Health Care Politics And Policy In America Pdf
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Academic Editor: Jonathan Oberlander. A leading journal in its field, and the primary source of communication across the many disciplines it serves, the Journal of Health Politics, Policy and Law focuses on the initiation, formulation, and implementation of health policy and analyzes the relations between government and health—past, present, and future. Read an interview with editor Jonathan Oberlander.
- Taking the Pulse of Health Care and Politics
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- Taking the Pulse of Health Care and Politics
Share this page. Follow Ballotpedia. The aim of the law was to expand health insurance coverage to all Americans and to curb healthcare spending and costs.
Taking the Pulse of Health Care and Politics
Not a MyNAP member yet? Register for a free account to start saving and receiving special member only perks. Modern health policy poses complex legal, ethical, and social questions. The goal of health policy is to protect and promote the health of individuals and the community. Government officials can accomplish this objective in ways that respect human rights, including the right to self determination, privacy, and nondiscrimination.
Numerous papers have addressed the question, What is sound health policy? What data do policymaking bodies need? How can that data best be made available to decision makers?
The United States is a highly diverse and complicated society. Many groups "weigh in" on significant health policy issues. America's expansive range of policymaking bodies and groups seeking to influence policy render it impossible to offer a systematic and comprehensive analysis of health policy formulation.
To make an examination of policy development manageable, I will work from the following assumption, which is partly, but not wholly, valid. I will assume that formal development of health policy is the primary preserve of the three branches of government-the executive, legislature, and judiciary-at the state and federal levels.
In practice, many other bodies make policy such as professional associations or ethics groups through guidelines. It evaluates the relative strengths and weaknesses of each branch of government with respect to health policy formulation. It also examines sources of. These include presidential and congressional commissions, task forces and advisory bodies, professional and trade associations, and public interest, consumer, and community-based groups.
Although I argue below that health policy is best formulated through rigorous and objective assessment of data, I do not support any restriction on the right of interest groups to publish their views and to appropriately lobby policy makers.
A robust constitutional society that values freedom of expression and unrestricted participation in the political process should support a role for interest groups in health policy formulation.
It should not censor or fetter the views of those who seek to participate in the process. Yet, the various branches of government should be able to rely on full, objective information and advice based upon sound scientific evidence. This essay will explore some mechanisms for achieving these aims.
Health policy encompasses a vast range of issues in health care, public health, and biotechnology. This essay selects illustrations from several areas that, over a period of time, have generated a great deal of policy formulated by each branch of government. These include reproductive rights, the right to die, and mental health. I will also use examples in the fields of health care reform, AIDS, and civil rights of persons with disabilities. What factors are important in developing sound health policies?
The policies themselves are rarely subjected to scientific scrutiny. Whether society seeks to reform the health care system, to restrict or to expand women's choices to receive an abortion, or to authorize or to criminalize physician-assisted dying, it has no precise means by which to test for the "correct" approach.
Health policy decisions often reflect choices between competing values, as well as assessments of available data. Interest groups, including organizations representing various health care professionals, select their values and evaluate data through their own lenses.
Clearly, groups comprised of highly expert and well-intentioned professionals often make markedly different decisions about health policy. Axelrod 3 exemplifies the difficulty of deciding on one "correct" policy solution to complex health problems. The highest state court considered whether the state health commissioner had correctly categorized HIV infection as a communicable disease. This policy, on its face, appears noncontroversial and subject to neutral assessment.
Yet, health professionals strongly split on this issue. Many public health organizations e. However, many medical and surgical organizations e. This would authorize greater use of compulsory testing, reporting, and contact tracing. What factors should have guided the court's decision between these two sets of respected professionals, who each used reasoned argument and data to argue that their preferred health policy was more effective?
Governmental officials need a framework for the development of sound health policy. Adopting the model I set out below does not guarantee that policies will be "effective"; but it does provide a way to filter out obvious biases and to focus attention on scientific data and reasonably objective assessments of arguments.
