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…
References
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
dignitydiscussion 
Something that really stuck with me about your post, was your interview with Sam Arora and the reason that special interest groups are so successful in policy making is because of the lack of money to employ staffers. It reminded me that money talks. And just as important is where money lacks; creating a weak spot for other controlling parties to step in. According the Kingdon (2011) special interests groups with money to spend, often get the ear of policy makers. Unfortunately, agenda setting is often swayed by interest groups who influence officials with cash. While the government puts limits on dollars spent on campaign contributions, organizations like Super Political Action Committee (PACs) can spend unlimited amounts of money supporting or denouncing a candidate or policy (Kingdon, 2011). I searched the internet for a Super PAC supporting assisted suicide and couldn’t find anything. The only thing I found was the National Right to Life Political Action Committee, which denounces legislation which supports assisted suicide. In order to help create and successful implement assisted suicide legislation, the State of Arizona might need the help of a special interest group or PAC.
References
Kingdon, J. (2011). Agendas, Alternatives and Public Policies, (2nd ed.). London: Longman Publishing Group
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Very good point, Jennifer. I hope to see this bill sponsored again, but it may take some heavy hitters to give it some legs. Unfortunately, it may not gain traction if not an important topic or priority to those making the laws. Although, with people like Brittany Maynard in the national spotlight it may be the boost states need to act now to propose theses aid in dying laws. Thanks for the input and I will look more into these PACs.
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I love the poll!. This was a creative idea.
I understand the death with dignity is not a moneymaker. It should though be considered a money saver. Think of the thousands of dollars that could potentially be saved per patient if the patient had a date chosen to die rather than to suffer for months later. In those months the patient would spend on doctors care for medications, palliative care costs, home nursing costs, hospital costs, and much more.
I was researching and one report out of Washington in 2010 stated that the death with dignity law actually saved families money. Please see the reference below there were many new articles on that law.
References
Washington state issues 5th official report on doctor-prescribed suicide.. (2014, June). Retrieved from http://www.patientsrightscouncil.org/site/washington/
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Hi Leslie,
Among the many issues that surround Death with Dignity, such as legal and cultural aspects, the one that I most frequently think about is spirituality. While some faith traditions may view it as compassionate, many would reject the practice, suggesting that it violates the sanctity of life. Because of this, I would consider faith traditions, religious groups, churches, etc. as major actors in the development of healthcare policy (or lack of) concerning aid in dying. It has also been suggested that the states that current have Death with Dignity laws perhaps are less traditionally “religious” than the states that do not, or at least have a greater separation of state and religion reflected in their laws.
Lisa
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Brittany Maynard was preceded by a short list of actors in right to die cases : Karen Quinlan (1985), Nancy Cruzan (1990), & Terry Schiavo (2005). Each of these cases were long drawn out legal ordeals. Why has it taken so long to start moving forward to change policy to have Death with Dignity?
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I am not sure why there has been such a lapse with the Death with Dignity movement. Oregon passed the bill in 1997, but it came with its its deal of controversy like the Supreme Court case (e.g., Gonzales vs. Oregon). Fortunately, Oregon prevailed and the law remains. I believe this triumph allowed other state lawmakers to gain confidence in backing these aid in dying bills.
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