Electoral Competition, Polarization, and the Breakdown of Elite-Led Social Learning

2020 ◽  
pp. 142-160
Author(s):  
Eric M. Patashnik ◽  
Alan S. Gerber ◽  
Conor M. Dowling
Keyword(s):  
Problem Solving ◽  
Social Learning ◽  
Comparative Effectiveness ◽  
Health Care Quality ◽  
Care Quality ◽  
Social Progress ◽  
Quality Improvements ◽  
Partisan Polarization ◽  
Partisan Competition ◽  
Zero Sum

This chapter evaluates the politics of the Obama administration's effort to promote comparative effectiveness research (CER) as the scientific foundation of health care quality improvements and cost control. It argues that elite polarization and a near parity of partisan competition degrades government problem solving in two ways. First, it creates incentives for politicians to transform what plausibly could be consensual “valence” issues, on which nearly all candidates and parties adopt the same stance, into contentious “position” issues, on which candidates and parties take different stances in a zero-sum competition for voter support. Second, elite partisan polarization can stimulate polarization among ordinary voters. Taken together, these twin dynamics can undercut the processes of elite-led social learning and technocratic problem solving on which social progress to no small extent depends. The chapter shows how these distortions played out in 2009–10, when the Obama administration moved forward with its proposal for a major investment in research on the comparative effectiveness of medical treatments, despite the lack of public buy-in for this reform project.

Capitation, Advances in Medical Technology, and the Advent of a New Era in Medical Ethics

1996 ◽  
Vol 22 (2-3) ◽  
pp. 331-360 ◽  
Author(s):  
Michael J. Malinowski
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
The United States ◽  
Care Quality ◽  
Care Needs ◽  
New Era ◽  
For Profit ◽  
Zero Sum ◽  
The Impact ◽  
Care Costs

Health care is being capitated throughout the United States, and much of the spread of capitation is attributable to the efforts of insurers to contain costs. The present lack of comprehensive studies evaluating the impact of capitation on overall health care quality leaves vast room for speculation.Capitation does, however, carry a very fundamental certainty with broad implications. Whether the arrangement calls for a fixed sum for treating a particular ailment, a set fee for meeting all of an individual patient’s health care needs, or a standard charge for supplying all the medication for a specific condition, capitation sets limits. Because the health care costs for any given patient or condition are in reality zero-sum rather than fixed, capitation is about pooling patients and rationing. It involves denying services to some patients despite a general contractual commitment to coverage, presumably so that more patients can be covered or receive better care. The implications of capitation are even more significant when set fully in the context of the overall health care reform now underway. Simultaneously and comprehensively, health care is being managed, made for-profit, and consolidated.

Zero-Credit Politics

2020 ◽  
pp. 110-141
Author(s):  
Eric M. Patashnik ◽  
Alan S. Gerber ◽  
Conor M. Dowling
Keyword(s):  
Health Care ◽  
Problem Solving ◽  
General Public ◽  
Health Care Quality ◽  
Care Quality ◽  
Policy Agenda ◽  
Medical Evidence ◽  
Medical Products ◽  
Electoral Incentives ◽  
Medical Products Industry

This chapter examines how the politics surrounding efforts to address the medical evidence problem have been “unhealthy.” It shows that while the pragmatic case for bringing standardized evidence more systematically to bear on decisions in health care is compelling, federal politicians took only modest actions to support steps to identify and eliminate wasteful, unnecessary services between the 1970s and late 2000s. Moreover, politicians (responding to their electoral incentives) were quick to abandon even these incremental reforms when they sparked opposition from providers and the medical products industry. In sum, the government's performance as a problem-solving institution with respect to health care quality and efficiency was doubly disappointing. First, the medical guesswork problem was a low-priority concern, barely registering on the policy agenda; it was an “inside initiative” in which the conversation excluded both politicians and the general public. Later, when the medical evidence problem began to generate the broad attention it deserved, proposed solutions became the object of partisan manipulation and political distortion.

Stakeholder Experiences With Gender Identity Data Capture in Electronic Health Records: Implementation Effectiveness and a Visibility Paradox

2020 ◽  
pp. 109019812096310
Author(s):  
Hale M. Thompson
Keyword(s):  
Health Care ◽  
Gender Identity ◽  
Health Care Quality ◽  
The United States ◽  
Care Quality ◽  
Data Capture ◽  
Care Providers ◽  
Quality Improvements ◽  
Extended Case Method ◽  
Electronic Health

Background Advocates have endorsed transgender visibility via gender identity (GI) data capture with the advent of the Affordable Care Act and electronic health record (EHR) requirements. Visibility in data in order to enumerate a population contrasts with ways in which other LGBT and public health scholars have deployed these concepts. Aims The article aims to assess the effectiveness of GI data capture in EHRs and implications for trans health care quality improvements and research. Method Semistructured interviews were conducted with 27 stakeholders from prominent gender-affirming care providers across the United States. A range of informants shared their experiences with GI data capture. Interviews were coded, themes were identified, and the extended case method was used to contextualize data in relation to key concepts. Results Data capture is effective for increasing patient counts and making quality improvements but limited in terms of enhancing gender-affirming care depending on provider size, type, and competencies. Many challenges were highlighted regarding use of GI data for research, sharing GI data across systems, as well the ways data capture erases the dynamism of GI. These issues create conditions for limited kinds of disclosure, capture of particular categories, and care and treatment barriers. Discussion Stakeholders exposed a visibility paradox emerging from GI data capture. While data fields are created to increase the visibility of trans persons in medical settings and in health research, they work to increase the visibility of some while reducing the visibility of other gender diverse persons, including trans, nonbinary, and cisgender. Conclusion New approaches are needed to explore implications of GI data standardization and the logics of health care in the face of gender expansiveness.

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