Historical and Contemporary Role of Institutions and Actors (Including Consumers) in Developing Healthcare Policies
Welcome back to Week Four’s discussion. This week let’s delve a little further into healthcare policies by focusing on the historical and contemporary aspects involving the role of institutions and actors (including consumers) in the policymaking process.
Last week, I mentioned the basics about policies and why they exist. To reiterate, policies ensure people’s basic needs and rights are met (e.g., health, education, and safety). Also mentioned was the Medicare and Medicaid Act in 1965 that was an amendment to the original Social Security Act of 1935 signed by President Franklin Delano Roosevelt (Centers for Medicare and Medicaid Services (CMS), 2013). The Medicare and Medicaid Act (1965) provided health care to citizens over 65 years of age (advanced age); and poor families (Social Security, n.d.).
In recent times, there have more amendments and provisions to the Medicare and Medicaid Act:
- In 2003, President George W. Bush signed the Medicare Modernization Act (MMA) that included an outpatient prescription drug benefit; and other provisions (CMS, 2013).
- In 2010, President Barack Obama signed the Affordable Care Act (2010) that included expansion of the Medicaid program with the goal of improving programs; and making healthcare affordable for low-income families (Medicaid.gov., n.d.).
So now that we covered some historical and contemporary healthcare policies what does it mean when asked how does the role of institutions and actors (including consumers) play in development of healthcare policies? Longest (2008) discusses the role people, organizations, and interest groups have on healthcare policies; and prefaces the discussion by noting two related areas of interest between the groups:
- All have an analytical interest, meaning how will these policies affect me and the ones I love? And demand to know prior to prepare.
- All want to have influence on the policies proposed since the consequences will be affecting them and their loved ones.
So far this makes sense…and to add one more thing… when one can effectively analyze and influence policy, one is deemed having policy competence (Longest, 2008).
Who are these people, organizations and interest groups that affect policymaking? Longest (2008) goes on to clarify:
- People – Would include citizens of the United States (US). The government mandates healthcare policies to aid its citizens for their pursuit of health.
- Organizations – Would include hospitals, state or county health departments, health maintenance organizations (HMOs), nursing homes, or hospices. Many of these organizations developed as a result of healthcare policymaking.
- Interest Groups – Would include groups like the American Hospital Association, the American Medical Association (AMA), the American Nurses Association (ANA), the Association of American Medical Colleges (AAMC); or the American Association of Retired Persons (AARP). it should be stated that these interest groups could be primary service providers (like the AHA); individual health practitioners (like the ANA); secondary service providers (like the AAMC); or individual (consumer) member constituencies (AARP). The interest groups are motivated to be involved in policymaking over the economic or health concerns of its members; or maybe both.
This brings up a good point that Sam Arora, the Maryland state legislator, mentioned last week during my interview which was having limited funds to pay staff to help develop and draft policies. You need staff to help in the policymaking process; hence why special interest groups are successful in developing policies because they have the money and staff to do these necessary tasks.
How Does This Relate to Death With Dignity?
A Death with Dignity law does not currently exist in the State of Arizona, but who could get involved (e.g, institutions or actors) to help develop this policy? To start, it helps to start with special interest groups because they have money. Organizations like Death with Dignity and Compassion & Choices have been essential to passing the aid in dying law in states like Oregon; and currently, they are helping states like California draft bills.
With stories like Brittany Maynard in the national spotlight, it gets individuals (actors) involved in their state policymaking for bills like aid in dying. Media attention equals exposure. Just this week I spotted Brittany Maynard’s widower on the cover of People magazine. This will only help in getting individuals to sign petitions and demand action from their elected officials. This is power!
Death with Dignity is not considered a money maker in the healthcare world (nor should it be). Meaning if it were to make some company or institution millions, it may have more institutions or actors behind the bill. Although when we look back in history, the Medicare and Medicaid Act in 1965 was supported heavily by such groups as the American Hospital Association (AHA), the American Federation of Labor and Congress of Industrial Organizations (AFI CIO) and the ANA. The AHA got involved heavily with the bill because private hospitals were losing money due to elderly patients being unable to pay their bills (Social Security Online, n.d.).
Let’s end this post with a poll. I am interested in your opinion…
Centers for Medicare and Medicaid Services (2013). History. Retrieved from http://www.cms.gov/About-CMS/Agency-Information/History/index.html?redirect=/history/
Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.
Medicaid.gov (n.d.). Provisions. Retrieved from http://www.medicaid.gov/affordablecareact/provisions/provisions.html
Social Security (n.d.). Chapter 4: The fourth round 1957 – 1965. Retrieved from http://www.ssa.gov/history/corningchap4.html
Social Security (n.d.). History of SSA and the Johnson administration 1963 – 1968. Retrieved from http://www.ssa.gov/history/ssa/lbjmedicare1.html