Suchergebnisse

The policy process -- Congress -- The presidency -- Interest groups -- The bureaucracy -- States and health care reform

Intergovernmental health policy has seen centralization and decentralization over the past forty years. The negotiations—and who wins and who loses—often depend on politics more than rational sorting of intergovernmental responsibilities. As in other policies, politics often trumps health policy—even where governors and state legislatures are of the same party as national leadership. Political rhetoric in 2017 once again calls for a larger role for states in possible reform of the nation's health system, but nation-centered federalism persists. Congressional inaction, executive uncertainty, and partisan polarization can provide states the opportunity for leadership and innovation in health policy.

Though the Obama health reform has become law and many think it revolutionizes our health care system, the reality is that it will do very little about our two biggest problems, costs and quality. Our costs are the highest in the world, and our quality is mediocre at best. We are getting coverage of three-fourths of our uninsured, but nothing in the bill will force physicians to follow protocols to move care more toward science and away from art, and the cuts promised in Medicare payments to hospitals and physicians are no more likely to occur in the future than they have been in the past. Not angering powerful interests meant not really cutting their earnings or telling them how to practice. New taxes and employer inducements to provide insurance or pay a fine were an inevitable product of lacking the political muscle to cut costs while having taken the bold step of reforming the insurance industry. That reform committed the president to an individual mandate to buy insurance, the only way of protecting insurance companies against adverse selection of sick patients once they give up refusal to cover pre-existing conditions. Our permeable political system, our health care history and ideological intransigencies make it hard to adopt truly comprehensive reform that controls costs and assures quality care.

Though the Obama health reform has become law and many think it revolutionizes our health care system, the reality is that it will do very little about our two biggest problems, costs and quality. Our costs are the highest in the world, and our quality is mediocre at best. We are getting coverage of three-fourths of our uninsured, but nothing in the bill will force physicians to follow protocols to move care more toward science and away from art, and the cuts promised in Medicare payments to hospitals and physicians are no more likely to occur in the future than they have been in the past. Not angering powerful interests meant not really cutting their earnings or telling them how to practice. New taxes and employer inducements to provide insurance or pay a fine were an inevitable product of lacking the political muscle to cut costs while having taken the bold step of reforming the insurance industry. That reform committed the president to an individual mandate to buy insurance, the only way of protecting insurance companies against adverse selection of sick patients once they give up refusal to cover pre-existing conditions. Our permeable political system, our health care history and ideological intransigencies make it hard to adopt truly comprehensive reform that controls costs and assures quality care. Adapted from the source document.

Studies of policy implementation have focused primarily on incremental policy change, yet policy change is sometimes implemented quickly and comprehensively. Such is the case with Michigan's recent implementation of a statewide Medicaid managed care initiative. This article analyzes Michigan's quick implementation and highlights the importance of political support, organizational change, and a supportive policy and administrative environment in affecting successful implementation. It also notes the price paid for quick implementation—namely, stakeholder dissatisfaction, mistakes, and lack of public involvement.