Health Politics

Bill Weissert

936-1311 M3141 SPH II weissert@umich.edu

ndobias@umich.edu

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