Health Politics and Policy Paper Instructions and assign reading attached below. If you have any questions feel free to ask. Instructions: This assignment

Health Politics and Policy Paper Instructions and assign reading attached below. If you have any questions feel free to ask. Instructions: This assignment must be done in APA format. A minimum word count of 300 words
(not including references) is required. A minimum of 3 references (with in-text citations) is required.
Please make sure that scholarly references are used. If you have any questions please feel free to ask.
Question
1. Your text (read section) offers you the basics of the congressional process. Given the
current “stalemate” in US congress over fixing the ACA or replacing it congress appears to
be split in several directions. Republicans debating with Democrats, Democrats debating
with themselves, and Republicans debating with Republicans. Identify the key positions
now being taken by the divided groups. Write one paragraph explaining each position. . Do
a comparative analysis (side by side) of the proposals. Where are they in agreement ?
Where are they at odds?
Why? Party line politics or ideological differences within/between parties?
Additional research will be necessary for you to discuss these issues. Use recent scholarly
publications. Cite them APA style.
Do not post just a series of quotes from your research. Establish the facts then offer your own
analysis, understanding and recommendations about the causes of the stalemate. This will not be
your opinions rather your conclusions based on your comprehension of the research and facts.
Thanks
Use scholarly sources. Cite the APA style. Apply the course/assignment requirements. Thanks
Reply
1.
Book Reference:
Morone, J. A., Litman, T. J., & Robins, L. S. (2009). Health politics and policy(4th ed.). Clifton Park, NY:
Cengage Learning.
Instructors Notes:
•
•
In professional writing avoid using first person “I” and third person “we”, as they detract from
the quality and turn professional researched statements into opinions. Instead of “I” use, for
example, use “the writer, the author or the researcher”.
Approved sources for this course include the course textbook and scholarly articles from the
Bethel library databases. No other source information is acceptable.
Chapter 3
Congress
Mark A. Peterson
H
I
G
G
S
,
We cannot understand health politics and policy without understanding
Congress. In this chapter, Mark Peterson explores the logic of our legislature,
S
shows how it is unique, and explains why it matters.
H
A
N
Congress has been both friend and foe of health policy. What
I all reit enacts, what it ignores, and what it actively defeats
veal a good deal about the legislative process in theCUnited
States and echo the changes that, over time, remake American
Q
lawmaking. As reflected in the landmark displays of congresU the
sional action, stalemate, and obstreperousness during
Obama administration, it is national politics writ large played
A
out in the most important crucible of policymaking.
The cumulative effects of what Congress has enacted are
substantial by any measure. Since the 1930s, as a 1
result of
legislative attention to hospital construction, biomedical re1
search, medical manpower training, drug safety, public health,
and workplace safety, as well as direct provision of
0 public
health insurance and tax subsidies for private coverage, Con5
gress has constructed a far-reaching national health-policy
domain with enormous financial consequences. JustTin monetary terms, a comprehensive analysis of all federal S
expenditures and tax benefits in 1999 estimated that federal dollars
represent 40.8% of the nation’s overall health care spending.
Throw in state funding for the federally established Medicaid
program and the total hits 47.3%.1
But for all of its engagement with health policy, ­Capitol
Hill has presented a nearly insurmountable hurdle for particular kinds of policies. Except for legislation that cuts
projected spending for public programs like Medicare and
Medicaid, Congress has consistently rejected proposals
designed to contain health care costs systemwide, even
when overall health care expenditures have increased at
more than two or three times the overall rate of inflation,
far faster than economic growth, and well beyond the demographic pressures of an aging society. It forthrightly
rejected, for example, President Carter’s initiative for hospital cost containment. 2 Moreover, until the enactment
of the Patient Protection and Affordable Care Act of 2010
(generally referred to as the ACA), for nearly 65 years the
legislative branch refused, time and again, all attempts to
establish a system that moves toward universal health insurance coverage. As every other advanced democracy
in the world achieved, each in its own way, the “international standard” that combines effective cost containment
and universal coverage, Congress has rejected comparable
efforts in the United States. 3 As we will see later in this
9781305172005, Health Politics and Policy, Fifth Edition, Morone/Ehlke – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.
