The politics of health care (original) (raw)
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International Journal of Sciences: Basic and Applied Research (IJSBAR), 2019
The changing political climate of Congress and the dilemmas of the Affordable Care Act (Obamacare) in reforming the U.S. health care system is the focus of this work. The author is with the view that most barriers that led to the denial of previous health care reform bills were as a result of the role played by Congressional caucuses and the continuous health care malpractices perpetrated by health care industries in the United States. Healthcare policy making in the United States therefore, owns its hegemonic past from a long standing institutional and ideological politics beginning with Theodore Roosevelt's failed proposal for a national health care system in 1912. The work further examines Congressional path dependency on health care reform and its role in health care policy adoption and implementation. The obstacles faced by Americans in having a relatively rational type of health care coverage system in the United States will also be discussed. The paper argues that the invisible hands of Congressional caucuses and health care industries continue to play integral parts in health care policy making in the U.S. thereby, frustrating government's efforts in order to uphold the privileges and profits enjoyed at the expense of tax payers. The puzzle the work seeks to unravel is to showcase whether the fight to repeal the Affordable Care Act by Congress, States and individual plaintiffs will hold in the light of the unprecedented health care burden on Americans. The work explores John Kingdon's Multiple Streams Framework in public policy making with particular reference to the health care policy reforms in the United States. The author concludes that in order to achieve an efficient market outcome in the case of the prevailing health care externalities in the U.S., the implementation of a policy where mostly everyone is expected to be better off is deemed necessary.
What Health Reform Tells Us about American Politics
Journal of Health Politics, Policy and Law, 2020
The passage and initial implementation of the Affordable Care Act (ACA) were imperiled by partisan divisions, court challenges, and the quagmire of federalism. In the aftermath of Republican efforts to repeal the ACA, however, the law not only carries on but also is changing the nature of political debate as its benefits are facilitating increased support for it, creating new constituents who rely on its benefits and share intense attachments to them, and lifting the confidence of Americans in both their individual competence to participate effectively in politics and that government will respond. Critics from the Left and the Right differ on their favored remedy, but both have failed to appreciate the qualitative shifts brought on by the ACA; this myopia results from viewing reform as a fixed endpoint instead of a process of evolution over time. The result is that conservatives have been blind to the widening network of support for the ACA, while those on the left have underestimat...
Health care reform: Is the process the outcome?
Clin Ther, 2009
The Pharmaceutical Economics & Health Policy section of this journal features empiric articles, editorials, and occasional commentaries to support evidence-based communications, all of them peer reviewed for relevance, technical accuracy, clarity, and objectivity. However, despite the availability of objective information both here and elsewhere, objectivity does not seem to figure in much of the media coverage of the current health care reform debate. It is clearly not the cumulative objective evidence that has generated the extreme passions surrounding health care reform. National health expenditures per capita increased 123% between 1990 and 2004, 1 but it was not this that evoked such intensity. The numbers of the uninsured are substantial and have been increasing for years without arousing anything like the present turmoil. So, why is health care reform so contentious, and what is the role for evidence-based pharmaceutical economics and health policy? Rates of unemployment in the United States increased from 4.8% in February 2008 2 to 7.2% in December 2008 3 and 9.7% in August 2009, 4 a 102% increase in 18 months. Under a system of employment-based health insurance, this magnitude of unemployment threatens or eliminates health insurance for millions. However, the fact of employment no longer guarantees health benefits: the percentage of firms offering health benefits declined from a high of 69% in 2000 to 63% in 2008. 5 Americans' domestic concerns are now dominated by the economy (33%), health care (25%), unemployment and jobs (14%), and the federal debt (7%). 6 The Kaiser Family Foundation has estimated that each 1-point increase in the national unemployment rate produces an additional 1.1 million uninsured and an additional 1 million Medicaid and State Children's Health Insurance Program enrollees. 7 Trends in health care costs also pose a substantial threat to employers. From 16% of the gross domestic product in 2007, health care costs are projected to reach 25% by 2025, threatening the competitiveness of US businesses and the fiscal soundness of federal, state, and local governments. 8 Financial crises, declines in employmentbased health insurance for those still employed, and the loss of health insurance by those in the growing ranks of the unemployed have converged to make the health care status quo unacceptable to many citizens. Public Opinion Strategies, LLC, the firm whose research contributed to the "Harry and Louise" campaign that helped defeat the Clinton Administration's Health Security Act of 1993, reported that by June 2007, 36% of voters endorsed "the need for radical change in the U.S. health care system," and about half supported reform. 