Chapter 1: Introduction: Understanding the Role of and Conceptualizing Health Policy and Law

Chapter Overview Describes why it is important to include policy and law in the study of health care and public health Describes three ways to conceptualize health policy and law

The Role of Policy and Law in Health Care/Public Health Federal and state policy and law shape virtually all aspects of the health care system, from structure and organization, to service delivery, to financing, and to administrative and judicial oversight Topics include: advertising and marketing of health services and products, health care contracting, employment issues, patents, taxation, health care discrimination and disparities, consumer protection, bioterrorism, health insurance, prescription drug regulation, assisted suicide, biotechnology, human subject research, patient privacy and confidentiality, organ availability and donation, and more.

The Role of Policy and Law in Health Care/Public Health Policy and law have also long played a seminal role in everyday public health activities as well as in many historic public health accomplishments One main focus of policy and law in the realm of public health is on locating the appropriate balance between public regulation of private individuals and corporations, and the ability of those same parties to exercise rights that allow them to function free of overly intrusive government intervention

Conceptualizing Health Policy and Law There are multiple ways to conceptualize the many important topics that fall under the umbrella of health policy and law Three conceptual frameworks: one premised on the broad topical domains of health policy and law, one based on prevailing historical factors, and one focused on the individuals and entities impacted by a particular policy or legal determination

Conceptualizing Health Policy and Law The first domain is reserved for policy and law concerns in the area of health care, another for issues arising in the public health arena, and the last for controversies in the field of bioethics.

Conceptualizing Health Policy and Law A second way to consider health policy and law is in historical terms, based on the social, political, and economic views that dominate a particular era Considered this way, health policy and law have been influenced over time by three perspectives: professional autonomy, social contract, and free market

Conceptualizing Health Policy and Law A third way to conceptualize health policy and law issues is in terms of the stakeholders whose interests are impacted by certain policy choices or by the passage or interpretation of a law Patients, health care providers, governments, the public, managed care and traditional insurance companies, employers, the pharmaceutical industry, the medical device industry, the research community, interest groups, and others all may have a strong interest in various policies or laws under debate.

Chapter 2: Policy and the Policymaking Process

Chapter Overview Chapter 2 provides a basic overview of policy and the policymaking process Chapter 2 focuses on: Defining policy Public policymaking structure Federal and State health bureaucracy Interest groups

Defining Policy Who makes policy? Public policy problems Private actors Government (federal, state, local) Authoritative decision makers Public policy problems Beyond individual concerns Structuring policy options Mandatory/voluntary Take action/refrain from acting

Federal Policymaking Structure Legislative branch House Senate Executive branch White House Administrative agencies Judicial branch discussed in chapter 3

Federal Legislative Branch Congress is lawmaking body of federal government Congress consists of Senate and House Senate statewide 2 senators from each state House Elected by district Proportional to population At least on representative per state

Legislative Branch Committees Workhouse of Congress Examples of key health committees: Senate Finance, subcommittee on health care Senate Health, Education, Labor and Pension House Ways and Means House Appropriations committee, subcommittee on Labor, Health and Human Services, Education, and Related Agencies

Legislative Branch Constituents Voters in state or district Voters in nation if have leadership role or national aspirations Political party President

Federal Executive Branch White House President Executive offices Assist and advise president 15 cabinet departments interpret and implement laws passed by Congress

Federal Executive Branch Presidential powers/duties Sets the agenda Budget proposals Persuasion Sign/veto bills Executive Orders

Federal Executive Branch Presidential Constituents Nation (all voters) Public who voted for president Political party Other nations International organizations

Federal Executive Branch Administrative Agencies Duties/powers: implement statutes through rulemaking Constituents President Congress Individuals and entities regulated by agency No one?

Federal Health Bureaucracy Key agencies Department of Health and Human Services (HHS) Department of Veterans Affairs (VA) Department of Defense (DOD)

Federal Health Bureaucracy - HHS Key agencies Administration for Children and Families Administration on Aging Agency for Healthcare Research and Quality Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention Center for Medicare and Medicaid Services Food and Drug Administration Health Resources Services Administration Indian Health Services National Institutes of Health Substance Abuse and Mental Health Services Admin.

Federal Health Bureaucracy – VA & DOD Provides comprehensive care to veterans who were not dishonorably discharged DOD TriCare Provides health insurance to current and retired military personnel and their families

State and Local Policymaking and Health Bureaucracy State-level policymaking is important Key decisions made on state level Variation among states in how policymaking process is structured State/local health bureaucracy State level agencies (ex: Medicaid, public health) Local public health agencies

Interest Groups Interest group is the general term used to describe a variety of organizations that focus on a particular issue or issues and have the goal of influencing and educating policymakers and the general public Interest groups do not make policy

Chapter 3: Law and the Legal System

Chapter Overview Chapter 2 provides a basic overview of policy and the policymaking process Chapter 2 focuses on: Defining policy Public policymaking structure Federal and State health bureaucracy Interest groups

Defining Policy Who makes policy? Public policy problems Private actors Government (federal, state, local) Authoritative decision makers Public policy problems Beyond individual concerns Structuring policy options Mandatory/voluntary Take action/refrain from acting

Federal Policymaking Structure Legislative branch House Senate Executive branch White House Administrative agencies Judicial branch discussed in chapter 3

Federal Legislative Branch Congress is lawmaking body of federal government Congress consists of Senate and House Senate statewide 2 senators from each state House Elected by district Proportional to population At least on representative per state

Legislative Branch Committees Workhouse of Congress Examples of key health committees: Senate Finance, subcommittee on health care Senate Health, Education, Labor and Pension House Ways and Means House Appropriations committee, subcommittee on Labor, Health and Human Services, Education, and Related Agencies

Legislative Branch Constituents Voters in state or district Voters in nation if have leadership role or national aspirations Political party President

Federal Executive Branch White House President Executive offices Assist and advise president 15 cabinet departments interpret and implement laws passed by Congress

Federal Executive Branch Presidential powers/duties Sets the agenda Budget proposals Persuasion Sign/veto bills Executive Orders

Federal Executive Branch Presidential Constituents Nation (all voters) Public who voted for president Political party Other nations International organizations

Federal Executive Branch Administrative Agencies Duties/powers: implement statutes through rulemaking Constituents President Congress Individuals and entities regulated by agency No one?

