The fragmentation of the U.S. health care system, with its differing modes of financing and service delivery, is a reflection of a dispersed government structure. Policy making is shared and distributed across various branches and levels of government. As a result, policy making processes can be slow to respond, manipulated towards personal interests, and often redundant. Consider, for example, the public entitlement programs such as Medicaid, Medicare, the State Children’s Health Insurance Program (SCHIPS), and the PPACA of 2010. Where is there overlap between these policies? How do they demonstrate a dispersed government structure?
This week, you will analyze the role of the federal government in health care policy making.
To prepare:
- Review this week’s Learning Resources focusing on the France article and the textbook readings.
- Identify two nursing or health care policies that address similar needs, one passed at the federal level and the other at another level of government (state or local).
By Day 3
Post a cohesive response that addresses the following:
- Provide an example of two policies that address similar needs, passed at two levels of government (i.e., federal, state, or local).
- What are the advantages and/or disadvantages of this duplication? How does this example reflect the implications of federalism? Provide support from the literature for your position.
- To what degree should the federal government get involved in health care policy making? Provide concrete examples to support your position.
Read a selection of your colleagues’ postings.
Learning Resources
Required Readings
Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical
approach (8th ed.). McGraw-Hill.
● Chapter 15, “Health Care Reform and National Health Insurance”
Chapter 15 discusses the history of legislating national health care insurance in
the United States. The chapter focuses on the different methods of financing a
national health care reform, from a single-payer government fund to employer
and individual mandates.
● Chapter 16, “Conflict and Change in America’s Health Care System”
Chapter 16 highlights the historical relationships between health care
purchasers, insurers, providers, and suppliers. Over the decades, these
stakeholders have battled for control of the U. S. health care system, as health
care costs increase and more people remain uninsured.
France, C. (2008). The form and context of federalism: Meaning for health care
financing. Journal of Health Politics, Policy & Law, 33 (4), 649-705.doi:
10.1215/03616878-2008-012
The author argues that the United States’ unique form of federalism works
negatively within a fragmented societal context to create an equally
fragmented and dispersed health care system. The article highlights the
United States health care system by comparing it with systems in Canada,
Germany, and Australia.
Frankel, M. S. (2009). Commentary: Public outreach by the FDA: Evaluating oversight
of human drugs and medical devices. Journal of Law, Medicine & Ethics, 37 (4),
625–628.
Kennedy, E. M. (2005). The role of the federal government in eliminating health
disparities. Health Affairs, 24 (2), 425-428.
In this article, the late Senator Kennedy discusses health care disparities
among marginalized groups in the United States. He proposes the
expansion of Medicaid and State Children’s Health Insurance Program
(SCHIP), increased cultural competency among health care providers,
health care research related to marginalized groups, and an increased public
health investment by the United States. He includes a brief history of
government involvement in reducing health care disparities.
