The history, structure, and process of health-care-policy and politics in nursing

n recent decades, the focus has shifted to reform, driven by rising costs and a lack of universal access. The most significant development was the Affordable Care Act (ACA) of 2010, which aimed to expand coverage through subsidies, mandates, and the expansion of Medicaid. This period highlights the constant tension between market-based and government-regulated approaches to healthcare.

Structure of the Healthcare System

The U.S. healthcare delivery system is a complex and fragmented mix of public and private entities.

Public Sector: This includes government-funded programs like Medicare, Medicaid, and the Veterans Health Administration (VHA). These programs are funded through taxes and serve specific populations. The public sector also includes state and local health departments responsible for public health initiatives.

Private Sector: This is the dominant part of the system, comprising private insurance companies, private hospitals, and for-profit clinics. Most Americans get their insurance through their employer.

This structure lacks a unified, national system, which leads to significant disparities in access, cost, and quality.

The Process of Policy and Politics

The process of healthcare policy and politics is driven by a wide array of stakeholders and interests. It's a highly political process influenced by lobbying, public opinion, and the legislative process.

Agenda Setting: A problem, such as rising drug costs or a lack of access, is identified and gains public and political attention.

Policy Formulation: Various solutions are proposed by different groups, including politicians, think tanks, professional associations (like nursing organizations), and industry lobbyists. For example, during the ACA debate, numerous proposals for expanding insurance coverage were considered.

Policy Adoption: A chosen policy is passed into law. This involves legislative debate, voting, and the potential for a presidential veto. The passage of the ACA required significant political maneuvering.

Policy Implementation: Once a law is passed, government agencies like the Centers for Medicare & Medicaid Services (CMS) create and enforce regulations to put the policy into action.

Policy Evaluation: The implemented policy is reviewed to determine its effectiveness and identify any unintended consequences. This can lead to further amendments or new policy debates.

The Role of Nursing in Policy and Politics

Nurses are increasingly active in this process. As the largest group of healthcare professionals, they are uniquely positioned to advocate for policies that improve patient care.

Advocacy: Nurses lobby lawmakers on issues such as full practice authority for advanced practice registered nurses (APRNs), patient safety regulations, and funding for public health programs.

Expertise: Nurses bring a vital clinical perspective to policy discussions. Their firsthand experience with patients and the healthcare system provides valuable insights into the real-world impact of policies.

Leadership: Nursing organizations like the American Nurses Association (ANA) are powerful political forces, mobilizing nurses to vote, contact their representatives, and run for office. This involvement ensures that the nursing perspective is heard at all levels of government.

Sample Answer

History of Healthcare Policy and Politics in the U.S.

The history of healthcare policy in the United States is marked by a long struggle between different visions for the system. Early healthcare was largely private, with a focus on individual responsibility and charitable care. The first major government intervention came with the Social Security Act of 1935, which laid the groundwork for future healthcare programs.

The modern era of healthcare policy began in 1965 with the passage of Medicare and Medicaid. Medicare provided health insurance for Americans aged 65 and older, and Medicaid offered coverage to low-income families and individuals. These programs created a significant government presence in the healthcare market and established a two-tiered system of public and private insurance.