Health care on the agenda

In Public Administration classes students learn that policy-making generally follows a certain sequence.  An issue enters the political agenda.  Resources are mobilized for and against proposed changes.  Legislation action may then occur, followed by implementation of the policy.  Implementation results in feedback, which in turn brings about adjustments to the policy.  Policy-making, therefore, is often diagrammed as circular loop.

The most difficult part of the whole process is getting on the political agenda. Here are just two examples.  We were polluting the coal fields of eastern Pennsylvania for 150 years before acid mine drainage, air pollution, and mountaintop removal became a public issue.  Blacks were segregated for 75 years after the end of Reconstruction, but civil rights did not emerge as a national issue until the 1950s.  

Health care was on the national agenda during the Truman administration, but it never ever reached the legislative stage, and it died out as an issue.  Briefly revived during the Nixon and Clinton administrations, it again disappeared.  This didn’t mean the absence of problems--children and adults died every year from lack of affordable health care, but it wasn’t discussed.

This time the issue will stick.  I’ve written about flaws in the Affordable Health Care Act, and I’ve discussed some ways it might adjusted, but here is something I’m certain of.  Even if the Democrats lose big in 2014 Congressional races, we will not see a wholesale dismantling of government activity in providing health care.  We might see all sorts of adjustments and tweaks, but this issue will remain on the American political agenda.  We will not go back to 2008.