Policy models-343(2) [Compatibility Mode]

8/7/2019 Policy models-343(2) [Compatibility Mode]

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Policy Analysis Models

and Healthcare Issues

Interdisciplinary Studies:

Social Science,

Understanding Society,

And Policy Making


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How Models Are Helpful

Order and simplify reality Help identify what is significant

Congruent with reality, i.e., apply to and in the real world

Provide meanin ful communication about the world

Help direct inquiry and research into problems, issues, andworld as it is or can be known

Suggest explanations for what is observed

Suggest alternative solutions for issues, problems, etc.

All models from Thomas Dye, Understanding Public Policy, 7th edition, unless otherwise indicated.


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Primary Groups

Secondary Groups

and Associations

Community

Nations & International

Organization

Economy--production &distribution of resources as

well as class status.

Culture--artifacts, symbols,

values, norms, expectations,

assignment of social status

Socio-Political Forces and Society

INDIVIDUAL

Family, Kinship Groups,

Tribal Groups

Schools, Employers, Npfs,

Voluntary Groups, Businesses,

etc.

Neighborhoods, Towns, Cities,

Villages--Connected Places

Nation of Citizenship

World Nations, UN, etc.

State--Collective authority,

right to make binding

decisions and applylegitimate power and force.From Norbert Wiley, Ph.D., 1977.Dept. of Sociology, University of Illinois C-U.


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The Wiley Model of Society

Three forces impact all levels of human life and society--culture, economy, and the state or political system.

What is valued, emphasized, and important in each is

v

and pursue what we call science. Of the three forces, the most dominant in American society

is probably the economy, i.e., the capitalist approach to

the production and distribution of goods, services, and

economic value.

Cultural values include many values and beliefs that conflict

with those of science.

The state role is to use authority to decide these conflicts.


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Wicked Problems and Healthcare Issues

Complex choices about and also involving the interaction of

state/culture/economy create wicked problems:

1. Intractable and very difficult

2. Never simple or singular but multiple issues nested

or interlocked with other equally complex issues.

3. Definition of the problem and also of solutions vary

from stakeholder to stakeholder.4. Rarely are solutions value-free, totally objective, or

fully rational in nature.

5. Yet, they are important and have serious consequences.

6. Costs are differential and often paid by others.7. Require community-building & consensus.

8. Open-ended and hard to know when fully studied or

finally, if ever, solved.

From Cunningham & Cunningham (2006). Principles of Environmental Science. See p. 355.


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Remembering Wicked Problems Healthcare problems tend to be intractable because

they are nested within sets of interlocking issues--some involving access to healthcare resources orthe health systems, others scientific, cultural,economic, and/or political in basis.

Often poor match between bearers of costs andbearers of benefits--the Navajo example,

East St. Louis example, RMI example, etc.

No value-free objective answers exist. Best approach is often consensus building which

may be hard or impossible to do.


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Exercise: Applying Wiley

1. Name one wicked healthcare problem.

2. Name one characteristic of our economy or our

Diminishes that problem?

3. Name one characteristic of our culture or cultural

behavior that contributes to that problem?Diminishes that problem?

4. Name one way that government helps solve the problem?

Make it worse?


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A Wicked Example--SW Power


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The Flip Side of the Solution


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Two Views of Equality

Substantive

Equality/Fairness

Procedural Equality/Fairness

People can be treated fairly but in a manner that fair procedures deny fairness in outcomes.


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Choosing Means of Acting

We can choose to act individually or collec-tively to solve problems.

We can use primary groups like the family.

We can use voluntary groups or nonprofitorganizations as allies or problem solvers.

We can use private businesses to supplyand from which to buy solutions.

We can call on government to define publicinterest, solve problems, and take action.


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Why Government Gets Involved

When a primary level solution doesnt work When voluntary or nonprofit solution doesnt

work or is too limited

en a pr vate sector so ut on oesn t wor , stoo expensive, or distributes benefits and costs tooinequitably

When consensus must be built across institutionsand levels of society

When authoritative, binding decisions are neededand applicable across all of society and citizens


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Governments by Democratic Typology

Procedural/Processes/

Sructural

LOW

PuredemocraciesDemocratic

oligarchies

Distributive/substantive/egalitarian outcomes

HIGH

Authoritarian

oligarchiesAuthoritarian

democracies


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Categories of State Authority

Government or the state exist along a continuumfrom mostly democratic/participatory/open tomostly authoritarian/elitist/closed.

