Domestic Policy
On the evening of April 20, 2010,
an offshore drilling well, leased and run
by British Petroleum (BP) and known as
Deepwater Horizon, exploded off the coast
of the state of Louisiana. The well released
methane gas and ignited into flames, killing
eleven workers and injuring seventeen
others. Two days later, on April 22, the
rig completely sank into the ocean, and
workers observed an oil slick forming in
the Gulf of Mexico. What followed became
the greatest environmental disaster in
American history, as BP repeatedly tried—
and failed—to cap the leak or capture the
oil leaking in to the Gulf.
The company used a variety of tactics to
try to stop the constant flow of oil. These
included using unmanned underwater robots
to close the open valves on the rig, installing
containment domes, and attempting to divert
the flow away from the fractured pipe. Finally,
on July 15, almost three months after the leak
534
had begun, engineers were able to cap the
leaking well.
Although estimates are imprecise (in part
because BP refused to allow independent
scientists to evaluate the rig), the oil company
has stated that the rig released almost 5 billion
barrels of oil over the duration of the leak.
This caused immeasurable destruction to the
natural environment of the Gulf of Mexico.
The oil in the Gulf, for example, led to
petroleum toxicity and oxygen depletion,
which put the lives of hundreds of thousands
(if not millions) of marshland birds,
mammals, and reptiles in danger. It also
negatively impacted the fishing industries in
the Gulf and other regions. Scientists as far
away as the North Carolina beaches, for
example, observed the environmental effects
of the spill and feared that the oil would
smother East Coast reefs and completely
disrupt the food chain throughout southern
American waters.
Drilling for oil has been a major industry in the United States since the 1850s. At left, an oil well at
Semitropic, California, in the late 1800s. At right, the Deepwater Horizon in the Gulf of Mexico following the
2010 disaster.
Exactly who has responsibility for cleaning
up the spill and restoring the Gulf region has
been the subject of much controversy. Many
Gulf state politicians initially called on the
national government for support. Later,
however, they criticized the Army Corps of
Engineers’ and the Coast Guard’s efforts to
limit the spill. In particular, Louisiana
Governor Bobby Jindal said, “We’ve been
frustrated with the disjointed effort to date that
has too often meant too little, too late for the
oil hitting our coast . . . It is clear we don’t
have the resources we need to protect our
coast . . . we need more boom, more
skimmers, more vacuums, more jack-up
barges . . .”1 Despite U.S. military and
administrative involvement in the cleanup
efforts, President Barack Obama has claimed
that the cost of cleansing affected areas should
fall entirely on the shoulders of BP. “We will
fight this spill with everything we’ve got for
as long as it takes. We will make BP pay for
the damage their company has caused,”
President Obama said.2 The oil company, to
date, has agreed to pay all of the costs of the
cleanup, which are estimated to total at least
$10 billion.
What Should I Know About . . .
After reading this chapter, you should be able to:
17.1 Trace the stages of the policy-making process,
p. 536.
17.2 Describe the evolution of health policy in the
United States, p. 544.
17.3 Outline the evolution of education policy in the
United States, p. 550.
17.4 Explain the evolution of energy and
environmental policy in the United States, p. 554.
17.5 Assess the ongoing challenges in U.S. domestic
policy, p. 560.
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D
omestic policy is a term that designates a broad and varied range of
government programs designed to provide citizens with protection from
poverty and hunger, to improve their health and physical well-being, to
provide transportation, to maintain a healthy and livable environment,
and otherwise enable people to lead more secure, satisfying, and productive lives.
In a nutshell, domestic policies are intended to enhance quality of life through the
establishment of societal conditions that allow citizens to pursue happiness and feel
secure. These policies are meant to benefit all segments of society, but they often
focus on the less fortunate members who find it more difficult to provide for themselves and their families.
This chapter discusses the policy-making process and examines how it has
played out in three key domestic policy areas—health care, education, and energy
and the environment. We will thus explore the following topics:
■
First, we will examine the roots of public policy and the policy-making process.
■
Second, we will investigate the evolution of health policy in the United States,
including Medicare, Medicaid, health insurance, and public health.
■
Third, we will describe the evolution of education policy in the United States,
including its foundations, challenges, and the No Child Left Behind Act.
■
Fourth, we will trace the evolution of energy and environmental policy in the
United States, including its foundations, hibernation, and return to
prominence.
■
Finally, we will assess the ongoing challenges in domestic policy.
ROOTS OF Public Policy: The
Policy-Making Process
17.1 . . . Trace the stages of the policy-making process.
public policy
An intentional course of action or
inaction followed by government in
dealing with some problem or matter of concern.
Public policy is an intentional course of action or inaction followed by government
in dealing with some problem or matter of concern.3 Public policies are thus governmental policies; they are authoritative and binding on people. Individuals, groups,
and even government agencies that do not comply with policies can be penalized
through fines, loss of benefits, or even jail terms. The phrase “course of action” implies
that policies develop or unfold over time. They involve more than a legislative decision to enact a law or a presidential decision to issue an executive order. Also important is how the law or executive order is carried out. The impact or meaning of a
policy depends on whether it is vigorously enforced, enforced only in some instances,
or not enforced at all.
Theories of Public Policy
Political scientists and other social scientists have developed many theories and models to explain the formation of public policies. These theories include elite theory,
bureaucratic theory, interest group theory, and pluralist theory. According to elite theory, all societies are divided into elites and masses. The elites have power to make and
Roots of Public Policy: The Policy-Making Process
implement policy, while the masses simply respond to the desires of the elites. Elite
theorists believe that an unequal distribution of power in society is normal and
inevitable.4 Elites, however, are not immune from public opinion, nor do they by definition oppress the masses.
Bureaucratic theory dictates that all institutions, governmental and nongovernmental, have fallen under the control of a large and ever-growing bureaucracy that
carries out policy using standardized procedures. This growing complexity of modern
organizations has empowered bureaucrats, who become dominant as a consequence of
their expertise and competence. Eventually, the bureaucrats wrest power from others,
especially elected officials.
In contrast, according to interest group theory, interest groups—not elites or
bureaucrats—control the governmental process. Interest group theorists believe that
there are so many potential pressure points in the three branches of the national government, as well as at the state level, that interest groups can step in on any number of
competing sides. The government then becomes the equilibrium point in the system
as it mediates among competing interests.5
Finally, many political scientists subscribe to the pluralist perspective. This theory
argues that political resources in the United States are scattered so widely that no single group could ever gain monopoly control over any substantial area of policy.6 Participants in every political controversy get something; thus, each has some impact on
how political decisions are made. The downside to this is that, because governments
in the United States rarely say no to any well-organized interest, what is good for the
public at large often tends to lose out in the American system.7
A Model of the Policy-Making Process
The policy-making process is often viewed as a sequence of stages or functional activities. One illustration of such a model is shown in Figure 17.1. This model can be used
to analyze any of the issues discussed in this book. Although models such as these can
be useful, it is important to remember that they are simplifications of the actual
process. Moreover, models for analyzing the policy-making process do not always
explain why public policies take the specific forms that they do. Nor do models necessarily tell us who dominates or controls the formation of public policy.
Policy making typically can be thought of as a process of sequential steps:
1. Problem recognition. Identification of an issue that disturbs the people and leads
them to call for governmental intervention.
2. Agenda setting. Government recognition that a problem is worthy of
consideration for governmental intervention.
3. Policy formulation. Identification of alternative approaches to addressing the
problems placed on government’s agenda.
4. Policy adoption. The formal selection of public policies through legislative, executive, judicial, and bureaucratic means.
5. Budgeting. The allocation of resources to provide for the proper implementation
of public policies.
6. Policy implementation. The actual administration or application of public policies
to their targets.
7. Policy evaluation. The determination of a policy’s accomplishments,
consequences, or shortcomings.
With this overview in mind, we examine the various stages of the policy process
or cycle.
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Figure 17.1 What are the stages of the public policy process?
One of the best ways to understand public policy is to examine the process by which policies are made. Although there are many
unique characteristics of policy making at the various levels of government, there are commonalities that define the process from
which public policies emerge. In the figure, the public policy process is broken down into seven steps. Each step has
distinguishing features, but it is important to remember that the steps often merge into one another in a less distinct manner.
1. Problem Recognition
Identification of an issue that
disturbs the people and leads
them to call for governmental
intervention.
A finding that
the policy is
ineffective will
likely restart the
policy process.
7. Policy Evaluation
The determination of a policy’s
accomplishments, consequences,
or shortcomings.
6. Policy Implementation
2. Agenda Setting
The actual administration or
application of public policies
to their targets.
Government recognition
that a problem is worthy of
consideration for governmental
action.
3. Policy Formulation
5. Budgeting
Identification of alternative
approaches to addressing the
problems placed on the
government’s agenda.
The allocation of resources to
provide for the proper
implementation of public policies.
4. Policy Adoption
The formal selection of public
policies through legislative,
executive, judicial, and
bureaucratic means.
PROBLEM RECOGNITION AND DEFINITION For a condition to become a problem, there must be some criterion—a standard or value—that leads people to believe
that the condition does not have to be accepted and, further, that it is something with
which government can deal effectively and appropriately. For example, natural disasters such as hurricanes are unlikely to be identified as a policy problem because there
is little that government can do about them directly. The consequences of hurricanes—the human distress and property destruction that they bring—are another
matter. Relief from the devastation of natural disasters can be a focus of government
action, and agencies such as the Federal Emergency Management Agency (FEMA)
have been created to reduce these hardships. When these agencies fail to fulfill their
roles, as FEMA did in the wake of Hurricane Katrina in 2005, the public requires
answers for why government has not done its job.
Usually there is not a single, agreed-on definition of a problem. Indeed, political
struggle often occurs at this stage because how the problem is defined helps determine
Roots of Public Policy: The Policy-Making Process
what sort of action is appropriate. For example, if we define
access to transportation for people with disabilities as a transportation problem, then an acceptable solution is to establish
other means of transport for disabled citizens, such as a special van service. If we define access to transportation as a civil
rights problem, however, then people with disabilities are
entitled to equal access to the regular transportation system.
The civil rights view triumphed with congressional passage
of the Americans with Disabilities Act in 1990, which
mandated that local and state governments must make
transportation accessible to the elderly and to all people with
disabilities.
