health politics bill weissert 936-1311 m3141 sph ii [email protected] [email protected]
TRANSCRIPT
Course Objectives
• Understand how health policy is made and role of institutions which make it
• Equip you to keep up with policy changes
• See that you can change policy
• Learn one policy analysis technique
Why Care?
• Gov’t ubiquitous in health policy
• Half of all health dollars
• Controls who practices, served, covered, what paid for public clients
• Curbs and incentives on life styles
• Major surveillance efforts
• Reform everywhere– policy change rapid
Course Content• Institutions
– Congress, Pres, Budget, Int Groups, Bureaucracy, St Gov’t
• Structure, processes, incentives
• Role in policy making
• Policy making process• Agenda setting
• Problem definition
• Political feasibility
Texts• Weissert & Weissert.
Governing Health:
The Politics of Health Policy• Coursepack - optional• Web page
– http://www.lib.umich.edu/libhome/Documents.center/healpol.html
Requirements
• Assignment 1 Problem Definition– Due April
– Matrix: 2 10 pt pgs matrix, 3 pages text – 12 pt Columns
– Authors (3 or 4 key authors; all other authors)
Rows:• Nature of the problem, indicators, consequences, severity• Prevalence, incidence, differential effects, trends• Causes, contributing factors• Rationale for government intervention
Requirements continued
• Assignment 2: Solution Options (June)• Columns
• Solution Options (3 or 4)
• Rows: Criteria• Effectiveness (extent to which solves problem you defined) • Cost (per unit of effectiveness; total spending one or
multiple years)• Equity (vertical and horizontal)• Administrative burden (paperwork, privacy invasion,
transaction costs)• Political feasibility (will it be enacted and implemented –
why & why not)
• Your weights and recommendation
Requirements continued
• Assignment 3: Issue Participation• Due: August• Columns
– Committees, subcommittees responsible, party leaders participating
– Interest groups– Bureaucratic agencies
• Rows– Motivations, institutional endowments, strategies,
effectiveness
Some Basic Concepts
Freedom
• Absence of constraints
• Confidence that others will respect your life, liberty, property and pursuit of happiness
Government
• The social institution which is empowered to legitimately use force to regulate behavior
Policy
What government does
Power
• Ability to influence what gov’t, groups, and individuals do
Legitimate Use of Power
• Depends on political system– In monarchy: authorized by
hereditary king
– In oligarchy: acceptable to propertied and wealthy
– In democracy: consent of the governed
Politics
• The efforts of individuals, groups and institutions to gain power over policy.
The Public Interest
Democratic Policy Making
• Political process by which
individuals, groups and institutions
exercise their power to influence
government policy.
Origins of Democracy
• Social contract theory
– Individuals form social compact
• agree to follow the rules laid down by
government
Mayflower Compact (1620)
• Formed compact:
– “solemnly and mutually...covenant and combine ourselves together into a civil body politic, for our better ordering...and by virtue hereof to enact, constitute, and frame such just and equal laws, ordinances, acts, constitutions, offices from time to time as shall be thought most meet and convenient for the general good of the colony; unto which we promise all due submission and obedience.”
Some Major Ideas Behind Our American Social Contract
• Thomas Hobbes
– Leviathan (1651)
• John Locke
– Second Treatise on Gov’t (1690)
• Adam Smith
– Wealth of Nations (1776)
• Thomas Jefferson
– Jefferson’s Letters (1787)
• John Stuart Mill
– On Liberty (1859)
Hobbes
• Life in state of nature:– Solitary, mean, poor nasty, brutish and short
• Individuals compact, choose ruler– to control individuals’ behavior– but ruler is not party to compact– can coerce, confiscate property of, even kill
individuals
• But individual has a right to resist death
Locke
• Just as person has right to own body
• Has right to own labor– and fruits of labor
• People form gov’t to protect life, liberty, property
• Since gov’t formed to protect these– can’t harm or take them away
Smith
• Private enterprise most efficient means of production– produces most income and wealth
• Limited gov’t essential for econ freedom
• Government must protect econ freedoms:– free trade, free choice to work, invest, spend – by providing common defense, preventing
monopoly, regulating weights & measures
JS Mill
• Individuals need freedom to develop full faculties– including thought and discussion
• Gov’t must be limited to protect these freedoms
• But must also protect minority views from majority
• Hence, need for limited gov’t based upon principles, not just majority rule
Thomas Jefferson
• “...I am not a friend to a very energetic gov’t. It is always oppressive...Nor will any degree of power in the hands of gov’t prevent insurrections...Educate and inform the whole mass of the people. Enable them to see that it is in their interest to preserve peace and order, and they will preserve them.”
Limited Government
• Three branches– to check each other
• Two levels– to share power
• Constitution – grant and constrain powers– assure individual liberties