Public Policy Sixth Edition
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| Chapter 12
Steps to Analysis: The National Security Agency and Domestic Surveillance (box) 447 Steps to Analysis: What Is the Cost of the Global War on Terrorism? (box) 460 Foreign Aid Given by OECD Countries, Total (in billions of dollars) and as Percent of Gross National Income, 2015 (figure) 462 Top Foreign Aid Recipients, 2016, Including Military Assistance, Estimated (figure) 463 Steps to Analysis: Should Passenger Aircraft Be Equipped with Antimissile Defense Systems? (box) 470 Chapter 13 Steps to Analysis: Money in Politics (box) 506 Steps to Analysis: Using Websites to Influence Public Opinion and Policy Debate (box) 509 Preface
Forecasts about likely future conditions often are hard to make. But we can be sure of one thing. Health care costs are going to soar in the coming decades as the baby boom generation continues to age and demands an array of increasingly expensive medical services. From 2008 through 2013, U.S. health care spending grew by less than 4 percent annually, one of the lowest rates in more than fifty years, providing some modest relief from what had been an unrelenting upward spiral in costs. In 2014, the rate increased somewhat from these levels, rising to 5.3 percent, following a 2.9 percent rise in 2013, largely because of expanded coverage under the Affordable Care Act; and in 2015, the rate increased again, to 5.8 percent. Total health care spending rose to a record high of $3.2 trillion in 2015, or almost 18 percent of the nation’s gross domestic product (GDP). The United States spent $9,900 per person for health care in 2015, a figure certain to grow substantially over the next decade. Indeed, the Centers for Medicare and Medicaid Services projects that per capita spending on health care by 2025 will be an astonishing $16,032 and that overall health care spending will rise to $5.6 trillion, or nearly 20.1 percent of GDP. The new spending figures were released in late 2016, more than six years after President Barack Obama succeeded in gaining approval from Congress for his sweeping changes in health care policy, the Patient Protection and Affordable Care Act of 2010, also known as Obamacare. One purpose of the act was to slow the rate of increase in the nation’s health care spending. Whatever effects the complex and far-reaching act may have, assuming that it survives continuing legal challenges and opposition by Republicans in Congress as well as the administration of President Donald Trump, we are still likely to see an ongoing rise in national health care costs. What is the best way to deal with these ballooning costs, particularly in light of other trends—for example, continuing high levels of obesity—that could drive up costs even further? How should we protect the solvency of the Medicare trust fund as demands from baby boomers threaten to bankrupt it and jeopardize benefits for future generations? Indeed, what forms of health care and Social Security will be available to the generation of citizens now in their teens and twenties? What are the alternatives from which we must choose, and on what basis should we decide? Such public policy decisions touch nearly every aspect of daily life in the United States, although many people fail to recognize or fully understand their impacts. Social Security reform, for example, may not seem terribly urgent to most young people today, but it undoubtedly will shape the quality of their lives decades down the road. This is why citizens need to understand not only how governments make policy choices but also how to evaluate those choices in what is often a sea of conflicting and misleading information and arguments. We believe the reason to be politically aware is simple: policymakers are more responsive to the public’s preferences and needs and, in some cases, are more effective when citizens take a greater interest in public affairs and play a more active role in the policymaking process. We hope this text stimulates readers’ interest and concern while equipping them with the skills they need to think critically and creatively about policy problems. The subtitle of this book—Politics, Analysis, and Alternatives—explicitly expresses what we are trying to accomplish, which differs from conventional books on public policy. This text integrates three aspects of public policy study: government institutions and the policymaking process, the concepts and methods of policy analysis, and the choices that we make collectively about substantive public policies at all levels of government. Throughout, we focus on the interrelationship of government institutions, the interests and motivations of policy actors both inside and outside of government, and the role of policy analysis in clarifying public problems and helping citizens and policymakers choose among policy alternatives. These central themes are reinforced by providing students with the tools they need—how to find key and reliable information, how to use specific evaluative criteria, how to apply policy analysis methods and critical thinking, and how to assess the role of politics in policymaking—to investigate issues and carry out policy analysis on their own. We believe that this hands-on approach is the best way to teach the skills of analysis and give students not only an understanding of the conduct of public policy but also a way into the process. Download 115 Kb. Share with your friends:
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