Rationing medical care is a very important subject. Many low-and-middle income people lack health insurance and could not afford an expensive treatment if it were needed. The best care is given to those with money enough to pay for it or with good insurance plans paid for by employers.
With the costs of health care increasing much faster than the rate of inflation, major changes in public policy will be needed, or to deny some kinds of care to some people.
( I ) From Public Purposes to Public Policies
Public policy consists of government's choices of actions intended to serve the public purposes. It is the bridge that connects the public purposes with the intended results for which administrators are responsible. Policies give government agencies authority and direction to spend money, supply personal services, restrict business practices, and carry on all governmental activities.

Policy Sources

a. Public policy takes several forms:

1- The most familiar policy form is the 'statutory law', enacted by Congress, State legislators, and local boards and councils.

2- Court decisions interpreting statutes and constitutions, and they are binding on legislators and executives.

3- Rules and orders issued by executives and administrative agencies, for they extend and apply the statutory law in greater detail.

4- Budgets of all governments, for they set the levels and objectives of spending as well as the amounts and sources of revenue.

b. Another key source of public policy is international relations:

Some policies cross national borders, taking the form of treaties and less formal working agreements between governments.
Ex: American relations with other countries and with private foreign enterprises. Making and adjusting such policies require negotiations with those governments, and will shape domestic policies in such as labor relations and environmental protection.

C. Policy in a more general sense also incorporates the informal statements and intentions of key decision-makers in government.

D. Administrators play a crucial role in formulating public policy because of their specialized knowledge and experience in implementing current policies. In general, the higher the administrator's stand in the government hierarchy, the greater will be his influence on the substance of its policy. On the other-hand, many high-level administrators lack expertise in their given policy area, and may not remain in their posts long enough to sustain their influence.

( II ) The Policy Cycle Begins: Setting the Agenda, Defining Problems, and Setting Objectives

The steps need not be taken in this order, and several can happen simultaneously, nor is the movement in only one direction.

1- Agenda Setting

Setting the agenda involves choosing the issues that warrant serious consideration for making or remaking policy.

There are two kinds of agendas:

a. Popular agenda, which is the list of problems and issues in which the general public is most interested. Opinion polls report that unemployment, crime, or lack of medical insurance heads of concern in a given month.

Issues rise and fall on this agenda because of such factors as media publicity, they reflect what government is already doing-well or badly. These issues can also vary regionally or locally.

Only a limited number of issues can hold the public's attention at anyone time, and as a new one rises, an old one must fall whether or not it has been resolved. Both success and failure of the action can be the reason of its removal from the agenda.


b. Institutional agendas, in contrast, consist of those items that government bodies or leaders rank as high priorities for action. These concerns reflect the popular agendas but emphasize specific matters on which some agreement is possible.

Ex: At a time, when the public is worried about crime, legislators' agendas may include proposals to put more police on the streets or increase prison terms for violent offenders.

Administrative departments and agencies also have internal agendas that develop from assigned missions.

Admission of an item to an institutional agenda is controlled by 'gate keepers', such as chief executives and legislative leaders.

2- Defining Problems

While they are setting the agenda, policymakers must also define the problem that faces them. A problem is essentially a gap between a current and a preferred situation. Every disparity between the actual and the desired is defined as a problem and is assumed to have a solution and one better than any other alternative.

In politics, no problem is given in the sense that everyone will regard it in exactly the same terms. There is no objective description of a situation, there can only be portrayals of people's experiences and interpretations.

One participant chooses definitions of problems to convince others that his concept of the issue is the most accurate and thus his proposed solution is the best.

Most issues that appear on popular and institutional agendas are familiar ones. There are no permanent solutions, but only permanent problems. They are there because they haven't yet been solved not because the earlier attempts have failed so much, but because they have been replaced by new versions of the problem or new causes.

Other problems are familiar but call for radical redefinition because of the failure of current policy.

Another group of problems is much smaller, which is the new ones that are so unlike others as to call for unique definitions.

Ex: Spend on research to map the entire human gene structure to be beneficially for the human health and well being.

Many agenda issues return for reconsideration on a schedule that is determined either by the legislated life of a program, or by the rapidly changing character of the problem.

3- Setting Objectives


A typical problem statement points to some potential objectives for solution, each attractive to specific persons and groups and each attainable in some degree but not fully compatible with one another. Such statements are most effective when expressed in concrete terms.

Ex: To reduce the incidence of death due to kidney disease by 50% in 2 years.

When there is a legislative struggle over which objectives will dominate, the final statement that goes into the policy is usually vague enough to encompass most of the favored ones.

Objectives can have many sources:

1- The ethical values of a society, such as the obligation to preserve (protect) life. Legal and professional standards interpret and expand these values and lay specific obligations on responsible people, particularly in government.

2- Society available resources. No matter what its current achievements are, a technological society always feel obligated to set its goals beyond them

3- Citizen's demands. Objectives must provide the most advantages for them.


( III ) The Policy Cycle continues: Discerning, assessing, and Choosing Alternatives

The objectives selected directly guide the choice of alternative policies. Choices involve selecting one course of action from several options with the expectation that the selections will serve the policymaker's purposes.


4- Discerning the Alternatives

In searching for alternative courses of action, policymakers usually begin with the 'short list' of ideas with which they are familiar, each of these ideas is suggested or mandated by the definition that influential people have already given the problem.

If time is short or political pressures exist, policymakers often 'satisfice' with the information they have. This means that the end the search before they analyze every alternative and decide on the basis of what they do know. But where the known solutions do not suffice for politically significant people, the search will continue.

Since politicians are likely to have already defined the problem and set the objectives, they have also thought about which alternatives are preferred, which can be mentioned and which must be excluded. So, controlling the number and kinds of alternatives considered is the essence of the political game.

Government administrators frequently suggest policy alternatives in the field of their expertise. Trough feedback from the operation of programs, implementation can lead to innovation. If bureaucrats find a program is not going to well in some particular, that recognition might feed into a policy change.

Similar to the international transfer of ideas ...