Introduction
Health Politics and Policy
James A. Morone
© 2008 Delmar Cengage Learning.
Overview
• Health care in America is fundamentally
political
• Like every other issue, health care tends to
follow the public policy process
• Costs are a paramount issue in American
health politics
• Managed care is a revolution without
revolutionaries
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© 2008 Delmar Cengage Learning.
Health Care Is
Inherently Political
• Health care decisions relate to the
allocation of scarce resources
– The very definition of politics
• National health care systems are reflective
of a country’s political traditions and norms
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© 2008 Delmar Cengage Learning.
Health Care
and the Policy Process I
• First step in policy process
– Getting item on national political agenda
• National Health Insurance (NHI)
– First appeared on agenda due to the efforts of
early (private) reformers
• Returned to agenda as part of FDR’s New Deal
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© 2008 Delmar Cengage Learning.
Health Care
and the Policy Process II
• In second step of policy process:
– Political solutions to a given problem are
formulated
• Could be “re-heated” policies hatched
previously
– Garbage can theory of policy making
5
© 2008 Delmar Cengage Learning.
Health Care
and the Policy Process II
• Early proposals to provide “workingman’s
insurance” resurrected during New Deal
era and after
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© 2008 Delmar Cengage Learning.
Health Care
and the Policy Process II
• Those opposed to comprehensive (public)
provision of benefits offered private
schemes
– More modest federal financing proposals
• Hill-Burton, et. al.
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© 2008 Delmar Cengage Learning.
Health Care
and the Policy Process III
• Third step of policy process involves
making a political decision
• National health insurance never enacted
– Medicare and Medicaid passed by Congress
• Signed into law 1965
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© 2008 Delmar Cengage Learning.
Health Care
and the Policy Process IV
• In fourth stage of the policy process
– Political decision (law) is implemented
• Medicaid initially left states with wide
latitude
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© 2008 Delmar Cengage Learning.
Health Care
and the Policy Process IV
• Some, such as New York, used program as
means to achieve universal coverage by
lowering eligibility requirements
• Federal government soon clarified law by
setting maximum income levels
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© 2008 Delmar Cengage Learning.
Health Care
and the Policy Process V
• Fifth stage of policy process involves the
administration of a given program
• Relates to the day-to-day functioning of
government program
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© 2008 Delmar Cengage Learning.
Health Care
and the Policy Process VI
• This final stage of policy process often not
realized
– Involves evaluation of a given program
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© 2008 Delmar Cengage Learning.
The Cost of
Health Care in America
• American health care system is by far the
most expensive in the world
– Accounting for an ever-burgeoning share of
gross domestic product (GDP)
– Many of the political issues revolving around
health relate to the cost of care
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© 2008 Delmar Cengage Learning.
The Managed Care “Revolution”
• Managed care offered as means of
reducing growth in health care costs
• Featured in failed Clinton health plan
– Eventually adopted independently by private
sector
• After brief stabilization:
– Health care costs continue(d) to rise
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© 2008 Delmar Cengage Learning.