Chapter 19 Outline
I. INTRODUCTION
A. Healthcare, energy, and the environment are types of public policies that are drivenby technology.
II. HEALTHCARE POLICY
A. The health of Americans.
1. Americans are not the healthiest persons in the world. Statistics show that theUnited States lags behind some other countries regarding the health of its citizensin key categories such as life expectancy and infant mortality rates.
2. As a nation we spend a far larger share of our national resources on health thanany other industrialized country, yet we are far from having the healthiestpopulation.
3. The healthcare system in the United States may help explain why the health ofAmericans does not measure up to that of citizens of some other countries.
B. The cost of healthcare.
1. Healthcare already takes up one-seventh of America’s GDP.
2. The United States is one of the wealthiest countries in the world, and it spends ahigher proportion of its wealth on healthcare than any other country.
3. Healthcare, mainly for the elderly and the poor, costs almost a fifth of the federalgovernment’s budget.
4. There are many reasons for rapid increases in healthcare costs (currently around$1.9 trillion a year).
a. New technologies, drugs, and procedures often add to the cost of healthcareby addressing previously untreatable conditions or by providing better (butmore expensive) healthcare.
b. Much of the money that Americans pay for healthcare goes to services likeorgan transplants, kidney dialysis, and other treatments that are not widelyavailable outside of the United States.
c. Doctors and hospitals have few incentives to be more efficient; in fact, withthe rise in medical malpractice suits doctors may be ordering extra tests toensure than they cannot be sued (an approach that is sometimes calleddefensive medicine).
C. Access to healthcare.
1. Inequalities in health and healthcare are major problems in America: the world’shighest-quality care is available to some citizens, but many poor and workingAmericans are relegated to an inferior healthcare system because access tohealth insurance is not universal in the United States.
2. Almost 47 million Americans lack health insurance altogether.
3. One of the most recent innovations in seeking to increase access is thedevelopment of managed care, which now represents 85 percent of workersreceiving health insurance. Health maintenance organizations provide
medical care, negotiate with physician groups, and try to monitor most aspectsof care to control unnecessary use.
D. The role of government in healthcare.
1. American healthcare is provided for by both government and private sources.
a. As in many other areas of the economy, the role of government in healthcareis smaller in the United States than in other comparable countries.
b. The United States lacks national health insurance or a national health serviceto provide healthcare directly to those who need it.
c. America has the most private medical care system in the developed world.
(1) Even so, 46 percent of the country’s total health bill is paid for bygovernment sources; the average for industrialized countries is about77 percent.
(2) The government also subsidizes employer-provided health insurancewith tax breaks, the benefits of which go disproportionately to affluent,highly paid workers.
(3) Private insurance companies cover one-third, and Americans pay nearlyone-fifth of their healthcare costs out of their own pockets.
d. A great deal of medical research is financed through the National Institutesof Health (NIH).
e. The federal government pays for much of the nation’s medical bill throughthe Medicare program for the elderly, the Medicaid program for the poor,and healthcare for veterans.
f. Government insurance programs.
(1) Harry S. Truman was the first president to call for national healthinsurance—a compulsory insurance program to finance all Americans’medical care; the idea was strongly opposed by the American Medical
Association, which called this program socialized medicine.
(2) Although national health insurance has never been adopted in theUnited States, Congress did recognize the special problems of elderlyAmericans by adopting Medicare in 1965.
(a) Part A of Medicare provides hospitalization insurance.
(b) Part B (which is voluntary) permits older Americans to purchaseinexpensive coverage for doctor fees and other expenses.
(3) Medicaid is a means-tested program designed to provide healthcare forthe poor; like other public assistance programs, it is funded by both thestates and the national government.
E. Policymaking for healthcare.
1. The cost of medical care in a high-tech age raises difficult and complex issues.
a. Equality of care and cost containment have taken a back seat totechnological advance.
b. Many lifesaving procedures are extremely expensive, so allocating theminvolves complicated questions of public policy.
c. Oregon has taken the lead on the issue of rationing healthcare, settingpriorities for medical treatments under the Medicaid program.