Note that public policies themselves are frequently
viewed as problems or the causes of other problems. Thus, for
some people, gun control legislation is a solution to gun violence. To the National Rifle Association (NRA), however, any
law that restricts gun ownership is a problem because the
NRA views such laws as inappropriately infringing on an
individual’s constitutional right to keep and bear arms. To
social conservatives, legal access to abortion is a problem; for
social liberals, laws restricting abortion access fall into the
problem category.
539
How does government identify public policy problems?
Public policy problems are circumstances that can be
addressed by government action. One example is disaster
relief. During and after Hurricane Katrina, the New Orleans
Centre housed many people displaced by the storm.
AGENDA SETTING
Photo courtesy: AP/Wide World Photos
After a problem is recognized and
defined as such by a significant segment of society, it must be
brought to the attention of public officials and it must secure
a place on an agenda, or a set of issues to be discussed or
given attention. Every political community—national, state,
and local—has a systemic agenda. The systemic agenda is
essentially a discussion agenda; it consists of all issues that are
viewed as requiring public attention and as involving matters
within the legitimate jurisdiction of governments.8 A
governmental or institutional agenda, in contrast, is much
narrower. It includes only problems to which public officials
feel obliged to devote active and serious attention. Not all
problems that attract the attention of officials are likely to
have been widely discussed by the general public, and not all
issues on the systemic agenda end up on the institutional
agenda. Issues may move from the systemic agenda to the
governmental agenda and vice versa in an almost limitless number of ways. This
movement is known as agenda setting. Whether because of their influence or skill in
developing political support, some people or groups are more successful than others in
steering items onto the governmental agenda. Among the most notable—though certainly not the only—agenda-setters are the president, interest groups, and political
crises.
As discussed in chapter 8, the president is an important agenda-setter for Congress.
In the State of the Union Address, proposed budget, and special messages, the president
presents Congress with a legislative program for its consideration. Much of Congress’s
time is spent deliberating presidential recommendations, although by no means does
Congress always respond as the president might wish. Congress can be recalcitrant even
when the president and congressional majorities come from the same party.
Interest groups are also major actors and initiators in the agenda-setting process.
Interest groups and their lobbyists frequently ask Congress, the courts, or the executive branch to address problems of special concern to them. Environmentalists, for
instance, call for government action on such issues as global warming, the protection
agenda
A set of issues to be discussed or
given attention.
systemic agenda
A discussion agenda; it consists of all
public issues that are viewed as
requiring governmental attention.
governmental (institutional)
agenda
Problems to which public officials
feel obliged to devote active and
serious attention.
agenda setting
The constant process of forming the
list of issues to be addressed by government.
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How does an issue get on the governmental agenda? The immigration issue
Photo courtesy: JOSHUA LOTT/Reuters/Landov
secured a place on the national agenda following the passage of a controversial
Arizona state law. Here, civil rights leaders, including the Reverend Al Sharpton,
protest the bill on Cinco de Mayo.
policy formulation
The crafting of proposed courses of
action to resolve public problems.
of wetlands, and the reduction of air pollution. Business groups may seek protection
against foreign competitors, restrictions on
product liability lawsuits, or government
financial bailouts.
Finally, crises, natural disasters, or other
extraordinary events may put problems on
the agenda. The attacks on the World Trade
Center and the Pentagon on September 11,
2001, placed the issue of homeland security
at the top of the policy agenda. The home
mortgage crisis and continuing recession in
2010 received significant media attention
and corresponding responses from Congress.
And more recently, a controversial immigration bill passed by state legislators in Arizona has put the issue of immigration back
on the agenda.
POLICY FORMULATION Policy formulation is the crafting of proposed courses
of action to resolve public problems. It has
both political and technical components.9 The
political aspect of policy formulation involves
determining generally what should be done
to address a problem. The technical facet
involves correctly stating in specific language what one wants to authorize or accomplish, in order to adequately guide those who must implement policy and to prevent
distortion of legislative intent.
Policy formulation may take many forms:
1. Routine formulation is the process of altering existing policy proposals or creating
new proposals within an issue area the government has previously addressed. For
instance, the formulation of policy for veterans’ benefits is routine.
2. Analogous formulation handles new problems by drawing on experience with similar problems in the past or in other jurisdictions. What has been done in the past
to cope with the activities of terrorists? What has been done in other states to
deal with child abuse or divorce law reform?
3. Creative formulation involves attempts to develop new or unprecedented proposals that represent a departure from existing practices and that will better resolve a
problem. For example, plans to develop an anti-missile defense system to shoot
down incoming missiles represent a departure from previous defense strategies of
mutual destruction.
Policy formulation may be undertaken by various players in the policy process:
the president, presidential aides, agency officials, specially appointed task forces and
commissions, interest groups, private research organizations (or “think tanks”), and
legislators and their staffs. The people engaged in formulation are usually looking
ahead toward policy adoption. Particular provisions may be included or excluded
from a proposal in an attempt to enhance its likelihood of adoption. To the extent
that formulators think in this strategic manner, the formulation and adoption stages
of the policy process often overlap. (To learn more about what entities the Framers
thought would be responsible for policy formulation, see The Living Constitution:
Article I, Section 1.)
Roots of Public Policy: The Policy-Making Process
541
The Living Constitution
All legislative Powers herein granted shall be vested in a
Congress of the United States, which shall consist of a Senate
and House of Representatives.
A
rticle 1, section 1 of the Constitution vests the
law-making power in the hands of the legislative branch of government because the Framers
believed that Congress, with its large and diverse
membership, was a much lesser threat to tyranny
than the executive branch. The judicial branch, the
Framers felt, was little more than a theoretical
necessity and would be the “least dangerous
branch.”
Today, Congress retains its law-making power
and does a great deal of public policy formulation
and adoption. But, it is by no means the only source
of public policy in the national government. The
president, for example, has the power to make public policy by using executive orders. President
Barack Obama has used these orders to make policy
on subjects such as abortion, foreign policy, energy,
and stem cell research.
The bureaucracy is also an important policymaker. Through a quasi-legislative process known
as rule-making, executive branch agencies formulate
and implement policies in nearly every imaginable
issue area. Rules, in fact, are the largest source
—ARTICLE I, SECTION 1
of policy decisions made by the national
government.
Even the judicial branch, which the Framers
thought would be essentially powerless, has evolved
into an important source of policy decisions. In recent
years the Supreme Court has made policy prescriptions in each of the domestic policy issue areas
discussed in this chapter, as well as in criminal
justice, civil liberties, and civil rights.
CRITICAL THINKING QUESTIONS
1. Should the legislative branch be the only
branch of the national government allowed to
make policy decisions? Why or why not?
2. What changes in the last 250 years have led the
executive and judicial branches to take larger
roles in the policy-making process?
3. Do these interventions in the policy process
strengthen or weaken the checks and balances
in the system devised by the Framers? Explain
your answer.
POLICY ADOPTION Policy adoption is the approval of a policy proposal by the
people with requisite authority, such as a legislature or chief executive. This approval
gives the policy legal force. Because most public policies in the United States result
from legislation, policy adoption frequently requires building a series of majority coalitions necessary to secure the enactment of legislation in Congress. To secure the
needed votes, a bill may be watered down or modified at any point in the legislative
process (see chapter 7). Or, the bill may fail to win a majority at one of them and die,
at least for the time being.
The tortuous nature of congressional policy adoption has some important consequences. First, complex legislation may require substantial periods of time in order to
pass. Second, the legislation passed is often incremental, making only limited or marginal changes in existing policy. Third, legislation is frequently written in general or
policy adoption
The approval of a policy proposal by
the people with the requisite authority, such as a legislature.
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ambiguous language, as in the Clean Air Act, which provided amorphous instructions
to administrators in the Environmental Protection Agency to set air quality standards that would allow for an “adequate margin of safety” to protect the public
health. Phrases such as “adequate margin” are highly subjective and open to a wide
range of interpretations. Language such as this may provide considerable discretion
to the people who implement the law and also leave them in doubt as to its intended
purposes.
BUDGETING
Most policies require funding in order to be carried out; some policies, such as those providing income security, essentially involve the transfer of money
from taxpayers to the government and back to individual beneficiaries. Funding for
most policies and agencies is provided through the congressional budget process (discussed in chapters 7 and 18). Whether a policy is well funded, poorly funded, or
funded at all has a significant effect on its scope, impact, and effectiveness. For example, as a result of limited funding, the Occupational Safety and Health Administration (OSHA) can inspect annually only a small fraction of the workplaces within its
jurisdiction. Similarly, the Department of Housing and Urban Development has
funds sufficient to provide rent subsidies only to approximately 20 percent of eligible
low-income families.
The budgetary process also gives the president and the Congress an opportunity to review the government’s many policies and programs, to inquire into their
administration, to appraise their value and effectiveness, and to exercise some influence on their conduct. Not all of the government’s thousands of programs are fully
examined every year. But, over a period of several years, most programs come under
scrutiny.
policy implementation
The process of carrying out public
policy.
POLICY IMPLEMENTATION Policy implementation is the process of carrying
out public policies, most of which are implemented by administrative agencies. Some
policies, however, are enforced in other ways. Voluntary compliance by businesses and
individuals is one such technique. Examples of this practice include when grocers
take out-of-date products off their shelves or when consumers choose not to buy
food products after their expiration dates. The courts also get involved in implementation when they are called on to interpret the meaning of legislation, review the
legality of agency rules and actions, and determine whether institutions such as prisons and mental hospitals conform to legal and constitutional standards.
Administrative agencies may be authorized to use a number of techniques to
implement the public policies within their jurisdictions. These techniques can be categorized as authoritative, incentive, capacity, or hortatory, depending on the behavioral assumptions on which they are based.10
1. Authoritative techniques for policy implementation rest on the notion that
people’s actions must be directed or restrained by government in order to prevent
or eliminate activities or products that are unsafe, unfair, evil, or immoral. For
example, consumer products must meet certain safety regulations, and radio
stations can be fined heavily or have their broadcasting licenses revoked if they
broadcast obscenities.
2. Incentive techniques for policy implementation encourage people to act in
their own best interest by offering payoffs or financial inducements to get them
to comply with public policies. Such policies may provide tax deductions to
encourage charitable giving or the purchase of alternative fuel vehicles such as
hybrid automobiles. Farmers also receive subsidies to make their production (or
nonproduction) of wheat, cotton, and other goods more profitable. Conversely,
sanctions such as high taxes may discourage the purchase and use of such
products as tobacco or liquor, and pollution fees may reduce the discharge of
pollutants by making this action more costly to businesses.
Roots of Public Policy: The Policy-Making Process
How are hortatory techniques used to implement public policy? The “Don’t
Mess with Texas” campaign is one of the most visible examples of a hortatory
technique.
