Speaking Notes

PADM 5791

January 13, 2009

Dr. Neubauer

WHERE WE ARE

· First class meeting

· Review syllabus

· Review calendar

· Take attendance

· Preview part of Chapter 1

CHAPTER 1 -- HEALTH CARE POLITICS

To say that there is a health care policy in the United States is misleading for a variety of reasons.

• We do not have a unitary system of government.
• The nation is not homogeneous. Different regions and locations have different needs.
• Policy is composed of multiple kinds of documents including legislation, codes, agency policies, executive directives and court orders.

• Our federal system of government was designed by men who shared a healthy distrust of authority and of government power.
• The political system they designed was intentionally fragmented and inefficient owing to a complex system of "checks and balances."
• Our system of government is not only FEDERAL but it is a system called PLURALISM.
• On top of that we have the three branches of government evident at each level of federalism.
• The Founders did not like interest groups so they concluded that the presence of many of them (pluralism) would itself be a form of balance.
• The original system assumed that the national government would survive on the voluntary contributions of money by the existing state governments.
• The relationship between the House and the Senate is clumsy. Every member of the House is continually running for reelection. Six-year terms in the Senate are staggered.
• Federal judges including Justices of the Supreme Court have life-time tenure.

Important things that the Founders glossed or did not anticipate:

• The emergence of political parties to further fragment the institutions of government.
• The power of organized interest groups.
• The emergence of huge and numerous federal agencies, often referred to as "the bureaucracy."
• The emergence of powers of taxation tending to shift power toward the national government.
• The ability of incumbent politicians to stay in office seemingly forever.
• The political powers of those employed to administer the federal agencies.
• The unionization of many government employees.
• Turf battles among federal agencies and between federal agencies and state/local agencies.
• COZY relationships involving legislative committees, federal agencies and powerful interest groups making NEEDED RATIONAL CHANGES almost impossible to pass politically and implement administratively.
• A system that makes it difficult for elected officials to take the high road and make difficult decisions with a LONG TERM PERSPECTIVE.
• The emergence of modern means of communication creating 24-hour news cycles potentials for political discourse to become increasingly negative and "bi polar."
• A proliferation of laws and codes seemingly without limit or end.
• A failure to anticipate globalization and the need for governments to join agile relationships with other kinds of organizations to survive economically and politically.

IN FAIRNESS, the Founders crafted a political document for the times in which they lived. A more ambitious solution to their immediate problems would probably not have been accepted by the people.

Some conservatives see the Constitution as almost a divinely inspired document and regard it as if words etched in stone. Others would say that 200+ years is not a long time in the larger scheme of things and that the Constitution continues not only through formal amendments but through the continual interpretation of its meanings.

The point is that such a system cannot be expected to produce comprehensive rational decisions or comprehensive rational policies.

Political outcomes are the consequence of power.

Agreement to abide by a constitution is fragile. Successful pluralism requires a willingness to accept the consequences of the system even when the consequences are not acceptable to individuals. What is required to win elections threatens the fragile fabric of our nation. There is no assurance (Divine or otherwise) that our nation will not someday break apart along either ideological or regional differences. The breaking apart of the former Soviet Union is evidence that the world does in fact change in dramatic ways.

The cost of this situation is that what passes for policy being far less than objectively rational, for multiple reasons of political origin.

The bureaucracy (so often the scapegoat for problems that in fact have political origins) can be viewed as what helps smooth the fragmented political system.

In order to pass legislation politicians must often write vague and even contradictory laws that become parts of codes to be administered by public administrators. Just as a cook often interprets a recipe, public administrators often use their ADMINISTRATIVE DISCRETION to fill in the details and to extend laws by the creation of administrative rules (pursuit to the laws governing rulemaking). That discretion often extends all the way down to the level of "street level bureaucrats."

Continuing the analogy to cooking, the EXECUTIVE is often in the kitchen also. After all, the agencies are part of the executive branch of government and the replacement of one chief executive with another (through voting) is assumed to have the potential to make a difference in terms of what government agencies do.

Federalism is a strange notion that both the national government and each of the state governments (plus Indian nations) can be sovereign at the same time. How this irrational idea plays out in practice has evolved in the history of the United States. Cities and counties are subdivisions of state governments but they sometimes have relationships with the national government and it is sometimes said that there are three layers (or levels) of government in the United States. And then there are the special districts. The Indian (Native American) nations are still political entities said to be sovereign and having some political powers. And on top of all this fragmentation and complexity is the fact that a very large part of what governments do involve contract relationships with nonprofits and for profit organizations.

SOMEHOW POLICY IS SUPPOSED TO EMERGE FROM this assembly of interests and institutions that now exist in the United States of America in the early 21st Century.

It is in the nature of evolutionary systems to somehow use parts that were created for needs long past. When a species becomes too burdened with luggage from its history to adapt to new needs it usually eventually goes extinct.

TO A LIBERAL MIND, the strength of a political system is its ability to shed what it no longer needs and to adapt as quickly as its environment changes. To liberals, hope resides in change and adaptation.

Perhaps to A CONSERVATIVE MIND the strength of a political system is associated with the idea that there are absolute and eternal truths and that security can only be found in steadfast allegiance to those truths and associated values.

Human brains have frontal lobes comprising two hemispheres. Under the frontal lobes are the structures of what many biologists consider to be the consequences of the evolution of the brain. We commonly speak of the hemispheres as the left and right brain. In a sense our nation has a divided DEMOCRATIC BRAIN (the political right and the political left) both under girded by political history of our nation's experiences to date.

To continue to function as a nation we must sustain PLURALISTIC VALUES sufficient to prevent our flying apart ideologically. Means of communication such as Talk Radio seem not to serve to sustain pluralistic values. It is yet uncertain what the effects of the World Wide Web will be regarding the future or failure of democracy.

PUBLIC POLICIES (such as they are) are the product of the underlying structures of our fragmented political system and the contest of wills between liberal and conservative political perspectives.

In one sense policy is what the words (in a legal code) say. In another sense, policy is what actually, somehow gets done.

Reasonable people can disagree regarding whether public administrators should be more attached to the words or to their reasonable interpretation of what can be done given the political and economic landscape.

You may want to read carefully President Eisenhower's farewell speech giving attention not so much to his military concerns as to his unclearly stated concerns regarding the future of the nation and the future of the administrative agencies of the national government.

http://www.h-net.org/~hst306/documents/indust.html