The Teflon Idea: Market Mechanisms within Medicare

Employing Medicare as a case study, the authors present a new theory of ideational path dependence. In order to contrast ideational path-dependence with established models of policy-making, we will introduce our case study, the advocacy of, and attempted applications of, market mechanisms within the Medicare program (our article will specifically focus on HMOs, PPOs, vouchers, and HSAs). which include, among others, vouchers and the inclusion of managed care organizations. Ideational path-dependence poses various challenges to conventional understandings of institutional and policy path-dependence, the garbage can model of policy-making, multiple streams theory, and punctuated equilibrium. What connects these distinct threads is the role of ideas in policy-making.