"In terms of social welfare and medical insurance, it is a breakthrough, " he says.

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Incentives, rules, and institutions that encourage a constructive role for insurance will ultimately improve individual and social welfare.

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But they reveal little understanding of the complex interest-group politics and broader meaning of Medicare in America, as a social insurance program, as a pillar of the liberal welfare state, as a force in the lives of millions of people.

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Brenner got a social worker to help Hendricks apply for disability insurance, so that he could leave the chaos of welfare motels, and have access to a consistent set of physicians.

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