CHAPTER 3 • Congress
chapter, even the enactment of the ACA, with all of its
substantive shortcomings, required extraordinary political
circumstances.
How are we to understand these dynamics of the ­American
legislative process, with its emphasis on distributive policymaking, bursts of regulation, episodic focus on particular
populations and constituencies, and enormous resistance
to broad-scale strategies to discipline health care spending
and provide universal insurance coverage? What does one
need to know about Congress to explain this mix of activism, struggle, and denial, to ascertain “the logic of congresH
sional action” and inaction in health policymaking?4 In this
I as
chapter, I describe the core features that define Congress
an institution and as a collection of individual legislators.
G I
also consider how unusual election results as well as changes
G
in the structure of Congress alter the internal politics of lawmaking, on occasion permitting dramatic policymaking. S
With
these fundamentals of the legislative branch in hand, I turn
,
to the issue that is often of paramount interest to students of
health politics and policy, offering a fairly detailed analysis of
the repeated failures of comprehensive health care reform
S in
the legislative arena and the sources of the relative success
in 2010. Finally, I assess the rise of extreme partisanshipHand
ideological division in Congress and consider its implications
A
for the future of health policymaking.
N
I
The Baseline Congress
C
One fact about Congress stands above all others: “Among
the national legislatures of major countries, Congress isQthe
only one that still plays a powerful independent role in public
U
policymaking. . . . Only Congress initiates legislation, makes
decisions on major provisions, and says ‘no’ to executiveApro-
posals.”5 Consider the stark difference between the United
States and the United Kingdom. Three major empirical studies
1
reveal that Congress in the postwar period adopted, typically
only in part, just 6 in 10 presidential initiatives. Some presi1
dents fared especially poorly—Gerald Ford and Jimmy Carter
0
could get Capitol Hill to accept only about a third of their leg6
islative agendas. In contrast, British Prime Minister Tony5Blair
was in office for more than eight years before the parliament
T
defeated—for the first time—one of his major legislative pro7
S
posals. Congress not only frequently exercises its authority
to block or substantially alter initiatives from the executive,
it often plays a critical leadership role in the formative stages
of policymaking. Policy ideas “proposed” by presidents often
31
begin as bills drafted much earlier by members of Congress.8
Based on his detailed historical analysis of 28 major statutes
enacted from 1947 to 1990, Charles O. Jones determined that
the impact of the legislature was “preponderant” for a quarter
of the laws, and in more than half the cases Congress shared
roughly equal influence with the president.9
What permits Congress to be so different from other national legislatures and therefore of such unique consequence
to health policymaking is the “separation of powers” and
attendant checks and balances established by the US Constitution. This system of independent legislative, executive, and
judicial branches of government, each with a formal claim
over some aspect of lawmaking and implementation—more
accurately captured by Richard Neustadt’s phrase, “separated institutions sharing powers”—ensures that Congress
is a central player in national policymaking.10 It also fosters
decision-making complexity by injecting multiple perspectives into the legislative process. Both the Constitution and
institutional arrangements that developed later (through law,
rules, and interpretation) make enacting statutes difficult.
Successful legislation requires assembling a daunting series
of like-minded coalitions in numerous venues—committees
and subcommittees within the House and Senate, while
also garnering the support of the president (or sufficiently
large majorities in both the House and Senate to override a
presidential veto). Just about everything engineered by the
Constitution makes that tricky to do, such as the separate
constituencies and election timetables for the president, the
House, and the Senate.