2. One reason for uneven government and private healthcare policies is related tothe representation of interests.
a. Powerful lobbying organizations representing hospitals, doctors, and theelderly want Medicare to pay for the latest techniques.
b. On the other hand, many groups are unrepresented in government; theirhealthcare needs may not be met simply because no well-organized groupsrepresent them.
3. President Clinton’s Health Security Act proposal was an effort to deal with thetwo greatest problems of healthcare policy: costs and access.
a. Paying for the plan required employers to provide health insurance for theiremployees or pay a premium into a public fund (which would also coverMedicaid and Medicare recipients).
b. Most companies would have to buy coverage through “health alliances” thatwould collect premiums, bargain with health plans, and handle payments.
c. Opponents labeled the plan a government takeover of the healthcare system;they launched an aggressive advertising campaign against it.
d. After a long and torturous battle, the plan died in Congress.
4. Managed care has received more criticism as it has come to dominate theprovision of healthcare in the U.S. Critics claim that managed care imposesstifling rules on network physicians, blocks sick patients from seeing specialists,and delays or denies coverage for recommended treatments or medications—allto save money.
5. Medical costs have skyrocketed in the last decade. President Bush and Congresscreated medical savings accounts and prescription drug coverage for Medicare.These two new reforms are expected to increase healthcare costs by about $60billion and $530 billion over the next decade.
6. There are likely to be increasing calls for more government regulation over thecosts of healthcare and some attempt to help those who fall through the cracksof the American healthcare system.
7. Affordable Health Care Act – “Obamacare”
II. ENVIRONMENTAL POLICY
A. Economic growth and the environment.
1. Issues of pollution affect political choices through their impact on business,economic growth, and jobs.
2. Environmentalists have been telling us for years that our air, water, and land arein bad shape.
3. Although Americans may be generally in favor of “doing something” about theenvironment, specific proposals to limit suburban growth, encourage carpooling,and limit access to national parks have met with strong resistance.
B. The agency charged with administering environmental laws is the EnvironmentalProtection Agency (EPA). Created in 1970, the EPA is now the nation’s largestfederal regulatory agency.
1. The Clean Air Act of 1970 charges the Department of Transportation (DOT)with the responsibility of reducing automobile emissions. The smaller size ofAmerican cars, the use of unleaded gasoline, and the lower gas consumption ofnew cars are all due in large part to DOT regulations.
2. The Water Pollution Control Act of 1972 was enacted in reaction to thetremendous pollution of northeastern rivers and the Great Lakes; since itspassage, water quality has improved dramatically.
3. The most consistently successful environmental campaigns in the postwar erahave been those aimed at preserving wild lands. There are now 378 nationalparks and 155 national forests. Still, only about four percent of the UnitedStates is now designated as wilderness, and half of that is in Alaska.
4 Endangered species are increasingly threatened by expanding humanpopulations and growing economic demands.
a. The Endangered Species Act of 1973 requires the government to activelyprotect each of the hundreds of species listed as endangered, regardless ofthe economic effect on the surrounding towns or region.
b. The act was later amended to allow exceptions in cases of overridingnational or regional interest.
a. A cabinet-level committee was established to decide such cases; so far, it hasgranted few exemptions to the act.
5 In 1980, Congress reacted to increased pressure to deal with toxic waste byestablishing a Superfund, funded by taxing chemical products. The lawestablished that those who polluted the land were responsible for paying to cleanit up.
