POLITICS, POWER, AND POLICY MAKING
The United States remains the only major industrialized nation in the world without a national health insurance system. The failed attempt to adopt comprehensive health care reform and establish a system of affordable health care for all Americans during the 1993-94 reform period stands as yet another tombstone on the long and torturous road to health care reform in the United States in the twentieth century. Previous attempts at comprehensive reform of the U.S. health care system during the Progressive era, the New Deal, and the Fair Deal met a similar fate. The epitaph on the tombstone of the last comprehensive reform effort might as well read "Here lies yet another effort to establish a national health insurance system-- 1993-94."
The same road to health care reform in the United States in the twentieth century is also marked with several milestones, small as they may be, each representing piecemeal and incremental reforms of the system. The names on these milestones read Medicaid, Medicare, health maintenance organizations ( HMOs), certificate of need (CON), Prospective Payment System (PPS) or the Diagnostic Related Groups (DRGs), and the Medicare Catastrophic Coverage Act of 1988. The 1995-96 reform established a few new milestones, notably the Health Insurance Portability and Accountability Act of 1996.
In this book, we have used the efforts to reform the U.S. health care system from 1993 to 1996 to help illustrate and illuminate the role of power and politics in the agenda-setting and policy-making processes. In so doing, we have utilized theories and concepts to help students understand our case studies; indeed, help explain the real world. Agenda setting and policy making in the U.S. political system involve a wide variety of political actors, inside and outside government, made up of individuals, groups, and institutions. These political actors bring their own set of unique attributes to bear on the policy-making process.