,including in areas like healthcare access.

In the latter, one or at most a few elites have thepower to decide what is done in society--and in

healthcare. The U.S. is a republican form of democracy--

citizens select representatives to decide action.


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Continuum of Authority Types

HIGH LEGITIMACY LOW

POPULAR ELITIST

Totalitarian/

DictatorOligarchy/

Dictatorship

Mass

democracy

Pluralist

Democracy

PARTICIPATORY/OPEN ELITIST/CLOSED

Mixture


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Principles of Democracy

Right to popular participation in decision that impact

Government by majority rule with minority rights (free

speech, free assembly, free press, petition, dissent,

, ,

Commitment to individual dignity and liberal values of

life, liberty, and property

Commitment to equal opportunity and development of

individual capacity (possibly equality of substance)

Right to revolt against illegitimate authority


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Key Framing Values of U.S.Governance & Authority

1. Freedom---for whom, in what situations/conditions, how

much

---. , ,

with how much sacrifice of freedom and why3. Equality---how much and for whom, substantive or

procedural in nature

4. Rule by the few or the many--majoritarian democracy,

pluralist democracy, or more purely elitist authority

Examples: Private versus public healthcare, single payer or

mutli-payer healthcare, etc.


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Key Features of Government

Possesses authority---decisions are binding Must maintain maximum legitimacy with citizens

Can use sanctions to enforce laws & policies

Legitimate authority can include right to useimprisonment, force and violence as means to

enforce policies and laws

Government also can legally take private property,take human life, and in general use force--evenagain state-sanctioned violence--to further enforcelaws, policies, the public will, etc.


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Institutional Complexity of Policy Making in the U.S. System


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Institutional Complexity

Founders trusted neither the people or the elites torule, preserve liberty, and make best policy.

Framers split authority between many different

institutions within government. Designed to prevent tyranny of oligarchs or

tyranny of the masses.

Makes solving wicked problems more difficult. Takes more time and is more incremental.

Often requires crisis before action will be taken.


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The Systems Model and Influencing Public Policy Making


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Features of the American System

Representative--people select others to make policy,including environmental kinds.

Representatives are to respond to citizen inputs--demands

system.

Legitimacy of policy depends on citizens playing this part

and expressing desires.

Examples: Individual student activities in support of

healthcare policy? Name any?


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The Middle Bias in American Two-Party System


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Public Choice in the U.S. Choice can be seen along a conservative to liberal

continuum.

Because of nature of the system, including the two-partyelectoral input process, representatives gravitate towardmiddle where most of citizen voters are (excluding non-

, , , , .

Healthcare policy, like most public policy, tends towardsame middle ground.

Example: Current attempts to limit healthcare costs, improvehealthcare access for children, reduce impact ofpreventable illnesses, etc.


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The Elite Dominance in Most Public Policy Making


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Elitist Slant to Public Policy Most citizens are relatively uninformed and too

busy to pay attention to most issues.

Healthcare access, healthcare provision, andaccess to healthcare resources falls down the list

voters/citizens--satisficing phenomenon. Because healthcare issues are wicked problems,

citizens prefer smarter elites to suggest,

implement, and manage policy.Question: What issues or problems are of most

interest to students today?


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The Power of Group Influence in a Pluralist, Free Society


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Group Influences on Policy

It is very difficult for the isolated and atomized

individual citizen to have influence. Best way to have policy influence is through collective

or group organization and voice.

Interest groups/lobbies are plural in number and views. Groups add more input to the policy making process and

compete for elite/representative interest.

Healthcare policy is almost always driven by acombination of elite and group dynamics.


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It Makes a Difference--Who Makes, Implements, Influences Policy


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Healthcare Group Action Healthcare nonprofit, nongovernmental,

professional, educational, and other engagedorganizations often run by well educated, highlymotivated, and often elite leadership.

and managed from above in many importantinstances.

