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Politics and Media M6920 October 9, 2001
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Goals Explore the relationship between policy and politics
Describe the role of media in US political life Use health reform as a case study of these issues Columbia University School of Nursing M6920, Fall, 2001
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Politics About the distribution and use of power
Can occur in any setting, but generally associated with the allocations of power and resources in public system Columbia University School of Nursing M6920, Fall, 2001
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Sources of power Heredity Economics Information Charisma Assembled
Columbia University School of Nursing M6920, Fall, 2001
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Power is experienced as
Ability to reward or punish Ability to determine what is done with knowledge Ability to distribute resources Ability to exercise referral power Columbia University School of Nursing M6920, Fall, 2001
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Electoral politics Who gets chosen Nominations Financing
Communications Columbia University School of Nursing M6920, Fall, 2001
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Executive/legislative politics
What is on the agenda Who sets/controls the agenda What solutions are considered What solutions are chosen Columbia University School of Nursing M6920, Fall, 2001
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Balancing and Competing Interests
Specific Benefit General Benefit Specific Burden General Burden Columbia University School of Nursing M6920, Fall, 2001
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Interest groups National/local As forums for discussion Act Now!!
As lobbying/ pressure groups Act Now!! Columbia University School of Nursing M6920, Fall, 2001
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Professional association as an interest group
advocating for its members advocating for its ‘clients’ advocating for its supporters or suppliers Columbia University School of Nursing M6920, Fall, 2001
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The Internet Almost all candidates and elected officials have web sites Rapid distribution has unquantified impact Fund-raising potential huge Equity in access is important Columbia University School of Nursing M6920, Fall, 2001
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At the intersection of Problems Alternatives Actions and policies
Politics Actions and policies Columbia University School of Nursing M6920, Fall, 2001
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Responses as issues emerge
National actors later rather than earlier State/local officials are front line Politicians engage when not reacting has more negatives than reacting Trying to avoid blame (from CH Foreman, Jr 1994 Plagues, Products and Politics, Washington, DC: Brookings Inst) Columbia University School of Nursing M6920, Fall, 2001
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Responses, cont. Interest groups/ constituents Press Fire alarms
Established and directly involved--representing victims Newly established by the emergence of new victims Opportunistic Press Fire alarms Breakthroughs Controversies Human interest Columbia University School of Nursing M6920, Fall, 2001
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As experienced in “drive through delivery” debate
Agenda building (Kingdon model) problem recognition formation of proposals (often by policy entrepreneurs) political mood of the time Columbia University School of Nursing M6920, Fall, 2001
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Was shorter stay. . . testimony to the system sensitivity to mother’s wishes to home sooner? reflection of the ability of technology to shorten unnecessary stays? economic decision imposed on mothers and doctors by greedy insurers? Columbia University School of Nursing M6920, Fall, 2001
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Apparent solution was simple:
an extra day in hospital fixes all almost no discussion of alternative models of discharge/home care personal experiences of legislators were critical Columbia University School of Nursing M6920, Fall, 2001
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In the debates hospital-based doctors and nurses very positive
those more committed to home care negative ACNM apparently silent Columbia University School of Nursing M6920, Fall, 2001
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The politics in 15 of 23 states adopting law, the single sponsor of the bill was female reasons for sponsoring: shift control to women avoid negative consequences fear that insurers wouldn’t act on their own Columbia University School of Nursing M6920, Fall, 2001
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End result largely symbolic and nonpartisan
no governmental resources invested an exception to ERISA was inserted Declerdq E & Simmes D. 1997 The politics of ‘drive-through deliveries’: putting early postpartum discharge on the legislative agenda Milbank Quarterly ( ). Columbia University School of Nursing M6920, Fall, 2001
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How a bill becomes law A civics lesson in pictures. . .
Columbia University School of Nursing M6920, Fall, 2001
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As legislator introduced it
Columbia University School of Nursing M6920, Fall, 2001
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As committee reported it
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As House amended it Columbia University School of Nursing
M6920, Fall, 2001
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As Senate amended it . Columbia University School of Nursing
M6920, Fall, 2001
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As passed into law Columbia University School of Nursing
M6920, Fall, 2001
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As agency understood it
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What budget allowed Columbia University School of Nursing
M6920, Fall, 2001
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What the taxpayer wanted
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Politics of health reform
Conflicting goals: Health Insurance Reimbursement Conflicting ideas: Government provides Incentives to induce Punishments to enforce Poor management of the debate Failure to keep an eye on the big picture Skewed media presentations Overlapping political agendas Columbia University School of Nursing M6920, Fall, 2001
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Media National Professional State/local
Columbia University School of Nursing M6920, Fall, 2001
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Politics and Media Power distributions and agendas influenced by what is said Communications mechanisms of media are used by wise politicians Role of media in free society often cited as critical Columbia University School of Nursing M6920, Fall, 2001
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Anticipating the Bush presidency
Medicare? Children? Research and academic health centers? Columbia University School of Nursing M6920, Fall, 2001
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