Health policy overview and implementation

Health Policy
Introduction
This paper will outline some of the high-level issues in the American health care system. At this level, the discussion centers around issues such as the political environment, the influence of key stakeholders and power structures. By analyzing the health care system through these lenses, the observer is able to better understand why (or why not) good ideas are implemented (or not). There are five central questions that will be addressed in this discussion, starting with the impact of socioeconomic and sociopolitical factors on US health care policy.
Socioeconomic / sociopolitical factors
One of the most critical issues in the US health care system is the socioeconomic disparity in health outcomes. This is typically driven by access to care. Lantz, House & Lepkowski (1998) found that mortality risk was a function of income, with the lowest-income groups in their study having the highest mortality risk. While there are a number of potential causal factors, each worthy of its own study, the basic fundamental link is that socioeconomic status affects health outcomes. Bravenman & Gottlieb (2014) noted that wealth gives better access to healthcare, but also to healthy lifestyles, in that wealthy areas have more parks, recreation facilities, and better access to healthy eating choices.
This should, in theory, lead poor and middle-class Americans to strongly favor any political action that increases health care access, but that has not shown to be true. Enter the sociopolitical dimension. The health care system, and access to health care, has become highly politicized, certainly in recent years. Many Americans who otherwise should favor policies that would expand access to health care, and who would benefit from such programs, are identified with the Republican party, which routinely seeks to undermine health care access. This creates an odd sociopolitical environment where there is strong political will to maintain the status quo, despite most American favoring better access to health care, at least in principle.
This is not to say that universal health care would otherwise be a done deal in the US. There is a strong capitalist interpretation of society in America, and a version of capitalism where even health is something to be commoditized and traded. This social outlook is prevalent among a wide swath of the US population, and is sufficiently strong that arguments in favor for other health care systems often fail to gain meaningful traction. This sociopolitical environment does not exist in many other OECD countries, most of which have instituted far greater access to health care than exists in the US.
Impact of healthcare politics
Healthcare politics recently has seen an expansion of health care access under the Affordable Care Act, multiple attempts to undermine key components of the ACA, and a certain amount of uncertainty, where key stakeholders simply do not know what the political environment is going to be, as power in Washington in particular fluctuates and health care is affected by these fluctuations.
Patients are a critical stakeholder that are often affected negatively. Uncertainty helps nobody, coverage levels wax and wane depending on the political climate, and so do cost controls. Because cost and access are related, the constant changes in the political environment have a significant impact on patients and their families.
Governments are affected by this as well, in the sense that an incredible amount of governmental energy is going towards trying to shape the course of health care in the United States, and not necessarily with much success. Furthermore, ever-changing policies, and the importance of health care, both seem to mean that politicians work a lot on health care, even if they don’t necessarily bring about change (Patel & Rushefsky, 2014).
The nursing profession can sometimes seem caught in the middle. Nurses work with patients, and often have to see patients who are struggling with health care access. Not just that, but nurses will sometimes face budget issues, and that can mean reduced hours, or working with lesser supplies, or fewer nurses. While nursing remains a growth industry, the reality is that the amount of money that is in the health care system, compared with the overall demand for health care, will have an impact on what nurses do, the nature of their jobs, and whether overall nursing is a favorable position to be in.
Healthcare is one of the most heavily-regulated industries in the US. This seems counterintuitive for many people, but the government is the largest payer, and both the insurance industries and health care service delivery are highly-regulated, to say nothing of drugs and medical equipment. Each individual regulation can affect the nursing profession, and overall the amount of regulation, its tone, and the degree to which it is enforced will all play a role in how nurses do their jobs, and whether or not they will gain satisfaction in their roles.
The legislative process and lobbies
Healthcare is the single largest lobbying sector, and accounts for at least 15% of all lobbying activity (Landers & Sehgal, 2004). Some of this lobbying is more along the lines of getting funding for specific projects, but a lot relates to ensuring that the structure of the health care system is relatively intact. Pharmaceutical and health product companies, whose products are subject to regulatory scrutiny, are among the biggest lobbying groups.