Organizations try to mobilize interested citizens

who aid in influencing rest of the masses and inimpacting policy making elites.

Often is a very top-down process.


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Fighting for Influence The group process is like a teeter-totter.

Each group or interest tries to sway the mass ofcitizens, the elected, representatives, and othergovernment officials to its point of view.

ea t care groups compete w t a ot er groupsfor influence, including economic/business oneswith different views of how to best use resources,how, why, etc.

Influence often goes to groups with mostresources--political, economic, human, systemic,etc.


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Balancing Costs, Benefits, Social Value and Social Costs


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Defining Maximum Gain

As the previous slide shows, what often happens is that

groups fight and compete with each other to define what

will deliver the most maximum social gain with the

minimum level of loss to key groups, society as a whole,

and to especially important interests.

Most times---not all---economic benefits will trump other

values, including those prevalent in environmental and

natural resources conflicts. Jobs, for instance, in mostpeoples minds and lives will be more valued than

investment in universal healthcare, immediate creature

comforts more than taking care of ones health, etc.


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The Scientific or Rational Model of Public Policy Making


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The Problem with Rational Science The major problem with science as a model for policymaking, as depicted in

the previous slide, is that science is a rational model and process.

It depends on complex data and factual input--often difficult when solvingcomplex, wicked problems.

The scientific methods also encourages doubt.

Because people and policy makers in society are influenced by many otherthings besides logic and critical reasoning, scientific reasoning as a basis formakin olic is often at a serious disadvanta e and takes back seat to otherfactors.

It is also true that, while all benefit from the advances science makepossible, many are inherently suspicious of and hostile to scientists andscience in general.

Example: Determining the extent of, the cause of, and a solution for lack of

health insurance for 50 million Americans.


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Irony of American Democracy

The few or elite possess power Masses possess influence over multiple

elites (Pluralism--Group Model)

Upward mobility into elite is slow,controlled, selective

Elite share consensus on values and this

preserves democracy Public policy usually elite, not mass based


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When Elitism Breaks Down

Sometimes the masses are able to elect to politicaloffice elites who do not share the values ofscientific elites and science itself.

-

scientific biases and values of the leastknowledgeable and most hostile of the masses.

Sometimes nonscientific elites just dont believe

the science. Often other elites, especially economic ones,

benefit economically by ignoring the science.


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Steps in Ideal Environmental Policy Analysis

Choice, and Decision Making

Define the problem

Assemble appropriate information and evidence Identify & construct alternative policy options

Define and select decision making criteria

ro ec poss e expec e cos s, ene s, an ou comes

Confront and balance appropriates trade-offs

Influence key power and authority centers to decide

Tell your story

From Eugene Bardach, A Practical Guide for Policy Analysis, 2000.


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Environmental Policy


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The Policy Cycle

Actors work to continually define and refine thepublic agenda.

One big obstacle to overcome is getting a problem-

tenor of shocking news. Does radical rhetoric help or harm?

How radical do you have to become as an

individual? As a group?

How critical the crisis before anyone cares or acts?Among masses? Among elites?


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ROLE OF INDIVIDUAL ACTION

Become informed about what you care about andwhat you should care about!

Get involved in the political system (model).

o n or at east gat er n ormat on rom pert nentenvironmental organizations.

Influence policy elites through voice oforganizations, by voting and supporting health-

based astute political elites, write, call, givemoney, lobby/educate, be an engaged, activecitizen in our representative democracy.


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Why We Care--The Primary Level We are all members of and

are dependent upon the

healthcare system. The health of each of us is

dependent upon the

One family

of consumers/

citizensimpacted by

public policy

and impacting

resources and

ava a ty o an access

to healthcare resourceswithin society.

Our reasons for caring,including as faculty, begin

at Wileys primary level ofsociety--with our ownfamilies acrossgenerations.

Four generations

from that single

family--Frances, 93,

and Jonah, 3 months,linked by past and

present resources

consumption

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Policy models-343(2) [Compatibility Mode]