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An Introduction to Health Policy and Law

An Introduction to Health Policy and Law Program Transcript

JOEL TEITELBAUM: Politics plays a huge role in the development and implementation of health policy.

NARRATOR: Joel Teitelbaum is the associate professor and vice chair for academic affairs in the Department of Health Policy at the George Washington University. He's also the school's director of the Hirsch Health Law and Policy program. Professor Teitelbaum co-authored The Essentials of Health Policy and Law for students studying law and policy as a component of their public health studies.

As a university professor and an academic lawyer, Joel has influenced health policy and the policymaking process.

JOEL TEITELBAUM: Two of the three branches of government are by intent by design political. So the executive branch and the legislative branch, the two branches of government that are tasked with designing and implementing health policy and laws, are by their design political, because we elect them. They're imbued with power as a result of federal and state elections.

So you from that starting point, you have to understand that anything that goes in the policy making and the legal process is going to be political. The Affordable Care Act, for example, passed without any Republicans signatures. And you can see, after it was passed and it's being implemented that fully half of the states, most of them led by either Republican governors or legislatures, are actively challenging or ignoring the law.

So it's clear that obviously politics is playing a very important role in both the design at the outset and now the implementation of the Affordable Care Act. Over the past century or so, there have been many examples of important health policies that have really changed the delivery of public health services in this country. I think a good starting point is with the Public Health Service Act in 1944, which at that point consolidated a lot of the health policies that were in existence and greatly expanded the role of the Public Health Service.

From there, you can look to the 1960s when we had the passage of Medicare and Medicaid, which of course gave health insurance and really did a lot to improve the public health for the elderly and for the disadvantaged and poor. The Community Health Center program, which has really influenced public health, was passed in 1965, was when the first health center opened.

From there, you can look at the Affordable Care Act of course in 2010. I think the Affordable Care Act has very much influenced the notion of health care as either a right or a privilege. I think it has taken us further away from the idea of health

An Introduction to Health Policy and Law

care as a privilege and closer to the idea of health care as a right. Now, the way that the Affordable Care Act mainly did this was through the creation and the regulation of new health insurance markets.

And there is clearly not a one to one correlation between having health insurance and health care as a right, because even with health insurance, there's no guarantee that someone will get quality health care or any health care at all if they can't access it. But I do you think that the Affordable Care Act has played a large role in helping the country move toward understanding that what it means to have an equitable and fair health care system means having access to insurance which then in many cases will then lead you to health care access.

Even after implementation of the Affordable Care Act, there's going to be 10s of millions of people without insurance. So the idea that we're somehow close even to universal insurance leading towards a right is still pretty far away. My experience in influencing health policy I think I can talk about in two different ways.

The first is what I have learned about what it means to be a health policy advocate or influential health policy maker or someone who can help influence the design of health policy. Broadly speaking, I think you have to have a lot of stamina, you have to be a very good team player understand that no one individual given the multifaceted nature of health policy making can have as great an influence as they can if they're working with, say, lawyers and economists and others. I think you have to have a fertile political environment, because again, as we've seen, something like the Affordable Care Act barely even passed even though it is something we've been working toward for many, many decades in this country.

In terms of my own experience, my role in thinking about health policy and law and the research and teaching and writing that I've done has spanned several topical areas. I started off working on behavioral health care issues in law and policy-- so substance abuse and mental health issues. That transformed into work around managed care law and policy, which then morphed into an interest that I brought the job which was health care civil rights, and after that into health care reform and implementation.

So along the way, I've been able I think to influence health policy in each one of those areas through articles, through presentations, I've testified before the DC council, I've written testimony for Congress. So there have been a lot of different ways I think as a university professor and as an academic lawyer that I've been able to influence the policy making process.

So what are some of the pearls and pitfalls of writing a health policy analysis? I'll give you a handful. The first one is that you should not go into the writing a policy analysis with an outcome in mind. You've got to be open minded and be able to

An Introduction to Health Policy and Law

really take a look at what the data says, what the literature says, and be thinking creatively about what all the various options are, as opposed to going in with one outcome in mind.

The second thing is that the advice that you give, the final recommendation that you make to the policymaker, whoever that may be, has to be within that policymaker's power to achieve. There's no point in giving advice that there is no either political environment for or is within the power of the policymaker to actually carry out. Another one is that you have to address all sides of a policy issue.

When you're writing a policy analysis, it's not enough to look at two or three, even if they're good, options. You have to address all sides of the issue. Otherwise, the policymaker won't really be able to make an informed decision. You can't be giving superficial advise. As the policy analyst, as the writer of a policy analysis, you have to be very well informed, oftentimes better informed than the policymaker him or herself.

It's you they're going to be relying on. And you have to be incredibly informed. So the giving of superficial advice is really something that you shouldn't do in crafting a policy analysis. Oftentimes students forget in writing a policy analysis that giving the recommendation to do nothing is an option. In fact, it is an option.

So when what you're doing is considering a policy question and thinking about what the options are, sometimes doing nothing, leaving things as they are, the status quo, is the best thing to do. A lot of times, students believe that they need to recommend a change just for change sake. I don't think that's always the best advice.

An Introduction to Health Policy and Law Additional Content Attribution Teitelbaum, J.B., & Wilensky, S.E. (2013). Essentials of Health Policy and Law (2nd Ed.). Burlington, MA: Jones & Bartlett Learning. MUSIC: Creative Support Services Los Angeles, CA Dimension Sound Effects Library Newnan, GA Narrator Tracks Music Library Stevens Point, WI

An Introduction to Health Policy and Law

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