Governing Health, Man-Made Medicine, and The System are about coming to terms with this political consensus: We have no public philosophy by which to judge government. The political themes and research parameters of these books include community, political culture, federalism, public policy analysis, government processes, and political economy.
The health care debate focuses on how society defines what each citizen owes the American family of citizens, or community, and what society, in turn, owes each citizen. Political culture concerns the many nuances of how many decisions are made in the health care debate. Federalism reveals the intergovernmental relations of how health care is implemented - by the federal government and 51 state jurisdictions.
Public policy analysis refers to the varied assortment of health care agenda raised, issues developed, programs offered, procedures put into practice, and laws passed. Government processes account for the formalized, structured, perhaps ossified ways of politics in the states and nation. Political economy incorporates the multibillion-dollar marketplace of the U.S. health care industry.
The late Aaron Wildavsky, in The Politics of the Budgetary Process (1984), distinguished between policy politics (which policy will be adopted?), partisan politics (which political party will win office?), and system politics (how will decision structures be set up?).
Governing Health, written by Carol Weissert, associate professor of political science at Michigan State University, and William Weissert, professor of health management and policy at the University of Michigan, is primarily about the policy and system politics of health care.
The book is divided into two parts. Part 1 describes the institutions of government. It reflects the insights of political science research into the interaction of structures and motivations influencing members of Congress. Part 2 describes the policy process.
Chapter 1 describes the structures and functioning of Congress and the motivations of members. Its theme is that Congress was intended to be the dominant branch of government. Summary comment:
The issue of comprehensive health care reform is difficult for a relatively decentralized, independent body of 535 members to tackle. It is salient, complex, and affects nearly everyone. There are few places to hide from constituents or concerned interests (p. 62).
Chapter 2 examines the domestic presidency, as the book is focused on health care policymaking. Summary comment:
The inability in recent years of Democratic presidents with a Democratic Congress to enact their top policy proposals, including health, can be explained by the small amounts of presidential political capital; the strengthened, independent congressional entrepreneur; the complexity of the issues; budgetary constraints; and the inherent differences in constituencies (p. 96).
Chapter 3 describes interest groups, including political action committees and other special interests. Summary comment: "As more and more health care interests come to realize that they too must be players to protect their interests, the number and variety of health care groups will continue to grow" (p. 143).
Chapter 4 offers a sympathetic perspective on public bureaucracy. Summary comment: "Many people worry that the unattractiveness of the public sector will repel the best and brightest young people and lead to a weakening of governmental expertise" (p. 181).
Chapter 5 examines the role of the states in health care reform. Summary comment: "With the popularity of neo-Reaganism in 1995 and the failure of any national health reform package, the focus again turned to the states in the second part of the 1990s" (p. 222).
The authors expertly weave the implications of health policy for institutions: Congress, the presidency, interest groups, bureaucracy, and state …