1. Policy Modification HAS 4320

2. Incrementalism Continuous modification Modest changes Mechanism for compromises

3. Modification At the agenda setting stage At the implementation stage

4. Evaluation Ex-ante policy analysis Policy maintenance Policy monitoring Ex-post policy evaluation

5. An example…Medicare 1935…Social Security Act 1950s…Truman 1960…amendments to Social Security 1967…more amendments 1972…more amendments 1976…reorganization of the U.S. Dept of Health, Education and Welfare

6. An example…Medicare 1977…rural health clinic amendments 1977…antifraud and abuse amendments 1978…end-stage renal disease amend. 1980…OBRA ‘80 1981…OBRA ’81 1982…TEFRA 1983…social security amendments

7. An example…Medicare 1984…DEFRA 1985…Gramm-Rudman-Hollins Act 1985…COBRA ’85 1986…OBRA ’86 1987…OBRA ’87 1988…Medicare Catastrophic Coverage Act

8. An example…Medicare 1989…OBRA ’89 1990…OBRA ’90 1993…OBRA ’93 1993-96…Clinton health care reform 1997…Balanced Budget Act of 1997

9. Political Competence Two major concerns Ability to analyze and influence

10. The benefits of analysis Clarify and organize Current issues Emerging issues Speculate about the future Link policy to goals

11. Limitations Tough to predict the future Policymaking is complicated Tough to discern impact Lack of resources

12. Procedure of analysis Scanning Monitoring Forecasting Trends Scenarios Assessing Diffusing

13. Influence … Focus and Power Positional power Reward or coercive power Expert power

14. Policy making model…a map Influencing policy formulation At agenda setting At legislation development Influencing policy implementation At rulemaking At policy operation Influencing policy modification

15. Corporate citizenship Ethical business behavior Stakeholder commitment Environmental commitment Socially responsible workforce

16. Why? Economics Health…our mission