Discuss the impact of health policies on the social factors that help determine health.
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J.W. Kingdon describes the agenda setting stage of policy formulation as a function of the confluence of three "streams" of activities: problems, possible solutions to the problems, and political circumstances (see Longest page 163). According to this metaphor, all three streams must be present for the policymaking process to move to the legislation development phase.
Analyze and discuss President Clinton's Health Reform Proposal of 1993 using the terms of this metaphor. Apply your critical thinking skills to assess the events surrounding this proposal as objectively as possible.
Kindly think in the following terms: As the 20th century neared its end, the United States enjoyed the dubious distinction of having the highest health care costs in the world while being the only major democracy with a substantial fraction of the population still lacking basic medical insurance.
Please think of the following; Rising health costs threatened to put American business at a disadvantage in world markets and thus made corporate executives receptive to a plan that might shift health costs to the government.
Growing segments of the medical community expressed a desire to consider reforms; even hospitals seemed interested in some scheme that would spare them the heavy burden of giving free medical care to the uninsured.
You should think of the following: How would we pay for all that care for all those people? Won't it require a huge new government bureaucracy?
Possible Solutions to the problems:
Please consider the following: On several occasions in this century, Congress seriously considered plans to provide universal health coverage.
You need to understand this: For most people, coverage would come from employers, financed by payroll taxes and delivered through carefully regulated competition among large non-profit health maintenance organizations, such as the Kaiser Plan and Blue Cross, or for-profit prepaid plans of the kind that were springing up across the country. For those who were not employed, the government would pay the cost of membership in a health maintenance organization. To negotiate with the health care providers on behalf of consumers, monitor their performance, and ensure their suitability, the Clinton Plan proposed the creation of new public organizations called health care alliances.
Please consider the following: In each case, determined opposition led by physicians, big business, and Republican lawmakers blocked the proposals.
You need to understand this: With the election of President William Clinton, however, all of the auguries seemed to favor major reform.
Please reflect on the following: Moved by these favorable signs, candidate Clinton made health care reform a centerpiece of his campaign platform. His election seemed to present him with an excellent chance to translate his promises into law.
Kindly reflect on this: Mrs. Clinton appeared before Congress to respond to detailed inquiries from one committee after another. Pictures of the First Lady sitting alone before a battery of lawmakers coolly answering questions on a subject of extraordinary complexity won her widespread applause.
Kindly think in the following terms: The opponents of the Clinton Plan proved more effective than the supporters. Many Americans were highly skeptical of government intervention and fearful that it would squander large amounts of money.
You should think of the following: In a survey of lawmakers taken after the Plan met its end, three-quarters of the members of Congress polled asserted that public opinion was a "very important" factor in the outcome of the deliberations.
Please consider the following: The appointment of the First Lady sends a clear signal to all in the administration and players in both parties on Capitol Hill that Clinton places great importance on Health Care. It also serves instantly to limit how far cabinet secretaries and White House aides can go in pressing their views.
Kindly reflect on this: Health and Human Services Secretary Donna Shalala told USA Today's editorial board that a value-added tax is one of the ideas under consideration.
Longest, Beaufort B. Health Policymaking in the United States. 4th ed. Chicago: AUPHA Press, 2006.
www.findarticles.com/p/articles/ mi_m0KVD/is_1_5/ai_n15927746 - 35k -
www.americanpresident.org/history/ billclinton/biography/domesticpolitics.common.shtml -
www.rand.org/publications/ randreview/issues/RRR.winter93.4.health/ -
Unit 2 Discussion Board 2: The Context and Process of Health Policymaking
HCM620-0602A-02: Health Policy
Professor Robert Rodriquez
Due Date: April 1, 2006
Identify at least two medical management committees within an HCO and explain their roles. How can medical management committees influence the process of health policymaking outside of their HCO's? List some legal and ethical dilemmas to consider when creating new policies.
Ethics Committees in HCOs. In hospitals throughout ...