Photo courtesy: Alamy
3. Capacity techniques provide people with
information, education, training, or
resources that enable them to participate
in desired activities. The assumption
underlying these techniques is that people
have the incentive or desire to do what is
right but lack the capacity to act
accordingly. Job training may enable ablebodied people to find work, and accurate
information on interest rates will enable
people to protect themselves against
interest-rate gouging.
4. Hortatory techniques encourage people to
comply with policy by appealing to people’s “better instincts” in an effort to get
them to act in desired ways. In this
instance, policy implementers assume
that people decide how to act according
to their personal values and beliefs. During the Reagan administration, First
Lady Nancy Reagan implored young
people to “Just say no” to drugs.
Hortatory techniques also include the use
of highway signs displaying slogans like
“Don’t Be a Litterbug” and “Don’t Mess
with Texas” to discourage littering.
543
Often government will turn to a combination of authoritative, incentive, capacity,
and hortatory approaches to reach their goals. For example, public health officials
employ all of these tools in their efforts to reduce tobacco use. These techniques
include laws prohibiting smoking in public places, taxes on the sales of tobacco products, warning labels on packs of cigarettes, and anti-smoking commercials on television. There is no easy formula that will guarantee successful policy implementation; in
practice, many policies only partially achieve their goals.
POLICY EVALUATION Practitioners of policy evaluation seek to determine
whether a course of action is achieving its intended goals. They may also try to determine whether a policy is being fairly or efficiently administered. Although policy evaluation has become more rigorous, systematic, and objective over the past few decades,
judgments by policy makers still are often based on anecdotal and fragmentary evidence rather than on solid facts and thorough analyses. Sometimes a program is
judged to be a good program simply because it is politically popular or fits the ideological beliefs of an elected official.
Policy evaluation may be conducted by a variety of players, including congressional
committees, presidential commissions, administrative agencies, the courts, university
researchers, private research organizations, and the Government Accountability Office
(GAO). The GAO, created in 1921, conducts hundreds of studies of government
agencies and programs each year, either at the request of members of Congress or on
its own initiative. The titles of two of its 2010 evaluations convey a notion of the
breadth of its work: “Military Readiness: Navy Needs to Reassess its Metrics and
Assumptions for Ship Crewing Requirements and Training” and “USDA Crop Disaster Programs: Lessons Learned Can Improve Implementation of New Crop Assistance Program.”
Evaluation research and studies can stimulate attempts to modify or terminate
policies and thus restart the policy process. Legislators and administrators may
policy evaluation
The process of determining whether
a course of action is achieving its
intended goals.
TIMELINE: National Government Involvement in Health Policy
1798 National Marine
Service—The NMS is established “for the relief of sick and
disabled seamen.”
1953 Department of Health,
Education, and Welfare—President
Dwight D. Eisenhower signs a bill
establishing the first Cabinet-level
agency to deal with health issues.
1887 National Institutes of
Health (NIH)—The
government’s health research
and education arm is established as the Laboratory of
Hygiene; it becomes the NIH
in 1930.
1965 Medicaid—The national
government enacts a health
insurance program for poor
and disabled Americans; it is
administered by the states.
1965 Medicare—The
national government
enacts a health insurance program for older
Americans.
formulate and advocate for amendments designed to correct problems or shortcomings in a policy. In 2006, for example, the national legislation establishing the
Medicare program was amended to create a prescription drug benefit for senior citizens, known as Medicare Part D. Policies may also be terminated as a result of the
evaluation process; for example, through the Airline Deregulation Act of 1978, Congress eliminated the Civil Aeronautics Board and its program of economic regulation
of commercial airlines. This action was taken on the assumption that competition in
the marketplace would better protect the interests of airline users. Competition indeed
reduced the cost of flying on many popular routes.
The demise of programs is relatively rare; more often, a troubled program is modified or allowed to limp along because it provides a popular service. For example, the
nation’s passenger rail system, Amtrak, remains dependent on government funds.
Although its northeastern lines are financially self-sufficient, many of Amtrak’s longer
distance routes are not able to operate without significant government subsidies. Nevertheless, the more rural routes remain popular with legislators in western states, and
thus Amtrak continues to receive governmental support.11
The Evolution of Health Policy
17.2 . . . Describe the evolution of health policy in the United States.
Governments in the United States have long been active in the health care field.
Beginning in 1798 with the establishment of the National Marine Service (NMS) for
“the relief of sick and disabled seamen,” the national government has provided health
care for some segments of the population. Local governments began to establish public health departments in the first half of the nineteenth century, and state health
departments followed in the second half. Discoveries related to the causes of diseases
544
2006 Medicare Part D—This
program creates an optional
prescription drug insurance
program for senior citizens.
1979 Department of
Health and Human Services
(HHS)—Under President
Jimmy Carter, the Department
of Health, Education, and
Welfare is split into two
Cabinet-level departments,
HHS and Education.
2010 Health Insurance
Reform—President Barack
Obama and the Democratic
Congress enact legislation
creating a national health
insurance program.
and human ailments in the late nineteenth and early twentieth centuries led to significant advances in improving public health. Public sanitation and clean-water programs, pasteurization of milk, immunization programs, and other activities greatly
reduced the incidence of infectious and communicable diseases. Public health policies
have also been highly effective in reducing the incidence of infectious diseases such as
measles, infantile paralysis (poliomyelitis), and smallpox. The increase in American
life expectancy from forty-seven in 1900 to over seventy-eight in 2010 is tightly
linked to public health programs.
Today, many millions of people receive medical care through the medical branches
of the armed forces, the hospitals and medical programs of the Department of Veterans
Affairs, and the Indian Health Service. The government estimated that it would spend
$78 billion in the 2010 fiscal year for health and human services, the construction and
operation of facilities, and the salaries of doctors and other medical personnel.12
The national government’s involvement in health policy extends to a number of
other policy areas. In the 1960s, the government began funding health programs for
senior citizens and the poor, known as Medicare and Medicaid, respectively. And, in
2010, the Democratic Congress passed and President Barack Obama signed into law
the Patient Protection and Affordable Care Act, which expanded the federal government’s role in the provision of health insurance.
Medicare
Medicare, which was created by Congress and Democratic President Lyndon B.
Johnson in 1965, covers persons who are disabled or over age 65. It is administered by
the Centers for Medicare and Medicaid Services in the Department of Health and
Human Services. Medicare is financed by a payroll tax of 1.45 percent paid by both
employees and employers on the total amount of one’s wages or salary. In 2014, this
tax will increase to 3.8 percent for Americans making more than $200,000 per year.
Medicare
The federal program established
during the Lyndon B. Johnson
administration that provides
medical care to elderly Social
Security recipients.
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Domestic Policy
Medicare coverage has four components:
Parts A, B, C, and D. Benefits under Part A
program for seniors added to Medicare during the George W. Bush administration.
are granted to all Americans automatically at
Here, members of Congress look on as President Bush signs the program into law.
age sixty-five, when they qualify for Social
Security (see chapter 18). It covers hospitalization, some skilled nursing care, and home
health services.
Part B, which is optional, covers payment for physicians’ services, outpatient and
diagnostic services, X-rays, and some other
items not covered by Part A. Excluded from
coverage are eyeglasses, hearing aids, and
dentures. This portion of the Medicare program is financed partly by monthly payments from beneficiaries and partly by
general tax revenues.
Medicare Part C programs are also
known as Medicare Advantage programs.
They are administered by private insurance
companies and provide coverage that meets
or exceeds the coverage of traditional
Medicare programs. Medicare Advantage
programs may also include additional services for a fee, such as prescription drug coverage and dental and vision insurance.
Medicare Part D is the optional prescription drug benefit that went into effect in
2006. Participants pay a monthly premium of approximately $35; after a $250 annual
deductible, 75 percent of their prescription costs are covered. For those whose annual
prescription drug costs exceed $5,100, the program pays 95 percent of prescription
costs over that amount.
Today, Medicare provides health insurance coverage for more than 45 million
Americans. Roughly 20 percent of these enrollees choose Medicare Advantage programs. More than half of Medicare enrollees also choose to take advantage of the
Medicare prescription drug benefit.
Photo courtesy: JASON REED/Reuters/Landov
What is Medicare Part D? Medicare Part D is the optional prescription drug
Medicaid
Medicaid
A government program that subsidizes medical care for the poor.
Medicaid, a government program that subsidizes health insurance for the poor, was
enacted in 1965, at the same time as Medicare. It provides health insurance coverage
for low-income Americans who meet a set of eligibility requirements. To receive
Medicaid benefits, citizens must meet minimum-income thresholds, be disabled, or
be pregnant.
Unlike Medicare, which is financed and administered by the national government,
Medicaid is a joint venture between the national and state governments. The national
government provides between 50 and 75 percent of the funding necessary to administer Medicaid programs (depending on state per capita income). This money is given
to the states in the form of block grants. States then supplement the national funds
with money from their own treasuries. They also are given the latitude to establish eligibility thresholds and the level of benefits available to citizens.
As a result, Medicaid programs vary widely from state to state. Most states provide coverage for all pregnant women and all children less than one year of age. And,
in a majority of states, the income requirement is set to provide coverage to citizens
with incomes up to 185 percent of the federal poverty line. This is equivalent to an
The Evolution of Health Policy
income of about $18,000 for an individual or $37,000 for a family of four. In some
states, all low-income residents receive Medicaid assistance, whereas in other states,
only one-third of the needy are protected. And, in some states “medically indigent”
people—those who do not meet traditional income requirements but have large medical expenses—receive coverage, whereas in other states, these citizens must find their
own funding.
In 2009, Medicaid provided coverage for almost 50 million Americans, making it
the largest government health insurance program in the United States. This program
comes with a substantial price tag: more than $400 billion in national and state funds.
Medicaid is also one of the largest and fastest growing portions of state budgets. In
recent years, it has accounted for roughly 17 percent of state general expenditures.
Health Insurance
National health insurance was first seriously considered in the 1930s, when Congress was legislating a number of New Deal social programs. But, because of
the strong opposition of the American Medical Association (AMA), universal
health insurance was not adopted. The AMA and its allies were distrustful of government intervention in their affairs and fearful that regulations would limit their
discretion as well as their earnings. In particular, they feared that the intrusion of
government into the health care field would limit physician charges, restrict the
amount of time approved for specific types of hospital visits, and constrain charges
for prescription drugs.
