Post an explanation for how you think the cost-benefit analysis in the statement from page 27 of Feldstein (2006) affected efforts to repeal/replace the ACA.

Regardless of political affiliation, individuals often grow concerned when considering perceived competing interests of government and their impact on topics of interest to them. The realm of healthcare is no different. Some people feel that local, state, and federal policies and legislation can be either helped or hindered by interests other than the benefit to society.

The suppliers of legislative benefits are legislators, and their primary goal is to be re-elected. Thus, legislators need to maximize their chances for re-election, which requires political support. Legislators are assumed to be rational and to make cost-benefit calculations when faced with demands for legislation. However, the legislator’s cost-benefit calculations are not the cost-benefits to society of enacting particular legislation. Instead, the benefits are the additional political support the legislator would receive from supporting legislation and the lost political support they would incur as a result of their action. When the benefit to legislators (positive political support) exceeds their costs (negative political support) they will support legislation. (page 27)

Source: Feldstein, P. (2006). The politics of health legislation: An economic perspective (3rd ed.). Chicago, IL: Health Administration Press.

Post an explanation for how you think the cost-benefit analysis in the statement from page 27 of Feldstein (2006) affected efforts to repeal/replace the ACA. Then, explain how analyses such as the one portrayed by the Feldstein statement may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid).

Contemporary Issues in Public Health Policy

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Contemporary Issues in Public Health Policy Program Transcript

JOEL TEITELBAUM: I think that there are quite a few trends that we can see in the future that will be greatly influencing health policy-making and implementation. One of them is an increased call for better mental health care. Another one is an increased call for universal insurance.

The Affordable Care Act got us probably about half way to insuring the 50 million people that were uninsured before the Affordable Care Act was passed and implemented. You’re still looking at probably 20 to 25 million people uninsured. So I think the Affordable Care Act, while putting us on the path toward universal insurance, we’re still a long way from it. And I think there will be a movement to keep heading in that direction.

And I worry that future politicians will wonder if this kind of major reform is something that is not worth trying because of the political pitfalls potentially. I think if that happens, we will be thrown back into an era of incremental reform, which is what we really saw between the 1960s and passage of the Affordable Care Act in 2010.

Another future trend I think is going to be a focus on how the social determinants of health are affecting not only individual healthful population held. So by social determinants, I mean those things that influence where we live, where we work, where we play. And this is getting a lot more attention in the past couple of years, than we have seen in the past.

I work on a project called the National Center for Medical Legal Partnership, which is a project that aims to embed legal services as part of the health care delivery team. The idea being that there are many social determinants of health that are better addressed by a lawyer then they can be addressed by a physician.

Regardless of how adequate the care and how compassionate the physician, there’s nothing a physician can do necessarily to ameliorate, say a moldy apartment that keeps sending a child with asthma back to that physician. But if you include, as part of the health care delivery team, a lawyer, who can go out and actually do something about remediating the mold in that apartment through housing laws, then perhaps you could see a real change in that child’s health. And then through individual health that way, you could more broadly impact public health.

Another future trends that we will likely see greatly influencing health policy- making is in fact climate change. Very likely that we’re already seeing the effects locally and nationally of climate change, to the point we’re going to have to be

Contemporary Issues in Public Health Policy

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thinking about what it’s going to mean for our food security and other aspects of the health policy-making process.

Another trend that I think we’re likely to have to grapple with is the increase in antibiotic-resistant bacteria. This has clearly become a problem in hospitals across the country. We don’t have a great answer for this one yet from a policy making perspective. But there’s no question that what we’re hearing from the CDC and other national organizations, this one is going to have to be dealt with and relatively quickly as well.

My advice to students who are interested in health policy and politics is to get the most well-rounded education that you can. What I have learned in my 17 years in teaching in the health policy department is that you need to understand so many various disciplines and aspects of policy and the health care system. We’re not only talking about the policy-making machinery in the policy-making process, but policy advocacy, law, medicine, public health, politics, and ever increasingly complex health care delivery system.

So the one thing that I would tell my own students if they’re entering a program, is you have to really go into this knowing that you’re not just studying policy as a stand alone project or topic, but rather you have to really grasp law and economics and public health and everything that connects to with health policy- making in the health care delivery system.

One last thing I would add for students who are studying health policy is it they must understand the critical link between policy-making and law. If you think about public policy in this country– putting aside health policy for a moment– if you’re going to make any major change to public policy, the only way to really achieve that is through law.

If you think about what a policy is, it’s really just a decision. There’s a problem that you might want to address, and you think about what the options are for addressing that problem. And you settle on what you think is the best choice. That’s a policy choice. That’s a policy decision. But then how do you implement it? How to effectuate that?

And the way you normally do that, especially with major public policy, including health policy, is through law. And so really understanding how the law operates, how the legal system operates, and the influence that law has over policies even after you think you’ve got a decision, is critically important.

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