The Role of the Medical Profession in Making Public Policy By Joseph R. Marbach, Ph.D. Dean, College of Arts and Sciences Seton Hall University

Introduction Historical overview of public policy making in the United States Public Health and Safety Political Culture

American Political Culture Broad based participation by many groups Checks and Balances Limited Government “The government that governs best, governs least.” Thomas Jefferson

Influence of the Medical Profession on policy Limited due to nature of society Expands due to  Industrialization  Urbanization  Overpopulation

The Medical Profession as Intetest Group  American Medical Association – 1847  New York Academy of Medicine – 1847  American Pharmacists Association – 1852  American Dental Association – 1859  American Nursing Association – 1896  American Hospital Association

Role of Federalism States respond to domestic problems Response rate uneven Laboratories of Democracy

Police Powers of Government New York City Metropolitan Board of Health New York State Department of Health – 1901 U.S. Food and Drug Act – 1906 New York City Zoning Laws

Professionalization of Health Care State regulation of Occupations Delegation of occupational standards to profession Variations in standards by individual states

New Jersey Opticians = Eye Glasses, No Contact Lenses Optometrists = Eye Glasses + Contact Lenses Ophthalmologists = Eye Glasses + Contact Lenses + Surgery

Does this System Work Today? No 1770s – Minimimal Public Health Concerns – Agraian Lifestyle 2000s – Globalization = Global Public Health Concerns – International Travel and Urban Lifestyles

U.S. System $2 Trillion Spent on Health Care $6,830/person 16% of GDP $4 Trillion $12,000/person 20% of GDP

U.S System 46 Million Americans are uninsured Since 2002 – 266,000 employers have cut health coverage US ranked 37 th in mortality (24 th among Industtrial nations)

Solutions Reduce costs Universal coverage