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...…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…