As a result, government health insurance remained on the back burner for many
years. It received some consideration during the 1960s, when Congress and the Johnson administration were working to establish Medicare and Medicaid. Health care
also received a great deal of attention in the early 1990s, during the first year of President Bill Clinton’s term. Clinton established a health care reform task force led by his
wife, Hillary, and attempted to compel Congress to adopt legislation creating universal health coverage in the United States. Ultimately, however, these efforts failed. The
phrase “socialized medicine” and horror stories about long wait times for medically
necessary services in countries with nationalized health care turned public opinion
against Clinton and the Democrats.
Clinton’s failure at health care reform, as well as the extended period of
Republican legislative control that began in 1995, kept national health insurance
off the governmental agenda for the next fifteen years. During this time, health
care costs and the number of uninsured Americans rose dramatically. By 2008,
more than 45 million Americans had no health insurance coverage, and another
20 million were underinsured.
Thus, during the 2008 presidential election, Democratic candidate Barack Obama
ran on a platform that promised to bring much-needed reform to the American health
insurance system. After taking office, Obama and the Democratic Congress set to work
crafting legislation that accomplished their goal. More than a year later—and after a
great deal of political wrangling (see chapter 7)—on March 23, 2010, President Obama
signed into law the Patient Protection and Affordable Care Act.
This legislation marked the first major change in national health policy since the
adoption of Medicare and Medicaid in 1965. Its primary purpose was to establish
government-run health insurance exchanges to assure that nearly all Americans would
have access to health care coverage. These exchanges, which will not be fully implemented until 2014, are financed by a number of taxes and fees, most notably an
increase in the Medicare tax for Americans earning more than $200,000 per year.
Americans do not have to buy in to these exchanges—they have the option of retaining
their private health insurance if they so choose.
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Table 17.1 What do Americans think about health insurance reform?
Percentage of
Americans Agreeing
Question
Do these changes represent a major change in the direction of the
country?
Do you support the changes to the health care system that have been
enacted by Congress and the Obama administration?
80
Will the overall health care system get better as a result of these
changes?
37
Will these changes require everyone to make changes, whether they
want to or not?
60
46
Do you think these changes will increase the federal budget deficit?
65
Is the amount of government involvement in the nation’s health
care system too much?
49
Source: Washington Post poll, March 23–26, 2010. www.washingtonpost.com.
The bill also includes a number of other health policy-related provisions. Between
now and 2018, for example, the act will expand Medicaid eligibility and subsidize
insurance premiums for low-income Americans. It also provides incentives for businesses to offer health insurance—a very costly proposition for many employers. And,
importantly, it prevents health insurance companies from denying Americans coverage on the basis of preexisting conditions.
Reaction to the bill has been mixed. Large
majorities
of Americans believe that the legislation
How does the government promote public health? Advertising
will lead to significant changes in the American
campaigns such as this one are one of the major ways the government
promotes greater health among Americans.
health care system. However, only 37 percent of
Americans believe that these changes will improve
the system. (To learn more about public opinion on
health insurance reform, see Table 17.1.)
The legislation has been especially unpopular
with state governments. As many as twenty states
have already sued or announced that they will sue
the national government to block implementation
of the policy. These states believe that the act is an
infringement on states’ reserved powers, which are
granted to them under the Tenth Amendment of
the U.S. Constitution. (To learn more about the
national government’s role in providing health
insurance, see Join the Debate: Should the
National Government Provide Health Insurance?)
Photo courtesy: National Institutes of Health
Public Health
Government also plays a major role in managing
the growth of both infectious and chronic disease.
From AIDS to obesity, public policy makers have
attempted to use government power to fight
threats to the nation’s health. Among the tools
employed by government are immunizations, education, advertisements, and regulations. For many
contagious diseases such as polio, measles, and
chickenpox, the government requires young children to be immunized if they are to be enrolled in
day care, preschool, or elementary school. Public
health officials also use vaccines in the adult
Join the DEBATE
Should the National Government Provide
Health Insurance?
In March 2010, Congress passed and President Barack Obama signed into law the Patient Protection
and Affordable Care Act. This legislation took a number of steps to improve health care affordability and
access in the United States. Most notable among these was a provision that will allow uninsured
Americans with incomes up to four times the poverty line to buy into nationally administered health
insurance exchanges. Legislators hope that this provision will help to eliminate a large percentage of the
more than 45 million Americans who do not have health insurance coverage.
Less than an hour after the bill was signed into law, thirteen state attorneys general announced that
they would sue the national government to block enforcement of the legislation. They felt that the bill
was an unconstitutional infringement on states’ reserved powers. This case—as well as a number of later
cases filed by other attorneys general—is currently being litigated in the federal court system. However,
it raises a series of important questions: Should the national government take action to provide health
insurance to citizens? Or, should provision of these services be left to the states or to private industry?
■
■
■
National health insurance is a way for the government
to promote the general welfare. In what ways does
assuring citizens’ welfare require access to health
insurance? How do large percentages of uninsured
citizens negatively affect all Americans?
National health insurance for all is a logical extension
of the Medicare and Medicaid programs. How
successful have Medicare and Medicaid been at assuring the health of older and poor Americans? Should
the national government also provide similar services
to other Americans?
Uninsured Americans increase the cost of care for all
citizens. Who covers the cost when uninsured Americans are unable to pay their
medical bills? In what ways is it
cheaper in the long run to simply
provide these citizens with health
insurance?
What did the 2010 health care reform
bill do? The Patient Protection and
Affordable Care Act extended coverage
to more than 45 million uninsured Americans. Although the implementation
process has already begun, the full
effects of this bill will not be felt until
later this decade.
To develop an ARGUMENT AGAINST national
provision of health insurance, think about how:
■
■
■
National health insurance is inconsistent with the
American value of personal responsibility. How does
a national health insurance program decrease individual accountability? Should citizens have access to
health coverage if they don’t work?
Health care is a power reserved to the states under
the Tenth Amendment. How is national health
insurance an encroachment on state power? In what
ways are states more able to determine the needs of
their citizens than the national government?
Health insurance companies use precise formulas to
assure that the system will remain financially solvent.
Why is it necessary to refuse insurance to some Americans? In what ways are
health insurance companies better equipped
than the national government to administer
health care programs?
Photo courtesy: Used with the permission of Mike Luckovich
and Creators Syndicate. All rights reserved.
To develop an ARGUMENT FOR national
provision of health insurance, think about how:
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population to manage the spread of diseases such as influenza (the flu). While not
requiring citizens to receive flu shots, the government recommends that high-risk
groups (infants, senior citizens) receive immunizations and also subsidizes vaccines for
low-income populations.
The national government also finances medical research, primarily through the
National Institutes of Health (NIH). The National Cancer Institute, the National
Heart, Lung, and Blood Institute, the National Institute of Allergy and Infectious
Diseases, and the other NIH institutes and centers spend more than $30 billion annually on biomedical research. NIH scientists and scientists at universities, medical
schools, and other research facilities receiving NIH research grants conduct the
research. Most Americans accept and support extensive government spending on
medical research. Congress, in fact, often appropriates more money for medical
research than the president recommends.
The Evolution of Education Policy
17.3 . . . Outline the evolution of education policy in the United States.
Education policy in the United States has been a work in progress for over two
centuries. Education reform has focused on three central values of American
democracy: social and political order, individual liberty, and social and political
equality. Although all three of these values are important, the changing priority
placed on each value has often led to education reform, most recently with the No
Child Left Behind Act.
The Foundations of Education Policy
Photo courtesy: Bettmann/Corbis
In America’s earliest days, individual colonies were responsible for establishing their
own education policies. In New England, for instance, students often attended schools
operated by local churches. In other colonies, in-home tutors and secular schoolhouses were common. Regardless of the method, education was seen as a good
Who was John Dewey? John Dewey was
way of instilling the moral values of the community in future generations by focusan influential education reform advocate
ing on character traits and basic skills such as reading, writing, and arithmetic.
of the late nineteenth and early twentiFollowing the Revolutionary War, reformers of the era, such as Benjamin
eth centuries. He advocated active and
experiential learning.
Franklin, began to see education as a means of legitimizing democratic institutions in the minds of young people and of establishing social and political order
in the United States. Thus, education emerged as an issue on the governmental
agenda. In what is probably the earliest national policy discussing education, the
1787 Northwest Ordinance specifically set aside land for public schools to be
established.
In the late nineteenth and early twentieth century, when immigration was at
high levels, education again emerged on the governmental agenda. Many of the
social, economic, and political elites of the era came to view education as a tool
for assimilating immigrants and for protecting social and political order. Systems
of education had by this time evolved away from the church-based model of New
England and had become more professionalized institutions of local government
financed through county or municipal taxation. Taxpayers in the counties and
cities, rather than the tight-knit religious communities of an earlier era, came
from a variety of different backgrounds and were usually not inclined to support
religion and moral teaching in schools.
As a result, many ideas about education began to change. One of the most
prominent education reform advocates of the time was John Dewey (1859–1952).
A psychologist by training, Dewey’s writings on education revolutionized the
The Evolution of Education Policy
principles that shaped education policy, as well as the way that schools implemented
these plans. Rather than relying on a passive experience, whereby teachers would inform
students of “facts,” and students would memorize them, Dewey advocated experiential
learning. Students would be exposed to information through practical experience, which
could then become useable knowledge. In this way, Dewey felt that education would also
promote individual liberty, because every student’s knowledge-creating experience
would be particular to the learner and his or her unique needs or goals. Dewey’s influence on education continues to shape many education policy reform initiatives today.
Twentieth-Century Challenges
In the twentieth century, the Cold War between the United States and the Soviet Union
took education in a new direction. After the Soviets launched the world’s first satellite,
known as Sputnik I, into space, many American policy makers and citizens became concerned about the capacity of American technology to meet the perceived threat of the
Soviet Union and its allies. At the time, many policy makers saw education as an important weapon in the war against a rising communist threat. Through education policies
such as the National Defense Education Act of 1957 (NDEA), legislators attempted to
educate thousands of highly skilled scientists and engineers able to build the weapons
systems and other products needed to establish the United States as an even stronger
military and economic power. At the elementary and secondary education levels, for
instance, NDEA programs heavily emphasized science and math.
This cohesive public policy was short-lived. As the war in Vietnam brewed and
the Cold War eventually drew to a close, a split began to emerge between ideologically liberal and conservative reformers. Liberal policy reformers emphasized the need
to promote equality through educational opportunity and adopted many of Dewey’s
principles about education and freedom. More conservative policy reformers viewed
education through the lens of political and social order, while also emphasizing the
issue of economic freedom in educational choices.
