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Domestic Policy
Chapter 16
Evolution of Health Care
Policy
National Marine Service (1798)
First federal health care service to care for sick sailors
New Deal efforts
Opposed by the American Medical Association
President Bill Clinton
Universal Health Coverage defeated
Number of uninsured rose dramatically
President Barack Obama
Patient Protection and Affordable Care Act
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Evolution of Education Policy
Post-Revolutionary War
Legitimizing democratic institutions through education
Immigration Era
Assimilation via education
Brown v. Board of Education (1954)
Ended segregation of public schools
Outcome and Standards-Based Education
No Child Left Behind
Race to the Top
How did Title IX Change Education?
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Evolution of Energy and
Environmental Policy
Industrialization and Conservation
Abundant coal and oil
Teddy Roosevelt and the U.S. Forest Service, national
parks and other preserves
Environmental Protection
Rachel Carson’s Silent Spring, Earth Day 1970
Oil Dependency
OAPEC and OPEC
Speed limits, fuel efficiency standards
Climate change concerns
Greenhouse gases and global warming
A Model of the Policy-making
Process
Agenda Setting
Deciding which issues to discuss
Policy Formulation
Crafting of proposed courses of action
Policy Adoption
Approval of a policy proposal
Policy Implementation
Process of carrying out public policies
Policy Evaluation
Did policy achieve its goals?
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Medicare
Created in 1965
For people 65 and older or disabled
Part A
Covers hospitalization
Part B
Optional; covers doctors visits, outpatient services
Part C
Medicare Advantage, covers gaps
Part D
Optional drug benefit
Medicaid
Created in 1965
For people poor and disabled
Must meet eligibility requirements
Low-income
National and state government
Federal block grants cover 50-75%
States have latitude in setting eligibility requirements
and providing coverage
50 million Americans covered in 2010
$400 billion
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Health Insurance
Rising Costs
Technology advances
Americans living longer
Health care per capita costs
1970 $356 per capita
2013 $9,349 per capita
10 percent of Americans account for 63 percent of all health care
costs
Patient Protection and Affordable Care Act
No pre-existing limitation for eligibility
Everyone pays the same rate whether healthy or not
Subsidies given to poor to help pay for the health insurance
States have challenged the program and lost
Where Do American Health Expenditures
Go?
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Public Health
Tools to protect public health:
Immunizations, education, advertisements, regulation
Gardasil debate
Medical Research
National Institutes of Health
Obesity
Public health priority: 2/3 of adults and 1/3 of children
are overweight or obese
How Does the Government Promote Public
Health?
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No Child Left Behind Act (2002)
Accountability
Standardized tests, report cards, reorganization
Flexibility
Schools can tailor expenditures to meet their needs
Proven methods for quality outcomes
Best practices
School Choice
Vouchers for private or other public schools
Charter schools
Federal Aid to Higher Education
Federal government provides research grants and
financial assistance to students
Military academies
U.S.
U.S.
U.S.
U.S.
U.S.
Military Academy
Naval Academy
Air Force Academy
Coast Guard Academy
Merchant Marine Academy
Access to college
Student debt load increasing
Grants
College Cost Reduction and Access Grant
Stafford fixed interest rate
Repayments capped at 10% of income
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Energy Policy
President Obama’s budget
“All of the above” approach encourages development of
alternative energies
Oil and other fossil fuels
U.S. has 2 percent of world’s oils reserves but
consumes 20 percent of the world’s oil
Natural gas extraction
Problems with groundwater contamination
Consumption
Energy efficiency requirements for cars, buildings
Where Do U.S. Oil Imports Come From?
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How Does the United States Generate
Electricity?
Environmental Policy
National Environmental Policy Act of 1969
Required environmental impact statements when the
government proposed a project
Clean Air Act of 1970
Established national primary and secondary air quality
standards
Clean Water Act of 1972
Goal: make all surface water “swimmable and fishable” by
1985
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Climate Change
Difficulties for comprehensive federal reform
Exact impact unknown
State efforts
California – 30 percent reduction in automobile emissions
Regional Greenhouse Gas Initiative (RGGI) – a cap and
trade agreement among nine states
Renewable Portfolio Standards (RPS) – require set amounts
of electricity from alternative sources
How can governments encourage Americans
to go green?
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Ongoing Challenges in Domestic
Policy
Policies not fully implemented or successful
Health care costs, for example, are still rising
Quality standards for No Child Left Behind have not been
fully met.
Opportunities and barriers to change
Will these educational practices produce better results?
What exactly are the impacts of climate change?
Policy often formulated in context of uncertainty
Not having concrete answers to these questions can result
in changes in policy implementation along the way, which
can further muddy the policy waters.
And let’s not forget effect of the public’s attention span.
Once an issue fades from public focus, its chances of being
addressed in lasting policy are greatly reduced.
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