18.Context

18.Context - The Context of Decision-Making on the Floor 1...

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Unformatted text preview: The Context of Decision-Making on the Floor 1 Health Policy Again Lets say the policy subsystem that cares about health policy finance was trying desperately to find a way to control spending. Here are the options: cut back reimbursements to primary hospitals: Result, people suffer from lack of local facility when they have a heart attach or stroke. cut back reimbursement to tertiary referral hospitals: Result, lower the quality of research and care. cut back reimbursement to rural referral hospitals by reclassifying some of them as primary. Result, lower quality medicine in those particular communities. #3 seems least painful. HCFA starts writing rules for the reclassification. Q. How does this play in member districts? for example, this district? What would NC4 want its member to do on this issue? 2 What then about decision-making on the Floor? (Based on (Matthews & Stimson 1975).) How does roll-call voting differ from the context in policy subsystems? 1 Focus: Normal decisions, the everyday kind, not the highly unusual votes highly visible, speeches played on evening news, universally reported, etc. 1. Reported on inside pages of New York Times , not at all in typical newspapers or TV. 2. Few people outside the small number professionally concerned with hospital funding even aware the issue being discussed. 3. Not party-line issue (but simply because Democrats and Republicans typically see things differently, partisan division will be found in the vote anyway). 3 What does it illustrate? Complex Nothing simple like pay/dont pay for health care, and not good guys/bad guys stuffa serious issue that will affect the quality of peo- ples lives in many communities (although they will never probably be aware of it). Specific Not the creation of broad policy, but an incremental change, that is: one more step in a direction already long taken. Technical To make an intelligent decision, you need to know a great deal about hospital finance, the history of medicare/medicaid legislation, delivery of health services (e.g. what technology is cost efficient or inefficient in what kinds of communities, the trade-offs between the desirability of building centers of medical excellence vs. the desirability of local access when need arises, the supply of medical personnel and its influence on costs of care, and on and on) None of these are things you can just leave to the experts to decide, because how you come down on this issue (or vote if it becomes one) depends upon how you answer these questions. 2 And yet, complex issues also involve fundamental questions of allocating values, literally in this case who will live and who will die where you live has a measurable effect on whether or not you will recover from certain conditions, on whether or not babies will survive from difficult or unusual birth,...
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This note was uploaded on 11/27/2011 for the course POLI 100 taught by Professor Rabinowitz during the Fall '07 term at UNC.

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18.Context - The Context of Decision-Making on the Floor 1...

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