LIBERAL EDUCATION REFORMS Many liberal education reforms in the late twentieth century were derived from the principles enunciated in the Supreme Court’s landmark decision in Brown v. Board of Education (1954). In that case, the Supreme Court
unanimously ruled that separate educational facilities for black and white students were
inherently unequal. Brown established both the road map for racial desegregation in
American schools and a national standard for equality of educational opportunity. This
legacy was apparent in the Civil Rights Act of 1964 and the Elementary and Secondary
Education Act of 1968, which served as the legislative articulation of many of the education policy goals of liberal policy reformers. The Civil Rights Act made significant
strides in promoting equality of opportunity for all Americans, and the Elementary and
Secondary Education Act concentrated primarily on policies that would advance equality of opportunity for children.
The federal courts, too, took an active role in enforcing the sentiments of Brown.
Court-ordered education reform efforts led to the reformulation and equalization of
school funding and federally-mandated busing of students from schools in poor
neighborhoods to schools in middle-class and wealthy neighborhoods.
These policies marked an important turning point in education policy. Enforcement of civil rights legislation—related to both race and gender, such as Title IX of
the Education Amendments of 1972 (see chapter 6)—required the national government to become increasingly involved in a policy area traditionally reserved for the
state and local governments. As a result, the national government under the leadership of Democratic President Jimmy Carter established the Department of Education
in 1979. This Cabinet-level agency was created specifically to guide national education policy, establish education opportunity programs and curriculum guidelines, and
construct national examinations for administration in local schools.
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CONSERVATIVE EDUCATION REFORMS
How did Title IX change education? Title IX of the Education Amendments
Photo courtesy: Meghan O’Connor McDonogh/Catholic Lacrosse
of 1972 greatly expanded educational and athletic opportunities for
women. As a result of these gender equity requirements, women's
lacrosse is one of the fastest growing collegiate sports.
Conservative policy makers have also
attempted to create education policy that
reflects their values. In his 1955 book, Capitalism and Freedom, Nobel Prize–winning
economist Milton Friedman made a strong
argument for the privatization of elementary
and secondary education. Friedman’s premise
was built on a minimalist government vision
that saw private sector economics as a reaffirmation of the personal freedom of individuals
to choose what and what not to purchase.
Friedman viewed government involvement in
public education—or for that matter, most
public policy—as an intrusion on personal
freedom. Additionally, Friedman concluded
that through private marketplace competition, schools would be forced to either
improve student achievement outcomes or
face the shuttering of their enterprise. Friedman’s argument resonated with many conservative political leaders of the era. Prominent
Republicans such as President Ronald Reagan were strong advocates of Friedman’s educational proposals.
The No Child Left Behind Act
No Child Left Behind Act (NCLB)
Education reform passed in 2002
that employs high standards and
measurable goals as a method of
improving American education.
The conflicting viewpoints of liberal and conservative reformers continue to shape
education policies in the twenty-first century. A bipartisan education reform bill supported by the late Democratic Senator Edward M. Kennedy (D-MA) and Republican President George W. Bush was signed into law in January of 2002. This
legislation, commonly referred to as the No Child Left Behind Act (NCLB), employs
high standards and measurable goals as a method of improving American education.
In many ways, this legislation reflects a combination of liberal and conservative education policy reforms.
NCLB has four main pillars. First, results-oriented accountability plays a central role in NCLB. The legislation is designed to monitor student achievement in
schools, paying special attention to disadvantaged student populations. Each year,
students are given a battery of standardized tests designed to measure whether they
have met a set of educational goals. Test results are then tabulated and broken
down by race, ethnicity, and gender in order to better measure students’ progress.
Schools and school districts also use this data to issue annual report cards on their
achievement. Schools that do not meet their goals are encouraged to offer ancillary
education services, such as tutoring, to improve their students’ educational achievement. If progress is still not made, schools or school districts may be forced to reorganize. (To learn more about school report cards, see Analyzing Visuals: State
Education Report Cards.)
Second, NCLB was designed to encourage state and local flexibility in use of
national funds. Flexibility in funding is an effort to build a cooperative education
enterprise between national, state, and local government by reducing commitment
to “one size fits all” policy reforms. Thus, depending on their local needs, schools can
use resources to improve school technology, develop experimental programs
The Evolution of Education Policy
ANALYZING VISUALS
State Education Report Cards
This map shows state education report cards across the United States as of January 2010, as reported in Education
Week. The report measures the quality of education and relative education outcomes and assigns each state a
“grade.” Analyze the map and then answer the questions.
WA
MT
VT
ND
WY
CO
CA
AZ
PA
IL
KS
OK
NM
MO
TX
OH
IN
WV
VA
KY
SC
AR
AL
GA
C
LA
HI
Source: “Fresh Course, Swift Current: Momentum and Challenges in the New Surge Toward Common Standards,” Education Week. www.edweek.org.
■
■
Which states have the lowest ranking for overall quality of public schools?
Why do you think school quality rankings vary substantially from state to state?
How might policy makers use this data to improve educational equity in the United States?
intended to improve education outcomes, or invest in programs to improve teacher
training and quality. Outcomes are seen as more important than uniformity in
process.
The third pillar of NCLB envisions the national government as a purveyor of
proven methods of achieving high-quality education outcomes. National policy analysts and curriculum experts create best practices in a range of subject areas ranging
from reading to mathematics to science and share this information and curriculum
with schools and school districts. For example, NCLB’s “Reading First” and “Early
Reading First” programs are designed to produce high-quality readers. The programs
have established a track record for educational success.
Grade
A
B
FL
■
NJ
DE
MD
DC
NC
TN
MS
AK
RI
CT
MI
IA
NE
UT
MA
NY
WI
SD
NV
ME
MN
OR
ID
NH
D
F
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At times, schools and districts are
unable
to meet educational goals despite all
run by universities, non-profits, or corporations. Many charter schools, such as
of their efforts. Thus, NCLB’s fourth pillar
Harlem Success Academy, seen here, have achieved outstanding results in
traditionally under-privileged communities.
involves school choice. If a child is attending a failing school, students and their parents may have the option to enroll at an
institution that is successfully meeting its
educational achievement goals. In some
cases, this may mean sending a child to
another public school in the district or to a
private school.
One popular way to implement a
school choice policy is through the use of
vouchers, or certificates issued by the government that may be applied toward the
costs of attending private or other public
schools. These certificates are usually in
the amount that it would cost to educate a
student in their local public school. Supporters of vouchers essentially argue that
money talks. They believe that if parents
remove their students from failing schools,
these schools will quickly learn that they
have to take steps to improve educational
quality, or they will no longer have a reason to exist. Opponents, however, contend that allowing students to take money
vouchers
Certificates issued by the
away from failing schools is counterintuitive and actually makes it harder for failing
government that may be applied
schools to improve.
toward the cost of attending private
Parents may also choose to send their children to charter schools. Charter
or other public schools.
schools are semi-public schools founded by universities, corporations, or concerned parents. They have open admission and receive some support from the
charter schools
Semi-public schools that have open
government; they may also receive private donations to increase the quality of
admission but may also receive prieducation. In cases where more students are interested in attending a school than
vate donations to increase the quality
there are spots available, students are usually selected by means of a random lotof education.
tery. Charter schools are rapidly increasing in popularity in the United States. In
some jurisdictions, such as New Orleans, charter schools are consistently among
the highest performing institutions in the city. Critics, however, charge that it is
difficult to assure that charter schools are meeting educational standards, and that
there are inherent flaws in a system that cannot accommodate all students interested in attending.
Photo courtesy: Harlem Success Academy
What are charter schools? Charter schools are semi-public institutions that are
The Evolution of Energy and
Environmental Policy
17.4 . . . Explain the evolution of energy and environmental policy
in the United States.
Energy and environmental policies in the United States are prone to cycles that contain dramatic shifts in public attention over time. During some eras, these policies
remain dormant, barely noticeable within the broader sphere of public policy; at other
The Evolution of Energy and Environmental Policy
times, the issues become the dominant players in the political realm. As the first
decade of the new millennium unfurled, energy and environmental issues made their
way out of a period of dormancy and became dominant players in contemporary
domestic politics. Before looking at the current prominence of these concerns in the
United States, it is important to examine the cycles that energy policies have undergone during the past fifty years.
The Foundations of Energy and
Environmental Policy
In the late 1950s and early 1960s, America was in the midst of one of the most robust
economic periods in national history. The nation prospered, with vibrant manufacturing and transportation sectors that were being bolstered by access to cheap fossil fuels.
With the nation’s abundant coal supplies and relatively unfettered access to oil, there
was little need for government efforts in the area of energy policy. In essence, the issue
of energy was largely absent from the government agenda because energy was not seen
as much of a problem for the United States.13 However, the effects of intensive energy
use on the environment were becoming more obvious to the nation as a whole. From
heavy smog in major cities to thick clouds of smoke in industrial towns, Americans
had begun to take notice of deteriorating environmental conditions that were related
to its industrial might.
ENERGY POLICY By the early 1970s, America had grown increasingly dependent on
oil from foreign sources. In particular, oil from Middle Eastern nations such as Saudi
Arabia and Iran comprised a growing share of the nation’s energy sources. While
What does an energy crisis look like? After the OPEC oil embargo in 1973, soaring gas prices
Photo courtesy: Bill Pierce/Getty Images
and shrinking supplies led to a rationing of gas in the United States and long lines at the gas
pumps. Today, people are looking for ways to be less reliant on this politically volatile,
nonrenewable resource.
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foreign oil remained cheap and abundant, there was
little demand for the national government to invest
itself in major energy initiatives. But, in 1973, the
need for action in the area of energy became all too
obvious to the American public, and the energy problem was abruptly thrust onto the government’s
agenda. On October 17, 1973, the members of the
Fuel Taxes in Europe
Organization of Arab Petroleum Exporting CounFor decades, European countries have imposed high taxes on fuel
tries (OAPEC) announced an embargo of oil shipto encourage conservation and fuel-efficient technologies. In Great
ments to any nation that supported Israel during its
Britain, the Netherlands, and Scandinavia, taxes on gasoline are
war with Egypt and Syria; this included the United
more than twice as much as the underlying cost of the fuel; the
States.14 The embargo was compounded when the
price per gallon can be more than $9. The cumulative effect of
larger Organization of Petroleum Exporting Counthese taxes is stunning—one study estimated that the average resitries (OPEC) decided to raise oil prices throughout
dent of Great Britain spent more than $1,300 a year on fuel taxes.
the world.15 The cumulative impact of these actions
In the United States, the national government imposes a fuel
was a dramatic increase in the cost of oil in the United
tax of 18.4 cents per gallon. States can and do impose additional
States, with a gallon of gasoline increasing from 38
taxes; the average state gasoline tax in 2010 was 27.4 cents a gallon.
cents to 55 cents between May 1973 and May 1974.16
However, on the whole, the United States has long been reluctant
Soaring prices and shrinking supplies led to the first
to follow the European model. Both Democrats and Republicans
rationing of gas in the United States since the end of
have fought to maintain relatively inexpensive gas prices.
