Prescription for Pennsylvania: An Analysis

Issues surrounding healthcare have been discussed and debated for decades. Like anything that is considered more a process than a product, healthcare policy is an ongoing effort, a perpetual work in progress. With this said, it is probably unreasonable to expect a quick fix, a program or policy that will mend everything we believe is broken in the U.S. healthcare system and also provide the healthcare each citizen wants and believes they are entitled to. There are just too many stakeholders to accommodate; too many individual expectations; too many special interests. As a nation, we haven’t even settled the “healthcare as a right vs. healthcare as a privilege” issue, a debate that has been ongoing since the early twentieth century. “Do Americans have a fundamental right to health care, and is it the obligation of government to secure that right? The answer would seem to be, Depends upon whom you ask and when you ask it” (Engelhard & Garson, 2008, Sect. II, para. 15). As the cost of healthcare in the U.S. skyrockets, more and more citizens are without insurance, and the quality of the care continues to be questionable; the time may be right for a drastic change, a change that continues our longstanding pursuit of that ever-elusive goal of affordable, high-quality healthcare for all U.S. citizens.

Ideas are plentiful, consensus is negligible. No one can seem to agree on how to go about fixing our healthcare problems. Many are proposing a gradual approach, an approach that is frequently utilized in process improvement methodology. Others believe the gradual approach will not get at the underlying structural anomalies and will do little to affect our dysfunctional healthcare system; they want change, not simply modification (Ruff, 2007). Most stakeholders are somewhere in between. Much of what has been proposed is fraught with bias, the bias that comes from special interest group influence. We haven’t been totally paralyzed by the lack of consensus on how to fix our healthcare problems. Programs have been tried and policies initiated. But so far, we haven’t found the right mix of strategies nor the right system level (local, state, or federal) to affect sustainable change and put us on a trajectory to meet our healthcare goals. There have been successes (Medicare, Medicaid, SCHIP), and there have been failures, most notably, the Clinton Health Services Plan (1994).

Proposals to make significant reforms to the U.S. healthcare system have been prominent throughout nearly every recent U.S. president’s term, from Franklin Roosevelt to Bill Clinton. Special interests have consistently been able to convince the public that national healthcare reform will take away more than it will give. The two main drivers of healthcare reform, the disproportionate growth in healthcare spending and the number of uninsured Americans, have reached the highest levels in history (Engelhard & Garson, 2008). As Kingdon’s Model of Agenda Setting and Policy Formulation (1995) asserts, the “window of opportunity” for establishing policy to revamp the U.S. healthcare system may be now, with the three streams, the Problem stream, the Policy stream, and Political stream appearing to be associating to create the opportunity for policy change (Holy Family University, 3/03).