Health Policy, Politics, and Nursing Power in the US

Introduction

This paper outlines several high-level issues in the American healthcare system. At this level, the discussion centers on questions such as the political environment, the influence of key stakeholders, and existing power structures. By analyzing the healthcare system through these lenses, observers can better understand why good ideas are — or are not — successfully implemented. Five central questions are addressed, beginning with the impact of socioeconomic and sociopolitical factors on US health policy.

Socioeconomic and Sociopolitical Factors

One of the most critical issues in the US healthcare system is the socioeconomic disparity in health outcomes, which is typically driven by differential access to care. Lantz, House, and Lepkowski (1998) found that mortality risk was a function of income, with the lowest-income groups in their study bearing the highest mortality risk. While there are numerous potential causal factors — each worthy of its own study — the fundamental link is clear: socioeconomic status affects health outcomes. Braveman and Gottlieb (2014) noted that wealth provides better access not only to healthcare, but also to healthy lifestyles, since affluent areas typically have more parks, recreation facilities, and greater access to healthy food choices.

This reality should, in theory, lead poor and middle-class Americans to strongly favor political action that expands healthcare access — but that has not proven to be the case. This is where the sociopolitical dimension becomes critical. Healthcare access has become highly politicized in recent years. Many Americans who would otherwise benefit from policies that expand healthcare access are aligned with the Republican Party, which has routinely sought to limit such expansions. This creates an unusual sociopolitical environment in which there is strong political will to maintain the status quo, even though most Americans, in principle, favor better access to healthcare.

This is not to suggest that universal healthcare would otherwise be a straightforward policy outcome in the US. A strong capitalist worldview prevails in American society — one in which even health is treated as a commodity to be bought and sold. This outlook is widespread across the population and is sufficiently entrenched that arguments in favor of alternative healthcare models often fail to gain meaningful traction. This sociopolitical environment is largely absent in most other OECD countries, the majority of which have instituted far greater healthcare access than currently exists in the United States.

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