World War II and thrust energy to the front of the
government agenda.
■ Why might Europeans be more willing to accept high fuel
Policy makers confronted the energy problem
taxes than their American counterparts?
with a number of general approaches. First, the
■ Should the United States impose higher taxes on fuel
national government created a series of policies that
consumption? Why or why not?
were designed to reduce consumption of petroleum
■ Is a fuel tax the best way to encourage energy conservation?
in the United States. The national government estabWhy or why not?
lished a national speed limit of 55 miles per hour in
order to increase fuel efficiency, and Congress set an
earlier date for the start of daylight savings time in an
attempt to reduce demand for electricity.17 It also initiated Corporate Average Fuel
Efficiency (CAFE) standards in 1975 as a means of improving the gas mileage of automobiles in the United States. Under CAFE, automakers were required to meet average
fuel efficiency standards for the fleet of cars that they sold in the United States. For
example, General Motors was required to have the automobiles it sold domestically
average 18 miles per gallon (MPG) in 1978. This meant GM could sell a large sedan
that got 12 MPG if it also sold a smaller car that got 24 MPG.
Besides adopting energy conservation measures, the national government also
turned its attention to increasing the availability of energy for the nation. In order to
minimize the short-term impact of oil disruptions, Congress established the Strategic
Petroleum Reserve in 1975 as part of the Energy Policy and Conservation Act. The
Strategic Petroleum Reserve holds about two months of inventory that can be
accessed under a presidential order.
With policy initiatives mounting and the complexity of energy policy growing,
President Jimmy Carter called for the establishment of a Cabinet-level department
that would be devoted to the administration and implementation of energy policy. In
1977, Congress followed up on the president’s proposal and established the Department of Energy (DOE).18 The DOE brought a dozen national programs related to
energy under the control of Secretary of Energy James R. Schlesinger. In addition,
the DOE was handed an array of new programs when Congress adopted the wideranging National Energy Act of 1978 (NEA). This comprehensive law included a
variety of components related to both energy conservation and the expansion of energy
sources.
The Evolution of Energy and Environmental Policy
557
A key component of the 1978 NEA was the Energy Tax Act, which harnessed
the government’s tax powers as an energy policy tool. Under this legislation, the
national government gave tax breaks to individuals and companies that used alternative energy sources such as solar or geothermal power. Conversely, the Energy Tax
Act penalized inefficient use of energy by establishing a “gas-guzzler tax” on cars
that did not reach a minimum MPG threshold. Although the purpose of the gasguzzler tax was to reduce the public demand for such vehicles, the law did not make
the impact originally anticipated because it did not apply to vehicles over 6,000
pounds. What was originally considered an exemption for businesses that needed
vans and trucks to do their work turned out to be a way around the gas-guzzler tax
for business owners, who could purchase or lease sport utility vehicles (SUVs) to
conduct everyday business activities.
ENVIRONMENTAL POLICY
Photo courtesy: AP/Wide World Photos
As America was being forced to confront energy policy in the 1970s, the issue of the environment was also moving into a prominent role in
the national discourse. Americans’ growing concerns about environmental conditions
led to the first Earth Day in 1970, when millions of citizens took part in marches and
rallies demanding greater government action to protect the environment. This public
pressure had a tremendous impact on the state and national governments, ushering in
the “environmental decade” of the 1970s.
With strong public support for increased environmental protection efforts by the
national government, both the Congress and President Richard M. Nixon started the
decade with an incredible flurry of legislative and executive initiatives. First, in 1970,
Nixon signed into law the National Environmental Policy Act (NEPA), which
required the completion of environmental impact statements by bureaucratic agencies
Clean Air Act of 1970
when a government project was proposed. To help facilitate the oversight of NEPA
The law that established national
and other environmental protection efforts, Nixon created the Environmental Protecprimary and secondary standards for
tion Agency (EPA) by executive order in December 1970. The EPA assembled many
air quality in the United States. A
national environmental programs under one independent executive branch agency,
revised version was passed in 1990.
with the agency administrator reporting directly to the president.
What did the Superfund Act do? Superfund was established to provide funds to clean up
Congress followed up its efforts
hazardous waste sites, such as the Gowanus Canal in Brooklyn, New York, shown here.
with NEPA by passing the most significant piece of environmental legislation
in American history. Under the Clean
Air Act of 1970, Congress established
national primary and secondary air
quality standards for six air pollutants.
The primary standards were for the
protection of human health, and the
secondary standards were to protect
nonhealth values such as crops, buildings, lakes, and forests.
In 1972, Congress followed up the
Clean Air Act with the Clean Water
Act (CWA). With nearly unanimous
support among members of Congress,
the law established an overly optimistic
goal of making all American surface
water “swimmable and fishable by
1985.” Despite significant progress in
addressing some of the most egregious
sources of water pollution, the problem
558
CHAPTER 17
Domestic Policy
of water pollution—as well as the uneasy relationship between national and state control of clean water policies—continues.
National policy initiatives grew throughout the 1970s with the passage of legislation such as the Safe Drinking Water Act (1974), which established national standards
for drinking water quality; the Resource Conservation and Recovery Act (1976), which
eliminated the existence of unsanitary town dumps; and the Comprehensive Environmental Response, Compensation, and Liability Act (Superfund), which was designed to
clean up many of the nation’s hazardous waste sites. However, the arrival of the 1980s
would bring a major change to the standing of energy and environmental policy within
American politics.
Energy and Environmental Policy Hibernates
As the 1970s ended, so did the prominent role that energy and environmental policy
held on the government’s agenda. This reduced profile for energy initiatives was
brought about by a confluence of political and economic factors during the 1980s,
including the election of President Ronald Reagan. As a champion of smaller government and deregulation, President Reagan was anxious to reduce the national
scope and intensity of energy regulations.
Reagan took both real and symbolic steps to reduce government intervention in
energy and environmental policy. Among the real steps was Reagan’s 1981 National
Energy Policy Plan, which ended the price and allocation controls on crude oil and petroleum products that had been established in the 1970s. Reagan also did not seek to renew
tax breaks for alternative energy purchases or maintain government financial support for
many alternative fuel research projects. While balking at government support for alternative fuels, the president did call for increased research into finding cleaner ways to use the
nation’s gigantic coal reserves.19
Although Reagan’s approach to governing helps explain the dearth of energy initiatives during the 1980s, the availability and price of petroleum was at least equally
responsible for taking the energy issue off of the government’s radar screen. After rising steadily upward during the 1970s, oil and gasoline prices stabilized during the
1980s. There were no major disruptions in supply, and the public outcry for action on
energy issues largely dissipated. Despite the increased dependence on foreign sources
of petroleum, Americans were no longer feeling the day-to-day pain that they experienced in the previous decade.
During the George Bush and Bill Clinton administrations of the late 1980s and
1990s, energy and environmental policies largely remained off the governmental
agenda. With a few notable exceptions, such as the Clean Air Act of 1990 and the
Energy Policy Act of 1992, the national government did not aggressively tackle environmental and energy issues as it had done in the 1970s.
Energy and Environmental Policy
Returns to Prominence
When President George W. Bush was elected in 2000, he brought with him a comprehensive energy policy. Among the cornerstones of the Bush energy policy were
plans to allow drilling in Alaska’s Arctic National Wildlife Refuge, relaxing rules for
the placement of new electrical transmission lines, research into reprocessing nuclear
fuel, and greater funding and support for clean coal initiatives.20
Within months after the release of Bush’s energy plan, however, the nation suffered the terrorist attacks of September 11, 2001. After 9/11, the issue of energy
became an issue of national security. As American troops headed to war in Iraq, the
impact of the national dependence on oil became more apparent to the country
The Evolution of Energy and Environmental Policy
559
Figure 17.2 Where do U.S. oil imports come from?
American oil imports come from sources around the globe. Although the largest percentages
come from the Middle East and Africa, significant proportions also come from South
America, Mexico, and Canada.
Source: U.S. Energy Information Administration, Office of Senator Richard Lugar, lugar.senate.gov/energy/graphs/oilimport.html.
Canada
Europe
17%
5%
U.S
Middle
East
Mexico
22%
Africa
15%
Asia
22%
South
America
19%
Australia
than ever before. 21 Demands for new measures to make the nation more energy
independent grew, and Congress began to more aggressively assemble a legislative
response to the country’s energy needs. (To learn more about U.S. oil imports, see
Figure 17.2.)
These calls for more comprehensive energy policy were also fueled by the increasing concern about global warming, an issue related to climate change. Since the
1980s, scientists have warned that the burning of fossil fuels contributes to increased
levels of greenhouse gases in the atmosphere, which in turn lead to higher global temperatures. These higher temperatures have a number of significant impacts on the
planet, such as melting polar ice caps, increasing sea levels, prolonged droughts, more
intense storms, major habitat destruction, and species extinction. These scientific concerns have spurred international action to manage the problem of global warming.
Most of the world’s industrial nations ratified the Kyoto Protocol in 1997, which
committed them to reducing greenhouse gas emissions. Despite support from the
Clinton administration, the United States did not ratify the agreement. President
George W. Bush steadfastly refused to join with other nations by signing the treaty,
citing the damaging effects of the Protocol on the U.S. economy.
In the absence of major national activity to control global warming, the state governments have taken the lead. In 2002, the state of California passed a law aimed at
reducing greenhouse gas emissions from automobiles by 30 percent before 2016. This
law went far beyond the national standards for greenhouse gas emissions established
by the Environmental Protection Agency. By 2010, more than twenty other states had
followed California’s lead and adopted their own policies directed at reducing global
warming pollutants.
global warming
The increase in global temperatures
due to carbon emissions from burning fossil fuels such as coal and oil.
TOWARD REFORM: Ongoing
Challenges in Domestic Policy
17.5 . . . Assess the ongoing challenges in U.S. domestic policy.