Elaborating on the comparative context illustrates the
point. Arend Lijphart identified two “ideal types” of democratic constitutional design: “majoritarian” and “consensus.”11 Majoritarian systems simplify the burdens of decision
making by concentrating power in the hands of the leadership
of the political party that won the most recent election. They
dramatically limit the opportunities for independent action by
legislatures. Such systems have a prime minister as the single executive leader. The prime minister and the cabinet (together forming “the government”) are generally members of
parliament, thus fusing the executive and legislative authority. The legislature has only one body with policy-making
power. In addition, only two parties compete meaningfully in
elections and on issues that clearly differentiate the parties.
In those elections, a legislative district is represented by the
candidate who won a plurality of the vote. Lower-level governments are under the authority of the national government.
9781305172005, Health Politics and Policy, Fifth Edition, Morone/Ehlke – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.
32
PART II • National Political Institutions
The ­constitution is unwritten, interpreted largely by the parliament itself instead of an independent judicial branch of government. Majority party members in parliament are expected
to follow the lead of their prime minister and cabinet. New
Zealand’s political system fits this image nearly perfectly.12
The United Kingdom and Canada come close to this model.
Alternatively, nations that comport with “consensus”
a­ rrangements have governing systems in which taking
­action requires the nurturing of pervasive agreement among
­myriad policy makers located in multiple institutional settings. ­Everything about these systems fragments power
H where
­majoritarian systems concentrate it. As a result, consensus
I in any
systems invite any interest group with a large stake
policy question to work the institutional crevices of dispersed
G
policymaking in order to shape laws more to their liking or to
G
“veto” provisions with which it disagrees.13
S atThe United States possesses a number of majoritarian
tributes (executive power concentrated in a single president,
,
a two-party system, single-member legislative districts, and
“first-past-the-post” plurality elections for Congress and the
president). However, because of the separation ofSpowers
and the equal authority granted the two chambers of ConH
gress, each with distinctive constituencies; federalism that
protects the autonomy of the states (further reflectedAback in
the ­Senate and tensions between the House and Senate); and
N
a written constitution with the independent judiciary as the
I of the
­final interpreter, this system tilts heavily in the direction
consensus model. In addition, the United States has
Cfew of
the other social institutions—such as muscular political parties, a tradition of a strong administrative state, and Q
a widely
organized and influential labor movement—that bridge
U institutional divides in other countries.14
A
Knowing that Congress matters more than most national
legislatures as a policy-making body, and that legislating is
a complicated endeavor, does not yet tell us how and
1 why
Congress acts, or fails to act, in response to particular policy
1 the
issues. For insights on these issues, we must first examine
role and orientation of legislators in the American context
0 and
the effects of specific features of Congress as an institution on
5
legislative decision making.
The Legislator
T
S
Congress is ultimately an aggregation of its members, even
during periods of heightened partisanship and intraparty
unity. Its actions reflect the motivations, preferences, and
choices of the individuals elected to serve as representatives
and senators. One starting assumption is that members of
Congress are “single-minded seekers of re-election.” 15 That
proposition may be too analytically narrow and politically
cynical, but even when members are primarily intent on
wielding power or pursuing the public interest through good
public policy, reelection is the necessary predicate and thus
an inescapable objective.16 However, that goal creates different behavioral incentives in different systems. In many parliamentary systems, the political parties maintain close control
over the slates of legislative candidates not only determining
who will run (or “stand”) for election and reelection but even
what districts or constituencies they will represent. Electoral
success in such settings, therefore, hinges first on satisfying
the party’s needs, including supporting the expressed policy
positions of the party once in office.
Although there have been times in American history when
the major political parties have played a significant role in
candidate selection and promotion, congressional candidates
and incumbents running for reelection are usually independent agents who promote their individual political interests
(including pressuring their party to adopt greater ideological
purity). In some instances, party figures ranging from local
leaders to the president try to entice particular individuals
to seek election to Congress, with promises of support, but
most candidates launch the race for office under their own
volition. The party’s nomination is determined by voters in
primary elections, not the party’s leadership. In 1938, incumbent conservative Southern Democrats who opposed Franklin
D. Roosevelt’s (FDR) New Deal easily won renomination and
reelection despite the president’s bold efforts to defeat them.
