Politics and Media

1. Politics and Media M6920 October 9, 2001

2. Goals • Explore the relationship between policy and politics • Describe the role of media in US political life • Use health reform as a case study of these issues M6920, Fall, 2001

3. Politics • About the distribution and use of power • Can occur in any setting, but generally associated with the allocations of power and resources in public system M6920, Fall, 2001

4. Sources of power • Heredity • Economics • Information • Charisma • Assembled M6920, Fall, 2001

5. Power is experienced as • Ability to reward or punish • Ability to determine what is done with knowledge • Ability to distribute resources • Ability to exercise referral power M6920, Fall, 2001

6. Electoral politics • Who gets chosen • Nominations • Financing • Communications M6920, Fall, 2001

7. Executive/legislative politics • What is on the agenda • Who sets/controls the agenda • What solutions are considered • What solutions are chosen M6920, Fall, 2001

8. Balancing and Competing Interests Specific Benefit General Benefit Specific Burden General Burden M6920, Fall, 2001

9. Interest groups • National/local • As forums for discussion • As lobbying/ pressure groups Act Now!! M6920, Fall, 2001

10. Professional association as an interest group • advocating for its members • advocating for its ‘clients’ • advocating for its supporters or suppliers M6920, Fall, 2001

11. The Internet • Almost all candidates and elected officials have web sites • Rapid distribution has unquantified impact • Fund-raising potential huge • Equity in access is important M6920, Fall, 2001

12. At the intersection of • Problems • Alternatives • Politics Actions and policies M6920, Fall, 2001

13. Responses as issues emerge • National actors later rather than earlier • State/local officials are front line • Politicians engage when not reacting has more negatives than reacting • Trying to avoid blame (from CH Foreman, Jr 1994 Plagues, Products and Politics, Washington, DC: Brookings Inst) M6920, Fall, 2001

14. Interest groups/ constituents Established and directly involved--representing victims Newly established by the emergence of new victims Opportunistic Press Fire alarms Breakthroughs Controversies Human interest Responses, cont. M6920, Fall, 2001

15. As experienced in “drive through delivery” debate • Agenda building (Kingdon model) • problem recognition • formation of proposals (often by policy entrepreneurs) • political mood of the time M6920, Fall, 2001

16. Was shorter stay. . . • testimony to the system sensitivity to mother’s wishes to home sooner? • reflection of the ability of technology to shorten unnecessary stays? • economic decision imposed on mothers and doctors by greedy insurers? M6920, Fall, 2001

17. Apparent solution was simple: • an extra day in hospital fixes all • almost no discussion of alternative models of discharge/home care • personal experiences of legislators were critical M6920, Fall, 2001

18. In the debates • hospital-based doctors and nurses very positive • those more committed to home care negative • ACNM apparently silent M6920, Fall, 2001

19. The politics • in 15 of 23 states adopting law, the single sponsor of the bill was female • reasons for sponsoring: • shift control to women • avoid negative consequences • fear that insurers wouldn’t act on their own M6920, Fall, 2001

20. End result • largely symbolic and nonpartisan • no governmental resources invested • an exception to ERISA was inserted Declerdq E & Simmes D. 1997 The politics of ‘drive-through deliveries’: putting early postpartum discharge on the legislative agenda Milbank Quarterly 75@ (175-202). M6920, Fall, 2001

21. How a bill becomes law • A civics lesson in pictures. . . M6920, Fall, 2001

22. As legislator introduced it M6920, Fall, 2001

23. As committee reported it M6920, Fall, 2001

24. As House amended it M6920, Fall, 2001

25. As Senate amended it . M6920, Fall, 2001

26. As passed into law M6920, Fall, 2001

27. As agency understood it M6920, Fall, 2001

28. What budget allowed M6920, Fall, 2001

29. What the taxpayer wanted M6920, Fall, 2001

30. Conflicting goals: Health Insurance Reimbursement Conflicting ideas: Government provides Incentives to induce Punishments to enforce Poor management of the debate Failure to keep an eye on the big picture Skewed media presentations Overlapping political agendas Politics of health reform M6920, Fall, 2001

31. Media • National • Professional • State/local M6920, Fall, 2001

32. Politics and Media • Power distributions and agendas influenced by what is said • Communications mechanisms of media are used by wise politicians • Role of media in free society often cited as critical M6920, Fall, 2001

33. Anticipating the Bush presidency • Medicare? • Children? • Research and academic health centers? M6920, Fall, 2001