III. ENERGY POLICY
1. Today, 86 percent of the nation’s energy comes from coal, oil, and natural gas.
a. Oil, which accounts for about 40 percent of the energy Americans use, isone of nature’s nonrenewable resources.
b. The United States has about two percent of the world’s known remainingoil reserves, but uses more than a quarter of it.
c. The United States has plentiful supplies of coal, but coal is the mostpollutant energy source.
d. Only six percent of America’s energy comes from renewable sources.
e. The most controversial energy source is nuclear power. The tradeoffsbetween nuclear and other forms of energy emphasize many of theproblems of politics in a high-tech age.
f. Recently, policymakers have shown more interest in conservation,renewable energy supplies, and alternative fuels. President Bush said theU.S. was “addicted to oil.”
2. Many scientists believe that the atmosphere is being changed due to our heavyreliance on fossil fuels, which contribute to a “greenhouse effect” when energyfrom the sun is trapped under the (polluted) atmosphere and warms the earth.
a. There is no technology to control carbon emissions, so the only way toreduce greenhouse gases is to burn less fuel or find alternative sources ofenergy.
b. At the end of 1997, 150 nations met in Kyoto, Japan, and signed a treaty thatwould require nations to reduce their emissions of greenhouse gases below1990 levels by about 2010. Opponents fear that cutting greenhouse gaseswill cost a staggering sum. Due to the strong opposition to the treaty,President Clinton never submitted it to Congress. President Bush opposed it.
IV. GROUPS, ENERGY AND THE ENVIRONMENT
A. One of the biggest changes in environmental policymaking in recent years is theincreasing presence of new sectors of society joining interest groups to complainabout pollution and to press for government action.
1. The 1960s and 1970s saw an explosion in the size and number of environmentalinterest groups.
2. The nature of environmental policymaking changed; issues that were onceconsidered only from the point of view of jobs and economic growth are nowmuch more controversial.
B. There is currently a backlash against vigorous environmental protection; opponentsargue that the effects of environmental regulations on employment, economicgrowth, and international competitiveness must be part of the policymakingequation.
C. Widening opposition to potentially hazardous industrial facilities has furthercomplicated environmental policymaking in recent years; local groups have oftensuccessfully organized resistance to planned development under the banner “Not InMy Back Yard” (NIMBY).
V. UNDERSTANDING HEALTHCARE AND ENVIRONMENTAL POLICY
A. Democracy and healthcare and environmental policy.
1. High-technology issues make it especially difficult to include the public in areasoned political debate.
2. In the face of complex, high-tech issues such as nuclear power, many Americansrely on interest groups to provide technological expertise and to serve asadvocates for the public interest.
3. Individual citizens are unlikely to have the information or the resources toparticipate meaningfully because of the complexity of the debates.
B. Continued growth in the scope of government is expected in numerous areas of hightechnologyissues.
1. Americans do not hesitate to call for government to play a greater role in hightechnologyissues, and the scope of the federal government has grown inresponse to these demands.
2. At the same time, there are important forces reigning in the federal government.
3. A tension exists between demands for government services and protections anda concern about the government providing those services and protections.
KEY TERMS AND CONCEPTS
Clean Air Act of 1970: landmark legislation that charged the Department of Transportationwith the responsibility of reducing automobile emissions.
Endangered Species Act of 1973: legislation that required the government to actively protecteach of hundreds of species listed as endangered by the U.S. Fish and Wildlife Service,regardless of the economic effect on the surrounding towns or region.
Environmental Protection Agency (EPA): created in 1970, the government agency that ischarged with administering various environmental laws.
Health maintenance organization (HMO): a form of network health plans that limits thechoice of doctors and treatments.
Medicaid: government program designed to provide healthcare for the poor.
Medicare: government program designed to provide healthcare for the elderly.
National health insurance: a program—that has been proposed in a variety of ways over thelast few generations—to provide the financing, policies, and regulations to guarantee all oralmost all Americans’ medical health insurance.
Superfund: established by Congress in 1980, a fund devoted to cleaning up toxic wastesupported by taxes on toxic waste.
Water Pollution Control Act of 1972: passed by Congress to control pollution in the nation’srivers and lakes.