D.C.:
AARP, December 2005. http://assets.aarp.org/rgcenter/econ/2005_18_canada_quebec.pdf
6.
October 31. Social Security Privatization Plans, Individual Accounts
Read
Diamond and Orszag, Chapters 8, Appendix F.
Something else on the Bush privatization plan.
Reports:
 President Bush’s Social Security Commission of 2001 and its proposals
 President Clinton’s proposal for Universal Savings Accounts (USA Accounts)
 The 1994-96 Social Security Commission and its individual account proposal
 Schieber and Shoven’s plan.
 Bush’s effort in 2005 to produce individual account legislation
7.
November 7. Development of Medicare
Read
Oberlander, Chapters 1-4.
Kaiser Family Foundation. Medicare Fact Sheets – you can download them from:
http://www.kff.org/medicare/factsheets.cfm. The ones you should be familiar with are:
Medicare at a Glance (2-07)
Medicare Spending and Financing (6-07)
Medicare Advantage (6-07)
The Medicare Prescription Drug Benefit (6-07)
Medicare Part D Plan Characteristics (6-07)
Dual Eligibles: Medicaid’s Role for Low-Income Medicare Beneficiaries (2-06)
Reports:
 Medicare Catastrophic Coverage Act (MCCA) of 1988 – see Himmelfarb, Richard. Catastrophic Politics: The
Rise and Fall of the Medicare Catastrophic Coverage Act of 1988. University Park: Pennsylvania State
University Press, 1995.
 Retiree Health Benefits – Public Sector:
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Public Sector: Boyken, Grant. “California Research Bureau Public Retirement System Survey,
Preliminary Results.” California Public Employee Post-Employment Benefits Commission, July 2007.
Retiree Health Benefits – Private Sector:
o Private Sector. Kaiser Family Foundation and Hewitt Associates. “Retiree Health Benefits Examined,
Findings from the Kaiser/Hewitt 2006 Survey on Retiree Health Benefits.” December 2006. There is
also a chartbook associated with this report.
o
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8.
November 14. Reforming Medicare Through the Prospective Payment System and Through the Medicare
Modernization Act of 2003.
Read
Oberlander, Chapters 5-6.
Oberlander, Jonathan. “Through the Looking Glass: The Politics of the Medicare Prescription Drug, Improvement,
and Modernization Act.” Journal of Health Politics, Policy and Law. Vol 32, No. 2., April 2007.
Kaiser Family Foundation. Medicare Fact Sheets – you can download them from:
http://www.kff.org/medicare/factsheets.cfm.
The Medicare Prescription Drug Benefit (6-07)
Medicare Part D Plan Characteristics (6-07)
American Academy of Actuaries. Medicare Reform Options. June 2007. Download from:
http://www.actuary.org/pdf/medicare/options_june07.pdf
Kaiser Family Foundation. “The Medicare Modernization Act and Drug Plan.” March 2005.
Reports:
 Neuman, Patricia, et. al. “Medicare Prescription Drug Benefit Progress Report: Findings from a 2006 National
Survey of Seniors.” Health Affairs. August 2007. W630-W643.
 How to pay hospitals? Scanlon, William J. “The Future of Medicare Hospital Payment.” Health Affairs,
January/February 2006, pp. 70-80.
 The Breaux-Frist Plan for the modernization of Medicare (2001).
 The 1997 Balanced Budget Act and its effects on Medicare.
9.
November 21. No class.
10. November 28. Medicare Managed Care: Medicare + Choice, Medicare Advantage
Read
 Kaiser Family Foundation, “Medicare Advantage.” Fact Sheet. April 2005. PF
 Kaiser Commission on Medicaid and the Uninsured. “Dual Eligibles: Medicaid’s Role in Filling Medicare’s
Gaps. April 2004. PF
Reports:
 The history of Medicare managed care, from HMOs to Medicare+Choice to Medicare Advantage.
 Private Fee For Service Accounts – Gold, Marsha. “Medicare Advantage in 2006-2007: What Congress
Intended?” Health Affairs, May 2007, W445-W455.
 Medical Savings Accounts for Medicare? The history and development of Medical Savings Accounts. Steve
Forbes’ proposal for MSAs can also be covered.
11. December 5. Final exam. Papers due.