Applying this framework allows interest groups to continue making their voices heard, while it encourages decision makers to obtain information from more neutral sources as well. Several factors are important for developing sound health policies.
First, to the extent possible, the policymaker should be objective and dispassionate. This means that decision makers should have no conflict of interest or improper financial or professional incentive.
Policymakers should be able to understand the data and arguments presented, to assess them reasonably objectively, and to balance competing values fairly.
In many areas of health policy, it is not necessary or even desirable for policymakers to be "experts" themselves, as long as they have access to expert advice. Second, policymaking bodies should be publicly accountable for their decisions. If science or existing societal values do not support a decision, a democratic means for altering the decision is often desirable. Democratic societies thrive on the principle that government action that affects individuals and communities is subject to public review.
Periodic elections provide an opportunity for the public to demand explanations and for public officials to articulate and justify their decisions. At least one kind of health policy is not always best made through fully accountable decision makers: the kind that fundamentally affects the human rights of individuals and minority communities. Health policies that seriously burden individual rights to liberty, privacy, and nondiscrimination may require judicial, rather than majoritarian, determinations.
For example, a fetal protection policy that excludes all women from unsafe work places to promote the health of infants may violate fundamental rights of nondiscrimination. In Johnson Controls, the U. Supreme Court unanimously ruled that a fetal protection policy was discriminatory even though the company presented some scientific evidence that the fetus of a pregnant worker could be at risk.
Government entities often have access to a great deal of information, but assessing the reliability of that information may be difficult. Judges receive information from legal advocates as well as ''experts" selected by each side of a case; likewise, legislators and executive officials receive information from a wide array of lobbyists and professional groups.
Policymakers may recognize that information is coming from a potentially biased source, but may have difficulty weighing the relative value of the information they receive. In addition to receiving information from the wide variety of traditional sources, policymakers need access to objective and complete information from reasonably neutral sources.
This includes data and argument on the scientific, ethical, social, and legal aspects of the issue. Decision makers may seek information from one or several different objective sources in order to develop sound health policy.
Fourth, policymakers must have well-considered criteria for making the decision. Objective criteria help to guide decision makers in formulating goals, selecting means, and establishing the scientific, social, and ethical parameters for decision making.
They also reduce the arbitrariness or biases that often are inherent in decision making processes. I suggest the following steps to guide policymakers: 5. Examine the public health interest. Does the proposed policy seek to achieve a compelling health objective? The policymaker should clearly and narrowly define the health purpose s of the policy. This protects against biases in decision making, helps communities to understand the policy rationale, and facilitates public debate.
Examine the overall effectiveness of the policy. Is the proposed policy likely to be effective in achieving the stated goal s? This step requires an assessment of whether the policy is an appropriate intervention to achieve the stated objectives and whether it is reasonably likely to lead to effective action. The policymaker should gather scientific data and apply logic to analyze whether a policy will be effective. Evaluate whether the policy is well-targeted.
Is the proposed policy narrowly focused on the health problem? A decision maker should determine whether a policy is narrowly tailored to address the specific health problem, or whether it is over- or underinclusive. Overbroad policies target a population that is much larger than necessary to achieve the health objective. For example, the Bush and Clinton policy that interned or repatriated all Haitian refugees with HIV infection was overbroad, because it affected all of the group, regardless of whether individuals engaged in safe sex or other practices.
It adversely affected individuals who did not pose a significant risk of transmission of HIV. Identify the human rights burdens. This step requires an inquiry into the nature, invasiveness, scope, and duration of human rights violations. Does the policy interfere with the right to liberty, autonomy, privacy, or nondiscrimination? For example, a policy that requires women to use contraceptives as a condition of receiving welfare benefits might interfere with the right to reproductive privacy and discriminate against women because the policy does not apply to men and the poor because the policy does not affect higher-income women.
