Chapter 14 addresses the future of health services delivery including health reform initiatives, politics, innovation, and global threats to the U.S. health care delivery system.  Our country’s health care delivery system cannot be separated from health policy (see Ch. 13).  Health policy is developed within the political levels of our government (e.g., legislative and executive branches) and the bureaucratic levels of our government (e.g., administrative agencies such as the Centers for Medicare and Medicaid Services, Dept. of Labor, state insurance commissioner offices, etc.)  Health policy ebbs and flows with society and the economy.  As society changes, so does society’s views on what the U.S. health delivery system should look like.  As the economy improves or worsens, so do budgetary allocations.  However, while some health policy initiatives change with the political regimen in power, other policy initiatives such as Medicare, Medicaid, CHIP, VA and similar publicly funded health programs have become so engrained in the U.S. health system that they are viewed as entitlements. 

Regarding politics, Senator Ted Kennedy from Massachusetts fought hard, long and unsuccessfully for national health reform.  Bill Clinton took the presidential office for the first time in January 1993, and  immediately got to work on universal health care.  Hillary Clinton led the charge, overseeing a task force that proposed a highly bureaucratic and federally-controlled health care delivery system.  In spite of having a majority Democratic Congress, Clinton was not successful in getting universal health care. 

Barak Obama took office in January 2009.  In June 2010, the largest health reform effort since at least 1965 was passed into law.  While not a universal health care system, the Patient Protection and Affordable Care Act of 2010 fundamentally changed significant aspects of the health care delivery, access and payment systems in the United States. 

Please respond to the following question (which appears on p. 561 of your text): 

“Why do you think the Clinton health reform failed but the Obama health reform succeeded?”