Question

Discuss two methods through which government agencies such as the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) influence the development of public health policy in the United States. Are these methods convincing? Why? Ensure you provide specific examples with your methods.

Answer 1

Health care in the United States is provided by many distinct organizations. ... Healthcare coverage is provided through a combination of private health insurance and public health coverage (e.g., Medicare, Medicaid).Though responsibility for health care in the United States is, in unique fashion, both a public and private affair, in recent years, government—and most especially the federal government—has emerged as perhaps the single most important force shaping our health care system. This development has drawn attention to Washington and to what policymakers there are doing in health. Yet, as in other domestic policy areas, government's role in health is shared. No level of government—federal, state, or local—has its own entirely autonomous sphere of action, and all three levels interact in shaping policy, in financing and delivering health care, and in running programs. Students of intergovernmental relations are familiar with Morton Grodzin's now somewhat hackneyed metaphor for this state of affairs. The balance of government roles and responsibilities in America, he observed, looks much more like a marble cake than a layer cake with a clear separation of roles and functions.  ¹

However, despite the current preoccupation with events in Washington, increasingly we are seeing a rediscovery of the importance of the role of state and local governments in the health care field. Whether the issue is Medicaid, hazardous wastes, chemical spills, state rate setting or certificate-of-need, homeless persons on the streets of major cities, or lead paint poisoning, more and more attention is being focused on what state and local governments are doing in health. Several developments have spurred this apparent rediscovery of the state and local role, but three appear to be most noteworthy.

First, through his New Federalism initiatives, President Reagan has stimulated a fresh debate about the respective roles of each level of government in health as well as in other fields. This so-called New Federalism would substantially reshuffle the relationship between federal-state-local government, significantly expanding the role of the states in the governance and financing of domestic programs. President Reagan's initiative has renewed awareness of important differences between liberals and conservatives on the respective roles of federal and state government— with liberals in recent years fearful of the motivations and capacities of state government, and conservatives equally fearful of any expansion of the federal purse or presence. The fate of the Medicaid program, among others, has been a hot issue in this larger debate.

Second, these are hard times for state and local governments. The tax revolt that began with Proposition 13, recent cutbacks in federal aid, and the nationwide economic recession have placed a severe burden on state and local governments. Their fiscal plight and their efforts to cope are receiving increasing attention, much of which has concentrated on the health area where state and local governments have been grappling with the problem of how to trim expenditures while still maintaining services and programs.

Third, and perhaps most important, in a period of belt-tightening and retrenchment at all levels, both the general public and professionals in the health care field are concerned that these cutbacks might threaten the nation's health. Over the past twenty years, this country has made truly significant gains in access to health care and in health. For example, the poor in the U.S. now see a physician and receive hospital care at least as often as the nonpoor, and such health status measures as mortality and morbidity and infant mortality have shown steady improvement.  ²Though the evidence is not yet in one year or the other, there is now concern that the cutbacks that are being made threaten these gains. It is a concern that focuses not just on Washington, where broad financing and policy decisions are made, but at the state and local level as well, where the consequences of decisions are most visible and where services are actually delivered.