Li, Yifei;
(2025)
The Making of Entitled Consumers: A Conceptualization of Social Citizenship in Medicare Reforms.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
This research examines how ideological and budgetary pressures have shaped Medicare reforms and how these reforms, in turn, have influenced types of social citizenship in the U.S. Tracing the evolving politics of health rights for the elderly, it investigates who gains access to what rights and under what circumstances. Medicare is among the few programs that is resilient against what Paul Pierson called “the welfare retrenchment” since the 1980s, and therefore is particularly valuable in studying varying forms of social citizenship in the US context. Tracing the program’s development, I provide a typology of social citizenship reflected in different periods: contributory, ordo-liberal, consumerist, and post-neoliberal. Contributory social citizenship revolves around the idea of deservingness and involves a reciprocal relationship where citizens’ contributions are met with government obligations to provide access to essential needs. We shall see how Medicare institutionalized this form of social citizenship through its SocialSecurity-based financing mechanism and generous payment to hospitals. “Ordo-liberal” here describes the reactive way the government deals with social citizenship in the 1970s and 1980s. Consumerist is used to describe Medicare reforms around the turn of the century, but consumerist social citizenship means an “active citizen” mentality that regards seniors as knowledgeable consumers capable of making rational choices. At last, post-neoliberal social revolves around social investment, which emphasizes preventive care and long-term care. Together, the elderly as a distinctive category sheds new light on the idea of social citizenship and contribute to its theoretical debate regarding “residual” programs.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | The Making of Entitled Consumers: A Conceptualization of Social Citizenship in Medicare Reforms |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2025. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Education UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10205188 |
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