Politics and Media

M6920 October 9, 2001

Columbia University School of Nursing M6920, Fall, 2001

Goals

Explore the relationship between policy and politics

Describe the role of media in US political life

Use health reform as a case study of these issues

Columbia University School of Nursing M6920, Fall, 2001

Politics

About the distribution and use of power

Can occur in any setting, but generally associated with the allocations of power and resources in public system

Columbia University School of Nursing M6920, Fall, 2001

Sources of power

Heredity Economics Information Charisma Assembled

Columbia University School of Nursing M6920, Fall, 2001

Power is experienced as

Ability to reward or punish Ability to determine what is done

with knowledge Ability to distribute resources Ability to exercise referral power

Columbia University School of Nursing M6920, Fall, 2001

Electoral politics

Who gets chosen Nominations Financing Communications

Columbia University School of Nursing M6920, Fall, 2001

Executive/legislative politics

What is on the agenda Who sets/controls the

agenda What solutions are

considered What solutions are chosen

Columbia University School of Nursing M6920, Fall, 2001

Balancing and Competing Interests

Depends onweightof parties

Likely to Fail

Likely to Pass Depends oninterestgroupsaroused

Specific Benefit General Benefit

SpecificBurden

GeneralBurden

Columbia University School of Nursing M6920, Fall, 2001

Interest groups

National/local As forums for discussion As lobbying/

pressure groups

Act Now!!

Columbia University School of Nursing M6920, Fall, 2001

Professional association as an interest group

advocating for its members

advocating for its ‘clients’ advocating for its

supporters or suppliers

Columbia University School of Nursing M6920, Fall, 2001

The Internet

Almost all candidates and elected officials have web sites

Rapid distribution has unquantified impact

Fund-raising potential huge Equity in access is important

Columbia University School of Nursing M6920, Fall, 2001

At the intersection of

Problems

Alternatives

Politics

Actions and policies

Columbia University School of Nursing M6920, Fall, 2001

Responses as issues emerge

National actors later rather than earlier

State/local officials are front line Politicians engage when not

reacting has more negatives than reacting• Trying to avoid blame

(from CH Foreman, Jr 1994 Plagues, Products and Politics, Washington, DC: Brookings Inst)

Columbia University School of Nursing M6920, Fall, 2001

Responses, cont.

Interest groups/ constituents• Established and

directly involved--representing victims

• Newly established by the emergence of new victims

• Opportunistic

Press• Fire alarms• Breakthroughs• Controversies• Human interest

Columbia University School of Nursing M6920, Fall, 2001

As experienced in “drive through delivery” debate

Agenda building (Kingdon model)• problem recognition• formation of proposals

(often by policy entrepreneurs)

• political mood of the time

Columbia University School of Nursing M6920, Fall, 2001

Was shorter stay. . .

testimony to the system sensitivity to mother’s wishes to home sooner?

reflection of the ability of technology to shorten unnecessary stays?

economic decision imposed on mothers and doctors by greedy insurers?

Columbia University School of Nursing M6920, Fall, 2001

Apparent solution was simple:

an extra day in hospital fixes all almost no discussion of alternative

models of discharge/home care personal experiences of legislators

were critical

Columbia University School of Nursing M6920, Fall, 2001

In the debates

hospital-based doctors and nurses very positive

those more committed to home care negative

ACNM apparently silent

Columbia University School of Nursing M6920, Fall, 2001

The politics

in 15 of 23 states adopting law, the single sponsor of the bill was female

reasons for sponsoring:• shift control to women• avoid negative consequences• fear that insurers wouldn’t act on

their own

Columbia University School of Nursing M6920, Fall, 2001

End result

largely symbolic and nonpartisan no governmental resources

invested an exception to ERISA was inserted

Declerdq E & Simmes D. 1997The politics of ‘drive-through deliveries’: putting early postpartum discharge on the legislative agenda Milbank Quarterly 75@ (175-202).

Columbia University School of Nursing M6920, Fall, 2001

How a bill becomes law

A civics lesson in pictures. . .

Columbia University School of Nursing M6920, Fall, 2001

As legislator introduced it

Columbia University School of Nursing M6920, Fall, 2001

As committee reported it

Columbia University School of Nursing M6920, Fall, 2001

As House amended it

Columbia University School of Nursing M6920, Fall, 2001

.

As Senate amended it

Columbia University School of Nursing M6920, Fall, 2001

As passed into law

Columbia University School of Nursing M6920, Fall, 2001

As agency understood it

Columbia University School of Nursing M6920, Fall, 2001

What budget allowed

Columbia University School of Nursing M6920, Fall, 2001

What the taxpayer wanted

Columbia University School of Nursing M6920, Fall, 2001

Politics of health reform

Conflicting goals:• Health• Insurance• Reimbursement

Conflicting ideas:• Government provides• Incentives to induce• Punishments to

enforce

Poor management of the debate• Failure to keep an

eye on the big picture

• Skewed media presentations

• Overlapping political agendas

Columbia University School of Nursing M6920, Fall, 2001

Media

National Professional State/local

Columbia University School of Nursing M6920, Fall, 2001

Politics and Media

Power distributions and agendas influenced by what is said

Communications mechanisms of media are used by wise politicians

Role of media in free society often cited as critical

Columbia University School of Nursing M6920, Fall, 2001

Anticipating the Bush presidency

Medicare?

Children?

Research and academic health centers?