The legislative process, therefore, is influenced by this lobbying. Social capital is an important part of lobbying, as lobbyists must have the ears of key politicians in order to get their messages through to influence the legislative process (Carpenter, Esterling & Lazer, 1998). There is little doubt, however, that on a high level, lobbyists do have influence, as the shift represented by the ACA, and the shift back under the Trump Administration indicate. These high level shifts over how much regulation should be in health care, and how much government should work to ensure health care access for all Americans, is a constant source of lobbyist efforts, because the underlying principles of the US health care system are quite different from other benchmark systems, but the key corporate stakeholders in particular need to lobby to ensure that the system remains favorable to their interests.
Nurses have lobbies, too, even if they are not the most powerful. Ultimately, nurses need to participate in the power structure at a formal level, and that means lobbyists who can convey the right messages to the right power, so that nurses do have an impact on the political process, and are not just bystanders being affected by the work of other stakeholders’ lobbyists. While lobbying definitely has negative connotations for many, nurses are fully capable of leveraging this tool to increase their political power.
Nursing power
Nurses may not have much individual power, but collectively nurses have power in a few different ways. First, nurses do have advocates and lobbyists at the political level. But the power nurses have goes beyond that. First, nurses have organizations that work to advance the interests of all nurses. These organizations are necessary because the common perception is that among individual nurses, apathy towards politics is common (Boswell, Cannon & Miller, 2005). Their study cited several barriers, such as time constraints, feelings of powerlessness, sex issues and a lack of understanding of the political process. However, larger nursing organizations can foster this expertise, and gain much of their insight from their members, and the issues that their members face on the job each day.
Furthermore, nurses have power in their journals and other publications. These publications can express ideas, thought pieces and other concepts that might help the nursing profession to galvanize around particular issues. Publications combined with organizations can be critical for advancing ideas, building teamwork among those nurses are who inclined towards political activity, and provide funding for lobbyists and others who can advance these ideas through the political process.
While nurses may often be disinterested in the political process, there are some fairly compelling reasons why they might wish to participate more. For one, nurses are a key stakeholder, and on the front lines. This means that changes to the regulatory or political environment are going to affect the work that nurses do. Nurses have key knowledge that can ensure that regulatory changes have a positive impact, and nurses are in a position to notify lawmakers about unforeseen difficulties that might arise from some policies. Nurses being advocates for patients also can play a key role in driving change in the political process that will benefit patients. For these reasons, nurses should be more politically active, and definitely should take advantage of the formal power structures that exist to help nurses contribute politically.
Impact of Regulatory Organizations on Healthcare Delivery
The impact that regulatory organizations should have on healthcare delivery is that they should ensure that the laws are being followed. This should make health care delivery more streamlined, especially if the laws themselves are reasonable and logical. Regulatory bodies also ensure that standards are maintained, which should be a strongly positive impact on healthcare delivery. For the problems that the US health care system has with access, the actual quality of service delivery once access is gained, is actually quite good, and the regulatory bodies do play an important role in maintaining the standard of service.
For nurses, it is important to learn about the regulatory standards, and ensure that their work falls within those guidelines. The guidelines exist to provide patients with some sense of security with respect to healthcare provision, and there is little reason why nurses should find fault, on a high level, with that concept. There might be individual rules or laws that nurses might struggle with, but ultimately the regulatory bodies exist to ensure a high standard of care, and nurses generally should agree with that.
Regulators therefore can have a fairly significant impact on healthcare delivery. While the intent is that this impact is positive, that might not always be the case, especially where regulations prevent some service delivery, or limit access to health care services for some people. Nurses often will stay out of this part of health care service delivery, but it can impact on their jobs as well. This, again, is one of the reasons that nurses should be politically active where possible, so that they can have an influence over the legislative process, and in doing so ensure that the regulators are doing the right kind of work that helps improve overall service delivery, and not getting in the way of people trying to do their jobs and help patients.
References
Boswell, C., Cannon, S. & Miller, J. (2005) Nurses’ political involvement: Responsibility versus privilege. Journal of Professional Nursing. Vol. 21 (1) 5-8.

Braveman, P. & Gottlieb, L. (2014) The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports. Vol. 129 (2014 Supplement 2) 19-31.

Carpenter, D., Esterling, K. & Lazer, D. (1998) The strength of weak ties in lobbying networks: Evidence from health-care politics in the United States. Journal of Theoretical Politics. Vol. 10 (4) 417-444.

Lantz, P., House, J. & Lepkowski, J. (1998) Socioeconomic factors, health behaviors and mortality. JAMA. Vol. 279 (21) 1703-1708.

Landers, S. & Sehgal, A. (2004) Health care lobbying in the United States. The American Journal of Medicine. Vol. 116 (7) 474-477.

Patel, K. & Rashefsky, M. (2014) Healthcare politics and policy in America. 4th Ed. Public Integrity. Vol. 17 (1) 94-96.