9 Support for radical change came from 45% of Democrats, 43% of Independents, and 20% of Republicans. In the 2008 presidential election, voters elected a candidate whose central campaign theme was change; however, the details of that change have been slower to emerge than the opposition to it. The clarity of the election results are in stark contrast to the melee that took place during the congressional recess, when McCarthy et al, 10 writing in the Congressional Quarterly, observed that "as politicians and interest groups try to shape the outcome of the healthcare overhaul, they've offered interpretations that are so wildly different that truth sometimes seems to be taking a vacation." Examining a dozen major talking points in the media coverage of health care reform, the authors concluded that 5 were demonstrably false, 6 were misleading, and 1 was true. An article in Newsweek magazine was more blunt, referring to "the five biggest lies in the health care debate." 11 When so much valid information is available from unbiased and peer-reviewed sources, why is the debate dominated by highamplitude but demonstrably false claims? Given the current approach to health policy and reform, the question posed by a 2004 editorial in this journal-"Evidence-or Opinion-Based Pharmaceutical Policy?" 12-remains relevant today. Paul Grenier, writing in The Baltimore Sun, has asserted that "what we need…are not labels, but analysis." 13 Political theater is taking the place of the genuine work of crisis resolution. Only incomplete health care reform legislation had been drafted by the end of July 2009. Separate House committees had issued 3 marked-up bills, and only 1 Senate committee had completed its work. 14 The remaining committee with jurisdiction, the Senate Finance Committee, was still negotiating as the August recess began. Plotted over time, health care costs form an
Americans on health care reform: results from polls conducted with Zogby International, Inc
Transactions of the American Clinical and Climatological Association, 2010
During a time of uncertainty regarding the future of the American health care system, an assessment, over time, of Americans' opinion on different legislative or health policy directions is a valuable asset to decision makers. After polling over 10,000 Americans via three polls on these topics over four months, a few distinct trends have emerged. When it comes to health care reform, Americans want a "tune-up," not a "trade-in" of their health care system by implementing reforms that allow the system to work more efficiently for the largest number of people possible, paying for it through savings found by reducing extraneous and wasteful spending and by increasing the quality of care. A clear sense of equity is also evident, as a majority do not agree with insurance companies using pre-existing health conditions as a metric in determining eligibility and believe in mandating that those who are employed, except for the smallest companies, should be covered.
The Political Economy of Health Care Reforms
The Political Economy of Health Care Reforms, 2001
The facts presented in this study and the observations and viewpoints expressed are the sole responsibility of the authors. They do not necessarily represent positions of the W.E. Upjohn Institute for Employment Research.
Remedy and Reaction: The Peculiar American Struggle over Health Care Reform
Contemporary Sociology a Journal of Reviews, 2015
"Do we have an obligation to provide health care for our citizens?" Paul Starr opens this outstanding book with this question and follows up by asking another more vexing one: why is the U.S. health care system so stubbornly unique among capitalist democracies? It is a well-known and embarrassing fact that the U.S. has the most expensive health care system in the world and yet has the highest number of uninsured citizens of any western democracy. But the solution to the problem has always eluded us. The answers to Starr's questions vary widely across the political spectrum exposing deep divides between and within the major political parties and reveals how a combination of social forces prevents the U.S. from guaranteeing what people in many other democracies view as a fundamental right. Starr's argument is that the U.S. missed a chance to set up a general system for financing health care in the first half of the 20 th century, and when the government finally sought to do so, the nation was caught in what he calls a policy trap, in which enough of the public and health care industry leaders were satisfied with the complicated and costly system that changing it became nearly impossible. He addresses the three factors usually indicted for producing the health care crisis in the U.S.: "special interests," national values, and "the daunting complexity of the problems of health care and health policy." And while Starr agrees that there is some truth within each of these explanations, he challenges the claim that any one of them alone is responsible for the quagmire that is our health care system. Of the three explanations, the argument that "special interests" have prevented major health care reform carries particular weight with many observers. After all, as Starr demonstrates throughout the book, the American Medical Association and other key stakeholders actively opposed anything resembling a national health care system virtually anytime the idea emerged in U.S. politics. But that explanation is too tidy because there have been moments when health care industry leaders have supported expanded coverage proposals that they viewed as better than less appealing alternatives such as single payer. The "special interest" explanation really falls short when we discover that the public itself is split over reform because unionized workers, veterans, disabled persons, and the elderly can access Medicare, while segments of low income populations can also qualify for Medicaid. These millions of Americans may not have the best health care, but they often see themselves as "reasonably well-protected" and fear losing their coverage or benefits under any major reform, particularly since they feel they have earned their way into such programs while other groups are seen as less worthy. This, I believe, is the most disturbing and revealing aspect of the health care crisis in this country andalthough Starr does not draw the link-has strong echoes of the kind of divisive