Federal Health Bureaucracy Key agencies Department of Health and Human Services (HHS) Department of Veterans Affairs (VA) Department of Defense (DOD)

Federal Health Bureaucracy - HHS Key agencies Administration for Children and Families Administration on Aging Agency for Healthcare Research and Quality Agency for Toxic Substances and Disease Registry Centers for Disease Control and Prevention Center for Medicare and Medicaid Services Food and Drug Administration Health Resources Services Administration Indian Health Services National Institutes of Health Substance Abuse and Mental Health Services Admin.

Federal Health Bureaucracy – VA & DOD Provides comprehensive care to veterans who were not dishonorably discharged DOD TriCare Provides health insurance to current and retired military personnel and their families

State and Local Policymaking and Health Bureaucracy State-level policymaking is important Key decisions made on state level Variation among states in how policymaking process is structured State/local health bureaucracy State level agencies (ex: Medicaid, public health) Local public health agencies

Interest Groups Interest group is the general term used to describe a variety of organizations that focus on a particular issue or issues and have the goal of influencing and educating policymakers and the general public Interest groups do not make policy

Chapter 3: Law and the Legal System

Chapter Overview Considers the role law plays in everyday life Defines law and describes its multiple sources Discusses several key features of the legal system, including the separation of government powers, federalism, the role of courts, and due process

The Role of Law Law’s importance in U.S. stems from its primary purpose: to function as the main tool with which we organize ourselves as an advanced, democratic society A society as sprawling and complex as ours needs formal, enforceable rules of law to provide a measure of control

The Role of Law The main way the law governs the many kinds of relationships in society is to recognize and establish enforceable legal rights and to create the institutions necessary to define and enforce them A legal right denotes a power or privilege that has been guaranteed to an individual under the law, not merely something that is claimed as an interest or something that is a matter of governmental discretion

Defining Law Think of “law” not just as words on a page, but as the many interacting parts that are involved in drafting those words in the first place, and in bringing them to life once they have been enacted as laws Thus, consider “law” as a system by which rules are created, disseminated, enforced, violated, disputed, interpreted, applied, revised, etc.

Sources of Law Regardless of how “law” is defined, at the core of the legal system lays a body of enforceable written rules: -Constitutions -Statues -Regulations -Common law/case law

Key Features of the Legal System: Separation of Powers The legal doctrine that supports the arrangement of shared governance To guard against a concentration of political power, governmental powers and responsibilities are divided among three separate, co-equal branches Includes concept of “checks and balances”

Key Features of the Legal System: Federalism Refers to the allocation of Federal and State legal authority Under the Constitution, the federal government is one of limited powers, while the states more or less retain all powers not expressly left exclusively to the federal government

Key Features of the Legal System: The Special Role of Courts Courts have responsibility to determine what the Constitution means, permits, and prohibits. Courts protect and enforce individual legal rights, determine whether the political branches of government have violated the Constitution, and maintain stability in the law through the application of legal precedent

Chapter Overview Considers the role law plays in everyday life Defines law and describes its multiple sources Discusses several key features of the legal system, including the separation of government powers, federalism, the role of courts, and due process

The Role of Law Law’s importance in U.S. stems from its primary purpose: to function as the main tool with which we organize ourselves as an advanced, democratic society A society as sprawling and complex as ours needs formal, enforceable rules of law to provide a measure of control

The Role of Law The main way the law governs the many kinds of relationships in society is to recognize and establish enforceable legal rights and to create the institutions necessary to define and enforce them A legal right denotes a power or privilege that has been guaranteed to an individual under the law, not merely something that is claimed as an interest or something that is a matter of governmental discretion

Defining Law Think of “law” not just as words on a page, but as the many interacting parts that are involved in drafting those words in the first place, and in bringing them to life once they have been enacted as laws Thus, consider “law” as a system by which rules are created, disseminated, enforced, violated, disputed, interpreted, applied, revised, etc.

Sources of Law Regardless of how “law” is defined, at the core of the legal system lays a body of enforceable written rules: -Constitutions -Statues -Regulations -Common law/case law

Key Features of the Legal System: Separation of Powers The legal doctrine that supports the arrangement of shared governance To guard against a concentration of political power, governmental powers and responsibilities are divided among three separate, co-equal branches Includes concept of “checks and balances”

Key Features of the Legal System: Federalism Refers to the allocation of Federal and State legal authority Under the Constitution, the federal government is one of limited powers, while the states more or less retain all powers not expressly left exclusively to the federal government

Key Features of the Legal System: The Special Role of Courts Courts have responsibility to determine what the Constitution means, permits, and prohibits. Courts protect and enforce individual legal rights, determine whether the political branches of government have violated the Constitution, and maintain stability in the law through the application of legal precedent