America's Future Work Force: A Health and Education Policy Issues Handbook

By Carl W. Stenberg; William G. Colman | Go to book overview

Chapter 4
Public-Private Policy Options for Restructuring the U.S. Health Care System

In contrast to public K-12 education, health care for infants, young children, and adolescents, both in its delivery and financing, is both private and public. In brief, the nation's future course in revising its health care system to address the shortcomings identified earlier will be determined in Washington and state capitols, in local courthouses and city halls, and in corporate boardrooms across America. These determinations will be greatly influenced (1) by public opinion in general and powerful special interest groups and (2) by company management, stockholders, and customer/consumer considerations.

In both public and private sectors particularly difficult barriers to change exist: (1) highly compartmentalized public opinion as it relates to public policy issues and lawmakers and (2) the inexorable tilt in corporate decisionmaking toward the short term, with consequent serious impediments to long-term strategic planning and to the achievement of long term objectives. In the post -- World War II period, corporate concern with human capital investment was limited, until international competition and productivity imperatives began to manifest themselves in the late 1980s. In the public sector, Daniel Yankelovich described the public policy dilemma created by "compartmentalized" public opinion this way:

In today's America, the chief cause of poor-quality public opinion is the failure to confront the inevitable costs and trade-offs involved in making choices. Among the many devices people have for avoiding reality, the most common is to keep related aspects of an issue mentally separated, failing to make the proper connections between them. By compartmentalizing their thinking, people can maintain contradictory and conflicting opinions without being . . . discomforted. When people think about preserving American jobs, they endorse protectionism. When they think about consumer values -- lower prices, better quality, and more choice -- they oppose protectionism. As long as their thinking is compartmentalized, they are unable to take a firm and unwavering stand on the issue. 1

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