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Competing Ideals and the Public Agenda in Medicare Reform

The "Garbage Can" Model Revisited

Emporia State University, kalukalu{at}emporia.edu, kalu.kalu{at}yale.edu

This article analyzes the political and strategic reasons for the policy stalemate in Medicare reform in the United States. By using the specific case of the National Bipartisan Commission on the Future of Medicare, which was formed in 1997, this article attempts to explain the stalemate in the policy process by framing the activities of the various participants within the context of the "garbage can" model of decision making. It is equally argued that the utility of the model lies more in its ability to explain the dynamics of the policy process, and that the existence or nonexistence of a policy window provides the least logical explanation of how various policy episodes unfold. The cumulative effects of congressional behavior and whether members are engaged in the active-passive paradigm of policy making can provide more powerful indicators for policy events and outcome.

Key Words: Medicare reform • garbage can model • active-passive policy making • Kingdon’s streams metaphor • National Bipartisan Commission on the Future of Medicare • Breaux-Thomas proposal • Medicare Act of 2003

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