John J. Pitney, Jr.
Issues have life-cycles. 1 A problem may fester quietly for years until it reaches the national political agenda as the result of either a crisis or the gradual buildup of concern from citizens and policymakers. Then comes a burst of public debate that culminates in new laws and rules. As policy implementation unfolds, the general public loses interest while groups with a special stake in the issue come to dominate the field. The policy eventually causes, aggravates, or fails to stop new problems that plague the issue area. At this point, the cycle may start again. The politics of health care provides a clear example of the life-cycle of issues.
In the 1950s and early 1960s, concern with the health problems of the elderly and the poor gradually mounted and eventually resulted in the Medicare and Medicaid programs. Two decades later, the nation's medical needs appeared to be outstripping the capacity of these programs: problems of cost and access were vexing all segments of society, not just senior citizens and welfare clients.
In the late 1980s and early 1990s, health issues were again rising to the top of the political agenda. This changing political environment affected all the players in health policy, especially the providers of medical care. One such provider was a California-based corporation, FHP, Inc. (Family Health Program). An analysis of the FHP Health Care Political Action Committee provides a case study of how a corporate PAC adapts to the life-cycle of its issue area.
In traditional medical care, patients pay for each individual service, a practice that may encourage physicians and hospitals to carry out needless services in order to generate more income. One alternative in this practice is the health