The Public Policy Process:

Health Policy
Mon, Oct 24

Dr. Gregory Schober

Plan

Decision-making and Policy Analysis

Birkland, Ch. 8 (continued)

Small Group Discussion

Federal Politics and Lobbying for ACA
Brill, Ch. 5-6

Reminders

Early voting
October 24 - Nov 4
Thurs, Oct 27
UTEP Campus, Union East 1st floor (Andesite Room,
102B)
8am-5pm

Short Paper #2
Posted on blackboard soon
Due on Nov 9 (start of class)

Models of Decision-Making
Rational-Comprehensive DecisionMaking
Bounded Rationality and
Incrementalism
Garbage Can Model

Rational-Comprehensive Decision-Making

Decision-makers act as rational actors

Assumptions
Goal: to address a problem
All relevant information is gathered
Multiple options are analyzed
Best option is selected

Do human beings generally act like this?

Example: Selecting a Major/Minor

Volunteer?
Did you gather all possible
information about every single
major?
Did you compare the costs/benefits
of each major?

Rational-Comprehensive Decision-Making

In practice, this model is (almost)

never achieved
Limits on processing information
Too time-consuming

We do not act as rational actors

according to this definition of
rationality

Bounded Rationality and

Incrementalism
Bounded Rationality (March and Simon 1958)
People act as rationally as they can within certain limits
(time, information, ability)

Decision-makers thus take small steps, rather than

giant leaps
Incrementalism

Criticisms
Some problems require bold actions
Spending data suggests that inaction is common until a
breaking point is reached, then major change occurs

Garbage Can Model: Cohen et al.

Organized anarchies
Example: universities

Problems, solutions, and participants

are floating around
Solutions are looking for problems
just as much

Criticisms of the Garbage Can Model?

Not all groups/agencies are as
anarchic or unmanaged as a
university
Human actors are still bound by the
same limits or constraints

Federal Politics and Lobbying for ACA

Small-group discussion
New group members

So far, which decision-making model best

fits the evidence on healthcare reform
efforts?
What are some examples of politicians being
intentionally vague?
Why do they choose to provide few details?

Key Actors: Obama Campaign Staff

David Plouffe
Campaign manager

David Axelrod
Senior campaign advisor

Neera Tanden
Senior Domestic Policy Advisor
(healthcare focus)

Presidential Campaign Politics:

General Election

Interesting anecdote
Pollsters advise Obama to not talk about
healthcare reform

Obama decides to talk about healthcare

reform
Reason: he wants to move on it quickly if elected

Obama-Tanden exchange
Will probably need to have the mandate!

Key Actors: President Obamas Staff

Rahm Emanuel
Chief of staff
Politically moderate (practical)

Tom Daschle
Secretary of HHS
Healthcare czar in the White House

Jeanne Lambrew
Senior Advisor
Left-leaning (UT Professor)

Valerie Jarrett
Real Chief of Staff
Long-time mentor

Obama Administration:
Early Transition Efforts

Pressing Problem
Economic recession

Many advisors say:

Focus only on economic reforms

Decision
Combine economic reform efforts with
healthcare reform efforts

Unexpected Political Play: End of 2008

Senator Baucus releases a white paper on
healthcare reform
General reform plan (very vague)

Why release such a vague paper?

What happens next?
Lobbyists pounce
Pharmaceuticals, insurance, medical devices,
provider groups, patient groups, etc