In 1990, GOP leaders were embarrassed when the white
supremacist David Duke ran as the Republican challenger
to incumbent Democratic Senator J. Bennett Johnston in
Louisiana. The scores of winning “Tea Party” candidates in
the 2010 midterm election, who helped engineer the new Republican majority in the House, thrust themselves into the political arena. In general elections, various party organizations
inside and outside of Congress may provide some campaign
funding, media assistance, or campaign visits by their partisan
luminaries, such as the president or congressional leaders—all
now common practices—but for the most part, major-party
congressional candidates reflect their own coalitions of voters,
assemble their own electoral teams, hire their own consultants, do their own polling, and craft their own themes attuned
to their particular inclinations and ­constituencies. As a result,
9781305172005, Health Politics and Policy, Fifth Edition, Morone/Ehlke – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.
CHAPTER 3 • Congress
both congressional campaigns and legislative decision making
are especially responsive to local considerations even when
the campaign issues are of national consequence. Members
of Congress must, at least in part, judge policy issues like
educating health care professionals, funding Medicaid, and restructuring Medicare through the lens of their constituencies.
The late Thomas “Tip” O’Neill of Massachusetts, Democratic
Speaker of the House from 1977 to 1987, famously endorsed
the well-worn line that “all politics is local.”17 In more partisan times, perhaps it is not all, but surely it remains a lot.
H
I
G
Political parties in Congress are probably the single most
Gthe
­important organizational feature of the legislature. In both
House and Senate, the party that wins the majority of seats
S in
the election chooses the leaders of the chamber who, in turn,
,
determine which committees will be assigned bills and organCongressional Organization—
Legislative Parties
ize floor deliberations. Committee and subcommittee chairs
come from the ranks of the majority party, and they determine
the schedule of the committee’s work and hire most of itsSprofessional staff. Even during periods of weaker, less ­coherent
H
legislative parties, party affiliation is also the best single preA on
dictor of how members of the House and Senate will vote
18
pending rules and legislation.
N
That, however, is where any apparent similarities between
I
Congress and other national legislatures end. In many parliaCor,
mentary systems, the majority party has to hang together
in the extreme case, the government “falls” and new Q
elections are called. In purely majoritarian systems, a governU
ment (prime minister and cabinet) can almost always secure
a legislative victory, even for the most sweeping and A
controversial legislation. Congress, with few exceptions, could
not be more different. Because most members of Congress
1
have their own independent constituent base, Democratic
and Republican leaders often have had trouble motivating
1
individual members to support the party’s positions. House
0 loand Senate leaders of both parties understand the strong
cal ties. They rarely try to compel members to comply5with
party positions if it would risk severe electoral damage, and
T
few mavericks have been punished when they have broken
ranks on even major party priorities.19 The exceptions prove
S
the rule. After President Clinton and House party leaders
pushed a number of moderate to conservative Democrats to
join a party-line vote for the president’s budget plan in 1993,
33
and similar pressures were applied for the vote on the ACA
in 2010, many of these ­accommodating representatives lost
their seats in the next election and the majority swung to
the GOP. When a member’s vote is essential for a successful outcome, it is the representative or senator who has the
leverage in the negotiations with party leaders. One of the
more memorable examples is the so-called Cornhusker kickback, when conservative Democratic senator Ben Nelson of
Nebraska was promised a ­Medicaid exemption for his state
as part of wooing his vital vote to break a Republican filibuster in 2009 on health care reform.20
From 1956 to 2010, for example, Democratic party unity on
all such votes in the House ranged from a low of 58% in the
early 1970s to a peak of 92% in the late 2000s (Republicans
followed a similar pattern, although they acted with more sustained unity than Democrats from 1995 to 2003; the Senate
also closely matches the House).21
Congressional Organization—
Structural Characteristics
Any legislature has structural design features—established
by constitutional provisions, laws, or the rules of each
­chamber—that largely determine who in the legislature
can significantly affe…
Purchase answer to see full
attachment