Administrative Responsibility in the Public Sector
April 2, 2011
Can Health Care Costs be Controlled?
Although it has been a hot-button issue for years, the heated debate surrounding health care, the way it is administered, and the costs surrounding it came into full national view during the Fall 2008 Presidential Election cycle, and some would say it became an ultimate deciding factor. It seemed that almost simultaneously the general public cried out for nationalized health care, but almost as vociferously disparaged the expected increase in costs, specifically in new taxes levied against the populous. Now almost three years later, the debate over the cost of health care and what services are administered has trickled down to the state, with recently elected Governor of New York Andrew Cuomo making it his personal crusade to “rein in” spending when it comes to Medicaid and the various services offered under its auspices. This paper aims to focus on health care on both the national and state level. First, there will be an examination of the controversial passage of the Patient Protection and Affordable Care Act in the Senate and the Health Care and Education Reconciliation Act of 2010 in the House, and how the United States of America is now facing a shifting landscape within the window of four years, specifically in terms of how health care is delivered, and the costs incurred. Additionally, there will be an examination of the situation that New York State has found itself in, and the recommendations, implications, and repercussions Governor Andrew Cuomo’s “Medicaid Redesign Team” will have on health care within New York State. These issues illustrate, far better than any other, the dilemmas of policymaking in America, both on the national and state level. There are so many questions to be answered, like what is the difference between good health and good health care? In fact, often times good medical care does not necessarily produce good health. The essential question in this issue has simply been boiled down to, how do you tackle this challenge of improving the quality of health care, and reduce the soaring costs that have come with it? This paper intends to examine this and the underlying questions at its core. Before diving into the main issues and factors contributing to ever increasing health care costs in America and how this is a main policymaking issue in American politics today, one has to point out the inherent dilemma in policymaking and public administration in general: when making and shaping policy, how do you make value judgments in public policy and managing priorities for what is “the best for all”. Taking this into account, it should come as no surprise that health care is one of the most important policy questions that public officials face today. In fact, policy makers did indeed attempted to deal with this problem in the past. According to the text “Understanding Public Policy” (Dye, 2010) Medicaid, after its establishment in 1965, has become the federal government’s largest single welfare program for the poor, with its costs now exceeding all other public assistance programs. A welfare program designed for needy people, Medicaid required no prior contributions, monies came from general tax revenue, and most recipients were already on welfare rolls. To some though, this joint venture between the federal and state governments has effectively become insufficient, leading policymakers to have to question the best way to handle how health care is administered on a national level, but more importantly, how to handle the rising costs. According to the text “Understanding Public Policy” (Dye, 2010) the United States spends roughly $8,000 per person, per year on health care. According to Dye (2010), there are many contributing factors to this, such as advances in technology creating more expensive equipment,...