It may also burden the social and economic rights of dependent children if benefits were withdrawn. Examine whether the policy is the least restrictive alternative. A policymaker should assess whether the health objective could be achieved as well, or better, with fewer restrictions on human rights.
This step helps to ensure that a policymaker considers alternatives that may better accommodate societal and individual interests.
Fifth, the policymaker should pursue a fair process to arrive at the decision. This requires a careful examination of all relevant facts and arguments.
Procedures may include inquisitorial or adversarial hearings, investigations, or other rigorous methods for finding facts and examining arguments. A fair process requires that all persons or organizations that have a legitimate interest in the outcome should have a reasonable means of presenting evidence or arguments.
Careful attention to decision making processes achieves both more accurate fact finding and greater equality and fairness to interested individuals and groups. These five elements of policymaking impartial decision making, accountability, collecting full and objective information, applying well-considered criteria, and following a rigorous and fair process are often helpful in developing sound health policies. In the following section, I apply these criteria to decision making by each of the three branches of government and assess which bodies are most capable of resolving which health policy problems and why.
In theory, the judiciary provides the least ideal forum for the development of many health policies. Certainly, judges are thought to be impartial and able to assess evidence and arguments from a variety of sources objectively. However, many judges are insulated from public accountability.
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Health care is always on the minds of the public, usually ranking among the top 3 concerns. Virtually all of the Democratic presidential candidates have discussed or will shortly detail health care proposals, whereas President Trump and the current administration recently expressed support for repealing the Affordable Care Act. With the presidential election just 18 months away, it is an opportune time to introduce a new health policy series in JAMA. While various proposals to improve US health care will certainly differ in content, they will all by necessity share a common theme—a focus on reducing health care costs. This is an unsustainable trajectory. At the same time, there are also crises of access and equity.
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We uncover political dynamics that reward and reinforce increases in US health spending by studying the passage of the Medicare Modernization MMA. We focus on a provision added to the MMA, which allowed hospitals to apply for temporary Medicare payment increases. The payment increases raised local health spending and led to suggestive increases in health sector employment. Members of Congress representing hospitals that got a payment increase received large increases in campaign contributions before and after the program was extended.
Taking the Pulse of Health Care and Politics
As another U. In recent elections, for better or worse, health care and its delivery has entered that realm. This is just one among a growing number of health care—related issues being tossed around the political arena, and health care is a top priority for the U. With so many health issues being politicized today, health care providers are finding themselves thrust into the tense world of politics and policy.
This article describes the role of government in the health care system and the factors and forces that determine how that role is played. It examines the application of theories of political economy drawn from both economics and political science to this sector. It discusses the implications of these theories for political choices including interest groups, voting behavior, and institutions. Governments play several roles in the health care system and focus on four broad categories of government action in health care markets, linked to corresponding market failures, namely, health care as a merit good; information gaps; infrastructure as a public good; and externalities. It explores the relevance of this literature to the health domain, and confirms the powerful influence of politics on the shape of the health system. Keywords: health care system , political economy , government action , health domain , voting behavior.
Aging has become a hot topic. Once relegated to the smaller rooms in conferences and hidden in the back pages of news articles, aging-related topics dominate policy and lifestyle discussions. The demographic bulge created by the Baby Boom generation—the roughly 76 million people born between and —has shaped American politics since this group came of age in the s. Within the next 10 years, the oldest Boomers will reach 84 and the youngest myself included will be eligible for Medicare. Suddenly, aging issues have never been more relevant.
И мы, те, кто близко к сердцу принимает интересы страны, оказались вынужденными бороться за наше право служить своей стране. Мы больше не миротворцы. Мы слухачи, стукачи, нарушители прав человека. - Стратмор шумно вздохнул. - Увы, в мире полно наивных людей, которые не могут представить себе ужасы, которые нас ждут, если мы будем сидеть сложа руки.
Или жадность заставит его продать алгоритм. Она не могла больше ждать.