Domestic policy legislation has a rich history in the United States, as we have discussed in this chapter. However, in each of the issue areas we have considered, there
are public policy challenges that have yet to be solved. This section reviews just a few
of the many remaining challenges in health, education, and energy and environmental
policy. We consider the rising cost of health care, implementation of the No Child
Left Behind Act, and alternative energy and going “green.”
Health Policy: The Cost of Care
One of the most significant issues that policy makers must confront in the area of
health policy is the rising cost of care. As medical technology advances, citizens live
longer. But, this increased life span comes with a price tag. Often, it comes in the form
of long-term care, prescription drugs, and costly medical procedures that would have
been unimaginable even just forty years ago. These rising costs place a significant
burden on individuals and insurance companies, as well as the national and state governments in the form of Medicare and Medicaid.
A quick review of the increase in health care costs over the past forty years helps
to demonstrate the magnitude of the problem. In 1970, Americans spent about $356
per capita on health care costs. But, by 2009, Americans were spending $8,160 per
person on health care costs—almost 23 times 1970 levels. These levels far exceed the
rate of inflationary growth and are projected to continue
to rise to more than $13,000 per capita by 2018.
In reality, of course, these expenditures are not evenly
Figure 17.3 Where do American health care
distributed
across all Americans; 10 percent of citizens
expenditures go?
account
for
63
percent of all health care costs. The majority
Physicians and hospital care constitute a majority of health
of
these
expenditures
pay for physician’s office visits and hoscare expenditures. However, prescription drug and nursing
pital
care.
However,
prescription drug costs and nursing
home costs are rapidly rising.
home expenditures constitute rapidly rising proportions of
Source: Kaiser Family Foundation, www.kff.org/insurance/upload/7692_02.pdf.
American health care costs.22 (To learn more about AmeriHome
Health
Nursing Home
cans’ health care expenditures, see Figure 17.3.)
Care 2.6%
Care 5.9%
The rising cost of health care is a serious governmental problem for a number of reasons. First, under
the Patient Protection and Affordable Care Act of
2010, at least some of these health care costs will be
Prescription
shouldered by or through the government’s insurance
Drugs
10.1%
exchanges when they are fully implemented in 2014.
Hospital Care
Second, these rising costs coupled with the rising num31.1%
Other Personal
ber of beneficiaries and shrinking number of workers
Health Care
are projected to produce budget shortfalls for the
12.7%
Medicare program as soon as 2020. Among the policy
proposals to address this problem are raising the
Other Health
Physician/
Medicare tax on workers or increasing the age of eligiSpending
Clinical Services
bility for beneficiaries. Neither of these proposals is a
16.2%
21.4%
popular policy solution, but it will be up to legislators
and bureaucrats to navigate this complex policy issue in
the coming years.
560
Toward Reform: Ongoing Challenges in Domestic Policy
561
Education Policy: Implementing
No Child Left Behind
Despite efforts to improve education quality and
equality, implementation of the No Child Left
Behind Act remains controversial across the
Health Care Spending
political spectrum. Critics often claim that the
The cost of health care varies widely across nations, depending on
reform places too much emphasis on standardized
the level of available health technology, life expectancy, the way
testing as a means of measuring student achievehealth coverage is financed, and a number of other factors. Historiment. This, they argue, ignores many of the noncally, the United States, with its single-payer private insurance sysmeasurable but equally important aspects of
tem, has had much higher costs than many other nations, where
student learning. It also encourages teachers to
citizens are healthier and there is a more developed welfare state.
“teach to the test” rather than helping students to
This trend is immediately apparent in the figure.
learn analytical thinking skills. Finally, the
Health care spending per person, in U.S. dollars
requirements of NCLB may force schools and
teachers to sacrifice education in subject areas
Average life
United States $7,290
expectancy
that are untested, such as science, civics, art, or
at birth
Switzerland $4,417
music. These sacrifices may produce less wellrounded students or fail to engage or prepare stuCanada $3,895
dents for the professional world.
France $3,601
80
Other critics contend that the primary probSpain $2,671
lem with NCLB is that it further nationalizes
New Zealand $2,510
elementary and secondary education, which is
best administered by state and local governPortugal $2,150
ments. These observers believe that state and
76
local governments are better able to understand
Average number
Nation with universal
Nation without
of doctor visits a year
health coverage
universal health
the unique social and economic challenges that
provided by public
coverage
and private insurers
0
4
8
12+
face communities and may affect educational
Source: “The Cost of Care,” National Geographic. blogs.ngm.com/blog_central/2009/12/
policies and achievements. What is worse, these
the-cost-of-care.html.
critics argue, is that NCLB contains a host of
■ What factors appear to have the greatest influence on cost of
national mandates for state and local governcare? On life expectancy?
ments, but it contains little funding to help with
policy implementation.
■ How would you explain the United States’ relatively high cost
As a result of these criticisms, the National
of care, but low life expectancy?
Education Association and its affiliates filed a
■ What are some likely reasons that other countries pay lower
lawsuit charging that the act was unconstituhealth care costs per person but citizens are healthier?
tional because it required state and local governments to spend their own funds to comply with
national legislation. The courts, however, disagreed. More successful have been
legislative attempts to express opposition to the law. The states of Utah, Vermont,
and Hawaii, to name a few, have passed legislation or resolutions opting out of
portions of the law they consider to be unfunded or underfunded.
At least temporarily, it seems as though opponents of NCLB may have an ally
in the White House. President Barack Obama and his advisors have proposed
ending some of the most controversial provisions of NCLB, including the yearly
benchmarks and report cards, in order to focus on college and career readiness.
The administration has also proposed funding education through competitive
grant programs, rather than a formula based on student achievement on
standardized tests. 23 Implementing these proposed changes, however, may prove
challenging.
The Obama administration has also taken a number of other steps outside of
NCLB to advance education policy. Within one month of taking office, President
562
CHAPTER 17
Domestic Policy
Public Higher Education in N.C. in Line for
Federal Stimulus Money
October 15, 2009
Gaston Gazette
www.gastongazette.com
Critical Thinking Questions
1. How can the national
government use
funding such as these
stimulus funds to
control states’
education policies?
2. What programs are
national education funds
best suited to support?
Are there any programs
these funds should not
be used to support?
2. What responsibility
should state governments have for shortfalls
in education funding?
By Barry Smith
More than $449 million from the federal stimulus bill is on its ways to public higher
education in North Carolina, with most of the dollars going to plug holes and offset cuts in
the state budget.
The University of North Carolina system is getting $282 million over the next two years
to keep its budget in the black. An additional $112 million is primarily targeted for
research with more grants expected to be awarded in coming months.
Millions of dollars are flowing into the N.C. Community College System also; however,
the number is considerably smaller than the UNC system is receiving. The system used
$42 million during the previous fiscal year, which ended June 30, to offset a recessioninduced revenue shortfall. Another $13.5 million is earmarked for community college
programs geared toward retraining displaced workers.
Gaston College received $350,000. “Gaston is looking at nursing assistants, health care
billing/coding, office clerical support and welding,” said Jennifer Haygood, the chief
financial officer for the state’s community colleges system.
Kimrey Rinehardt, vice president for federal relations for the UNC system, said that the
research dollars flowing into the system will help save jobs.
“In terms of the research being stimulus, it does keep researchers in jobs,” Rinehardt
said. It also prompts researchers to buy lab equipment, helping out that sector of the
economy, she said.
More than half of the research-oriented money going to the UNC system thus far from
the American Recovery and Reinvestment Act of 2009 is headed toward the Chapel Hill
campus, which so far has been awarded $59.9 million. . . .
The second highest recipient is N.C. State University with $21 million, much of which
will fund energy research. N.C. State stands to gain additional research stimulus dollars
in the future, she said. . . .
UNC Charlotte was awarded $5.7 million and East Carolina University was awarded
$3.9 million, including breast and prostate cancer research programs along with
cardiovascular programs. . . .
The $13.5 million going to many community colleges is earmarked for
“Jobs Now” programs, designed to give displaced workers skills for new jobs within
six months.
Obama signed the American Recovery and Reinvestment Act. The act, which
became law in February 2009, commits approximately $91 billion to education
programming. Under the law, Head Start programs for low-income preschoolers
receive over $2 billion in supplemental funding. State departments of education,
which are struggling with budget shortfalls and teacher furloughs and layoffs,
were given nearly $45 billion in aid. Additional monies also were allocated
for childcare programs and the low-interest college loans known as Pell Grants.
Only time will determine how significant of an impact these funds will have on
Toward Reform: Ongoing Challenges in Domestic Policy
educational outcomes. (To learn more about national funding
of higher education institutions, see Politics Now: Public
Higher Education in N.C. in Line for Federal Stimulus
Money.)
563
Figure 17.4 How does the United States generate
electricity?
Although the percentage of American power coming
from alternative fuel sources has increased in recent
years, coal is still the largest source of electrical power.
Source: U.S. Energy Information Administration, www.eia.doe.gov.
Other
Renewables 3.6%
Energy and Environmental Policy:
Alternative Energy and Going “Green”
Petroleum
1.0%
Hydroelectric
Photo courtesy: Richard Levine/Alamy
6.9%
With the price of gas hovering around $3 a gallon and the
cost of home heating oil increasing each year, Americans have
become much more interested in the availability of alternative
energy sources. From solar panels to electric cars, once exotic
Coal
Nuclear
technologies have become much more sought after by every44.9%
20.3%
day citizens. However, energy usage statistics remind us that
fossil fuels still dominate the energy field in the United
States. According to the Department of Energy, only 10 percent of all energy used in America comes from renewable
Natural Gas
sources. In 2009, for example, coal continued to provide the
23.4%
power needed to generate almost half of American electricity;
coal and oil combined provided almost two-thirds of the
nation’s total energy consumption. With such disparities in
usage levels between renewable and nonrenewable sources, it
will take significant efforts to move alternative fuels into the
mainstream. It appears that such efforts may increasingly come from governments at all levels in the United States. (To learn more about how the U.S. generates electricity, see Figure 17.4.)
Over the past several decades, many state governments have begun to adopt
Renewable Portfolio Standards (RPS) that require set amounts of electricity to be
generated from alternative sources. In 2010, thirty-eight states and the District of
Columbia had RPS standards, with others considering such policies. For example,
California has mandated that the percentage of renewable energy sales reach at least
33 percent by the end of 2020. Similarly, Florida, a state that has been heavily reliant
on nonrenewable fuel sources, passed legislation mandating that renewable fuel
usage increase from 3 percent of total energy National and in 2009 to 20 percent of
total Energy in 2020.
