Stability and change in health care politics

This dissertation examines the politics of health care reform in the United States from the Carter to the Clinton administration. The stable coalition that dominated the health policy reform debate until the late 1970s has broken apart. Yet reform efforts continue to be limited compared to the approaches taken by other democratic nations. This study explores three important episodes of health care policy making in the United States in order to describe and evaluate the role of business-state relations and policy feedbacks in health care policy. By linking the literature on business and policy reform with the idea of policy feedbacks, this dissertation improves our understanding of business state relations and our understanding of health care politics.;The policy feedback argument claims that actions taken by the state often impact the nature of the demands articulated by interest groups, political parties, individuals, and the state itself. The use of an open-ended, fee for service method of reimbursement by private health insurance and the Medicare and Medicaid programs was inherently inflationary. This system, operating within the context of declining economic growth, has placed enormous strains on federal and state budgets. This eventually forced the federal government to become more aggressive with the medical community.;The escalation of health care costs also led to a breakdown in the long standing alliances between business and the health care industry. Many suggest that the power of organized medicine is due, in part, to their close ideological and political association with corporate leaders. As representatives of the business community began to view the current health care system as a threat to economic growth, however, their support for existing health care policies eroded. This resulted in greater support for reform by elected officials in Washington, D.C.;Despite these shifts, major policy reform was defeated in 1993. Our health policy legacy worked to divide reformers and focus the efforts of opponents. Until a fundamental restructuring of the health care system takes place, the problems of the health care system will continue. Unfortunately, our policy legacy makes the prospects for major reform unlikely.