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It Doesn't Get Worse Than This: Institutional Dilemmas of Policymaking in Health Care

Abstract: The failure of the Clinton health care reform plan in 1993 led to increased attention to the difficulties in making comprehensive health care policy in the United States. Many elements contribute to difficulties in this area; in this paper we provide evidence concerning the institutional structures of Congress. Using a new dataset consisting of every congressional hearing of the entire post-war period, we compare health care to other areas of congressional concern. We find that committee jurisdictions are more fragmented in the case of health care than in any other case. Congressional attention to health care dates mostly to the creation of Medicare. A huge increase in congressional attention in a topic that had not previously been the subject of sustained congressional attention (and, therefore, well defined committee jurisdictions) led to the piecemeal and haphazard division of committee jurisdictions. Within the subtopic of health care insurance reform, an area of particular interest, jurisdictional clarity is near a low point, even within the already low levels associated with health care in general. The paper demonstrates each of these findings, ending with discussions of how such a situation developed and of the implications for policymaking.

Home Papers Policy Agendas Project Other Projects Books Position Papers		Papers It Doesn't Get Worse Than This: Institutional Dilemmas of Policymaking in Health Care Abstract: The failure of the Clinton health care reform plan in 1993 led to increased attention to the difficulties in making comprehensive health care policy in the United States. Many elements contribute to difficulties in this area; in this paper we provide evidence concerning the institutional structures of Congress. Using a new dataset consisting of every congressional hearing of the entire post-war period, we compare health care to other areas of congressional concern. We find that committee jurisdictions are more fragmented in the case of health care than in any other case. Congressional attention to health care dates mostly to the creation of Medicare. A huge increase in congressional attention in a topic that had not previously been the subject of sustained congressional attention (and, therefore, well defined committee jurisdictions) led to the piecemeal and haphazard division of committee jurisdictions. Within the subtopic of health care insurance reform, an area of particular interest, jurisdictional clarity is near a low point, even within the already low levels associated with health care in general. The paper demonstrates each of these findings, ending with discussions of how such a situation developed and of the implications for policymaking.

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