Kant Patel - Healthcare Politics and Policy in America

Health policy in the United States has been shaped by the political, socioeconomic, and ideological environment, with important roles played by public and private actors, as well as institutional and individual entities, in designing the contemporary American healthcare system. Now in a fully updated fifth edition, this book gives expanded attention to pressing issues for our policymakers, including the aging American population, physician shortages, gene therapy, specialty drugs, and the opioid crisis. A new chapter has been added on the Trump administrations failed attempts at repealing and replacing the Affordable Care Act and subsequent attempts at undermining it via executive orders.

Authors Kant Patel and Mark Rushefsky address the key problems of healthcare cost, access, and quality through analyses of Medicare, Medicaid, the Veterans Health Administration, and other programs, and the ethical and cost implications of advances in healthcare technology. Each chapter concludes with discussion questions and a comprehensive reference list. This textbook will be required reading for courses on health and healthcare policy, as well as all those interested in the ways in which American healthcare has evolved over time.

Kant Patel is Emeritus Professor of Political Science at Missouri State University, USA.

Mark Rushefsky is Emeritus Professor of Political Science at Missouri State University, USA.

Fifth edition published 2020

by Routledge

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2020 Taylor & Francis

The right of Kant Patel and Mark Rushefsky to be identified as authors of this work has been asserted by them in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.

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A catalog record for this title has been requested

First edition published by M.E. Sharpe 2005

Fifth edition published by Routledge 2019

ISBN: 978-0-8153-7633-0 (hbk)

ISBN: 978-0-367-02774-2 (pbk)

ISBN: 978-0-429-39787-5 (ebk)

Visit the eResources: www.routledge.com/9780367027742

We are gratified by the reception Healthcare Politics and Policy in America has received since publication of the first edition. It has been well reviewed, it has sold well, and it has been adopted by many colleges and universities. We thank all those who have adopted it for their courses. The first edition was the first joint research project between Patel and Rushefsky. Since that time, we have published several books on healthcare with M.E. Sharpe: Politics, Power, and Policy Making: The Case of Health Care Reform in the 1990s; Health Care Policy in an Age of New Technologies; The Politics of Public Health in the United States; and Health Care in America: Separate and Unequal. We are grateful that Routledge has picked up this project as part of its purchase of M.E. Sharpe. We appreciate the support and enthusiasm with which Routledge has allowed us to continue our work. The staff, from editor Laura Stearns to the copy-editors, have been wonderful to work with.

Patel began working on the first edition of the book while on a sabbatical in the spring of 1991. Rushefsky joined the project in 1994. It continues to be an interesting experience for both of us. We do not have the same kind of work habits. One of us (we wont tell you which one) is very meticulous and organized; the other is considerably more scattered and sloppy. This has sometimes led to noisy discussions and scampering to find things. This is the kind of book Felix and Oscar, the Odd Couple, might have written! One adjustment we did make was that the neat, meticulous one kept all the papers and files because the other misplaced his. That we remain close friends who share common interests in professional basketball (and computer games) helped the relationship. Patel, who is from Houston, roots for the Houston Rockets. Rushefsky, from New York, is a lifelong, avid, irrational Knicks fan. Patel retired from Missouri State University in 2011, and Rushefsky retired in 2014.

Both of us have had a long involvement in healthcare, dating back to the 1970s. Rushefsky first became interested in healthcare when his wife, Cynthia, began teaching childbirth classes in rural Rocky Mount, Virginia. She trained some of the nurses and the wife of the administrator of the local rural hospital (about ten miles along winding mountain roads from where they lived), and that hospital maintained its maternity ward rather than closing it. That was fortunate for the Rushefskys when their second child, Leah, was born shortly after midnight on Halloween. They just made it those ten miles to the hospital. Had that hospital not maintained its birthing facilities, they would have had to go another 25 miles to Roanoke. Given the speed with which Leah was born (so fast that she beat the doctor to the delivery room!), Rushefsky half-jokingly says she would have been born in Boones Mill (about halfway between Rocky Mount and Roanoke), which had no hospital. Updating from the first edition of this book, Leah is now married and has given Rushefsky and his wife three grandchildren, Echo, Damian, and Gabriel, to whom he has dedicated this book. Echo and Damian were born prematurely, so the Rushefsky clan has had some close encounters with the American healthcare system.

Patels interest in healthcare was developed more conventionally, as an academic. He has a lifelong belief that access to good healthcare is a right. The two of us agree that the healthcare system has problems; before publication of the first edition of this book, there was no text that addressed those problems from a political perspective.

This fifth edition has been considerably updated and reconceptualized. The first two chapters of the book remain basically the same (with updates), providing background material. We have moved the discussion of the Affordable Care Act to , new to this edition, examines reform proposals: to the Affordable Care Act and from conservative and liberal perspectives.