National and state governments have also used their fiscal
How can governments encourage Americans to go green?
powers to increase the adoption of alternative energy techOne simple way governments have encouraged environnologies. For example, Maine offers its residents up to a
mental consciousness is to provide citizens with incentives
to purchase compact fluorescent light bulbs shown here.
$7,000 tax rebate on residential photovoltaic system (solar
power) installations and $1,250 on solar thermal water
heaters. Texas also offers tax incentives for individuals and
corporations who use solar or wind power to generate energy.
For its part, the national government offers tax incentives for
energy efficient construction and has also taken steps to
encourage the usage of compact fluorescent light bulbs, which
are more energy efficient and last longer than their incandescent counterparts.
State and local governments have taken a number of other
steps to encourage citizens to become more environmentally
friendly, or “green,” in other areas of their lives. Many states
and localities offer mandatory or optional recycling programs.
CHAPTER 17
564
Domestic Policy
The state of North Carolina, for example, recently passed legislation making it illegal to throw plastic bottles and aluminum cans in trash bins. Although the law has
proven difficult to enforce, activists still argue that it is a step in the right direction
and that it will have a significant environmental impact. And, in an attempt to
reduce the waste generated from plastic bags, a number of cities including San
Francisco have adopted legislation banning plastic bag usage or charging consumers for plastic bags with their purchases. In Washington, D.C., shoppers who
want a plastic bag must pay an additional five cents per bag. In the city of Seattle,
the fee is twenty cents per bag for paper or plastic.
These public policies represent only a small sampling of the legislation
enacted in recent years. They also say little about citizens’ and interest groups’
actions to put Earth-friendliness on the systematic and governmental agendas. It
is likely that these policy areas, along with the other domestic policy issues we
have discussed in this chapter, will continue to be important to Americans in years
to come.
What Should I Have LEARNED?
Now that you have read this chapter, you should be able to:
17.1 Trace the stages of the policy-making process,
p. 536.
Public policy is an intentional course of action or inaction
followed by government in dealing with some problem or
matter of concern. A popular model used to describe the
policy-making process views it as a sequence of stages
that include problem recognition, agenda setting, policy
formulation, policy adoption, budgeting, policy
implementation, and policy evaluation. Although this
model can be useful, it is a simplification of the actual
process, and it does not always explain why policies take
the forms they do or who controls the formation of
public policy.
17.2 Describe the evolution of health policy in the
United States, p. 544.
Governments in the United States have a long history of
involvement in the health of Americans. Beginning in
the 1960s, the government began to fund health
programs for senior citizens and the poor, known as
Medicare and Medicaid, respectively. And in 2010, after
several failed attempts by prior administrations, the
Democratic Congress passed and President Barack
Obama signed the Patient Protection and Affordable
Care Act, expanding the national government’s role in
providing health insurance. The U.S. government also
plays a prominent role in public health through the use
of immunizations, education, advertisements, research,
and regulations.
17.3 Outline the evolution of education policy in the
United States, p. 550.
Education policy in the United States has been a work in
progress for over two centuries, and reform has focused
on social and political order, individual liberty, and social
and political equity. In general, liberal policy reformers
have emphasized the need to promote equity through
educational opportunity, and conservative policy reformers
have emphasized issues of economic freedom. In 2002,
President George W. Bush signed into law a bipartisan
bill commonly referred to as No Child Left Behind. It set
high standards and measurable goals as a method of
improving American education. One of the act’s more
controversial tenets involves the issue of school choice,
whereby if a child is attending a failing school, parents
have the option of sending the child to another public,
private, or charter school that is subsidized through
government vouchers.
Test Yourself: Domestic Policy
17.4 Explain the evolution of energy and
environmental policy in the United States, p. 554.
As energy sources have become more limited and
environmental problems have magnified, government
efforts in these policy fields have expanded. Before the
1970s, there was very limited activity on the part of
government to establish policies related to energy and
environmental protection. Energy shortages and expanding
pollution problems propelled these policy areas into the
forefront of the government’s agenda in the 1970s, but their
prominence at the national level has fluctuated greatly.
During recent years, skyrocketing energy prices and
increasing concerns about global warming and other aspects
of climate change have placed these issues once again at the
center of American politics.
565
cost of care. As citizens live longer, costs increase, placing
a burden on individuals, insurance companies, and the
national and state governments. In the area of education
policy, implementation of the No Child Left Behind Act
remains controversial across the political spectrum. Critics
complain that among other things, it is not funded
adequately, it nationalizes elementary and secondary
education, and it places too much emphasis on standardized
testing. In terms of energy and environmental policy, as
prices have gone up, Americans have become much more
interested in the availability of alternative energy resources.
Although the national government has failed to act in a
cohesive way, many state governments have taken it upon
themselves to institute policies that encourage citizens to
become more environmentally friendly.
17.5 Assess the ongoing challenges in U.S. domestic
policy, p. 560.
One of the most significant issues that policy makers
must confront in the area of health policy is the rising
Test Yourself: Domestic Policy
17.1 Trace the stages of the policy-making process,
p. 536.
17.3 Outline the evolution of education policy in the
United States, p. 550.
The intentional course of action followed by government
in dealing with problems or matters of concern is called
A. policy formulation.
B. social welfare policy.
C. policy administration.
D. public administration.
E. public policy.
The earliest example of national government involvement in
education policy is the
A. Northwest Ordinance.
B. creation of the League of Nations.
C. Civil Rights Act.
D. creation of the Department of Education.
E. passage of the No Child Left Behind Act.
17.2 Describe the evolution of health policy in the
United States, p. 544.
17.4 Explain the evolution of energy and environmental
policy in the United States, p. 554.
Medicaid was designed to provide health care
A. for the aged and ill.
B. for the poor.
C. for the working class.
D. for children.
E. for everyone.
The federal government’s response to global warming
has been
A. ratification of the Kyoto Protocol.
B. generally absent.
C. extensive, particularly since the Clean Air Act
of 1990.
D. mandating that all new homes built must be green.
E. banning the sale of incandescent light bulbs.
566
CHAPTER 17
Domestic Policy
17.5 Assess the ongoing challenges in U.S. domestic
policy, p. 560.
Health care costs
A. are increasing at about the rate of inflation.
B. are lower in the United States than in other
industrialized nations.
C. are affected by life expectancy.
D. have declined as a result of the Medicare program.
E. do not affect states’ public policy decisions.
Essay Questions
1. What are the seven steps of the policy process? Give
specific examples for each step, and discuss why each is
important.
2. What is the Patient Protection and Affordable Care
Act of 2010, and how did it change health care?
3. How did the No Child Left Behind Act affect
education policy in the United States?
4. Discuss the sources of energy used in the United States.
5. What techniques have the federal and state governments
used to encourage Americans to be “greener”? How
effective have these techniques been as public policies?
Exercises
Apply what you learned in this chapter on MyPoliSciLab.
Watch on mypoliscilab.com
Read on mypoliscilab.com
eText: Chapter 17
Study and Review on mypoliscilab.com
Pre-Test
Post-Test
Chapter Exam
Flashcards
Video: Chicago Gun Laws
Video: Health Care Plan
Video: Making Environmental Policy
Video: Raising the Minimum Wage
Explore on mypoliscilab.com
Simulation: You Are an Environmental Activist
Comparative: Comparing Health Systems
Comparative: Comparing Social Welfare Systems
Timeline: The Evolution of Social Welfare Policy
Key Terms
agenda, p. 539
agenda setting, p. 539
charter schools, p. 554
Clean Air Act of 1970, p. 557
global warming, p. 559
governmental (institutional)
agenda, p. 539
Medicaid, p. 546
Medicare, p. 545
No Child Left Behind Act, p. 552
policy adoption, p. 541
policy evaluation, p. 543
policy formulation, p. 540
policy implementation, p. 542
public policy, p. 536
systemic agenda, p. 539
vouchers, p. 554
To Learn More on Domestic Policy
In the Library
Bryce, Robert. Power Hungry: The Myths of “Green” Energy and the
Real Fuels of the Future. New York: Public Affairs, 2010.
Dye, Thomas R. Understanding Public Policy, 13th ed. New York:
Longman, 2010.
Feldstein, Paul. Health Policy Issues: An Economic Perspective on
Health Reform, 4th ed. Chicago: Health Administration Press,
2007.
Gerston, Larry N. Public Policy Making: Process and Principles.
Armonk, NY: M.E. Sharpe, 2010.
Kingdon, John W. Agendas, Alternatives, and Public Policies, 2nd ed.
New York: Longman, 2002.
Kraft, Michael. Environmental Policy and Politics, 5th ed. New
York: Longman, 2010.
Longest, Beaufort B. Health Policymaking in the United States,
4th ed. Chicago: Health Administration Press, 2005.
Oberlander, Jonathan. The Political Life of Medicare. Chicago:
University of Chicago Press, 2003.
Olson, Laura Katz. The Politics of Medicaid. New York: Columbia
University Press, 2010.
Rabe, Barry G. Statehouse and Greenhouse: The Emerging Politics of
American Climate Change Policy. Washington, DC: Brookings
Institution, 2004.
To Learn More on Domestic Policy
Ravitch, Diane. The Death and Life of the Great American School
System: How Testing and Choice Are Undermining Education.
New York: Basic Books, 2010.
Ristinen, Robert P., and Jack P. Kraushaar. Energy and the
Environment, 2nd ed. Hoboken, NJ: Wiley, 2005.
Springer, Matthew G. Performance Incentives: The Growing Impact
on American K-12 Education. Washington, DC: Brookings
Institution, 2009.
Washington Post. Landmark: The Inside Story of America’s New
Health Care Law and What It Means for All of Us. New York:
Public Affairs, 2010.
Wilson, Steven F. Learning on the Job: When Business Takes on
Public Schools. Cambridge, MA: Cambridge University
Press, 2006.
567
On the Web
To learn more about how public policies are prioritized and
analyzed, go to the Web site of the National Center for Policy
Analysis at www.ncpa.org.
To learn more about public health initiatives and consumer health
advisories, go to the Web site of the National Institutes of
Health at www.nih.gov.
To learn more about education policy in the United States, go to
the Web site of the U.S. Department of Education at
www.ed.gov.
To learn more about major environmental policies, go to the
Web site of the Environmental Protection Agency at
www.epa.gov.