1. What is the role of congress in policy making process?
A policy is defined as a course of action that is established by the legislature, executive or the judiciary to influence the behaviors and decisions of the citizens in a federal state. Policy making process is not a monopolized affair and, therefore, involves decisive interactions among all arms of the government and the public participation. The congress and the President participate mutually in the legislative roles to a greater extent. However, their roles are made distinct at some point. The Congress is mandated in Law making, representation of the citizens as well as an oversight role on functions of the government.
The congress cannot establish and pass policies alone and thus requires the input of the Senate before it is assented to become a bill. When a congress member introduces a bill to the congress, the bill is read in the House of Congress and subsequently assigned to the relevant committee. For instance, health policies are addressed by the health committee that is sub-divided into sub-committees, each with a different assignment. After the Bill has been scrutinized by the relevant committee, it returns to the floor of the house for further debate based on the committee’s findings. The bill is then voted, and if successful, it is passed and further sent to the senate. Before the president assents to the Bill, both the Senate and the Congress are invited for a joint conference to resolve the contentious issues thus paving way for the bill to become a policy and enacted in the constitution.
Additionally, the house of Congress performs an oversight role on the policies made by the private enterprises and non-governmental agencies. Before the policies are implemented, they undergo thorough scrutiny by the congressional committees to iron out any law that is against the public interest and contrary to the federal constitution. For instance, agencies such as Bill Gates foundation are entitled to establish health policies such as mitigation of pandemic diseases and, therefore, would have to seek the approval from the House congressional committees before they engage in their operations.
2. What is the difference between mandatory and discretionary spending?
Mandatory spending a category of government expenditure that entails the amount that lawmakers are mandated by the law to spend on certain programs. The law cannot be partially amended unless the law is re-written again .The allocation is guided by a set of enacted laws passed by the House of Congress and the Senate and assented by the President. On the other hand, discretionary spending is category of government expenditure that is based on annual budgetary appropriations Act passed by legislature. Examples of mandatory spending include Medicare and social security while military spending accounts for the largest share of the discretionary appropriations budgetary allocation.
3. What are the primary power/tools of the presidency?
The president of any State or nation is the chief executive of his or her country. In the United States, the president is the overall head of the federal government. The president is the senior head of the military and authorizes the overall force on the defense mandates to undertake. Moreover, the President has the authority to appoint personnel especially his cabinet and as well recommend exemplary people for appointment. However, all these appointments must be approved by the House of Senate. Moreover, the President appends the final assent to any bill that passes through the House of Senate and House of Congress .In addition, the has the power to veto any legislation that he/she deems worth for the welfare of the citizens. For instance, the US president had been at the forefront in advocating for the Medicare policy that caters for the health safety of the US citizens.
4. What are interest groups and what is their role in policy making process?
The government and the legislature enact policies that aim at achieving the economic and social objectives of the nation. The policies should accommodate the opinions of citizens and other non-governmental organizations to ensure that social efficiency is achieved .These groups that are considered outside the ranks of government departments are regarded as interest groups. Interest groups are defined as all those organizations whose aim is to influence the enactment of policies by lobbying for partial or full amendments of contentious issues within the clause. Interest groups embark on educating the public about the contents of any bill that has been introduced into the national assembly and awaits debate by the members of the Senate and congress before it is passed and forwarded for President’s assent.
Interest groups role neutralizes information asymmetry between the government and the members of the public. Additionally, Interest groups may blow the whistle about contentious policies that may be formed by other private enterprises to alert the government about the contravention of the rule of law. Examples of interest groups include National Association of Public hospitals (NAPH) that participates in advocating for both public and other hospitals, embark on health research of health policies and express their professional opinions about any health issue. Additionally, all health practitioners use health interest groups to express their dissatisfaction over the enactment of certain healthy policy. Another example of interest group is the Center for Budget and policy Priorities that embarks on in-depth analysis of the proposed budget estimates to ensure that the budget policies and appropriations reflect the economy of the country. Other economic and social areas where interest groups are formed include consumer federations, manufacturing groups, investment groups and many others. Most interest groups comprise of professionals in the relevant fields alongside legal experts who advise the groups on the legal procedures and limits.
Interest groups mobilize resources from their own accounts and donors to initiate grass root campaigns and lobby against the adoption or rejection of a certain policy or a clause from the bill. Additionally, the interest groups may utilize social networks and media platforms to express their opinions about policy in order to reach a wide coverage of the population. Interest groups are an indispensable factor in enactment and implementation of public policy.
5. Explain the key concepts of ‘legal right’?
Legal right refers to rules that are entrenched within the legal system and granted to a legal entity to protect it from arbitrary harassment. Legal rights are applicable to every citizen, and abuse of any individual’s rights attracts punishment. For instance, all citizens have a legal right to access their medical records without any undue influence. Additionally, all patients have a legal right to better treatment and provision of quality drugs. The concept of a legal right can only be well interpreted in a court of law depending on the nature of the issue.
6. Explain the key elements of the various sources of Primary law?
Primary law refers to those laws that are binding and originate from a government entity such as the legislature, presidency, executive or the governor’s chamber. Primary law is entrenched in a written document or a legal opinion of the court. There are many sources of primary law that include constitutions, treaties, statutes court opinions executive order, rule of court procedures, legislative bills federal register, contracts, basic laws, administrative regulations and many others. Primary laws act as the legal point of reference by the government and other interested parties whenever a contentious issue arises during service delivery. For instance, Health Acts is entrenched in the constitution and, therefore, health practitioners can express their grievances based on the rule of law that govern health profession. For example, all health practitioners have the liberty to stage a health protest to express their grievances such as better wages, as the last resort after they have exhausted all avenues of resolving the conflict amicably. They are obliged to obey the code of conduct and prioritize human life above any personal agenda.
Primary laws are original i.e. they are not duplicated from any other source unlike the secondary sources of law. Additionally, primary sources of law are restricted from any arbitrary amendments without consultations among the legislative representatives, all arms of the government and participation of the public. In case a primary law is amended or scrapped from the constitution, the current law supersedes the previous as the previous is declared null and void. Moreover, primary authority is the legal guiding platform for the secondary sources because secondary sources derive basic legal foundation form the primary laws.
7. What is the separation of powers doctrine?
The separation of powers doctrine was first introduced by social and political philosopher called Charles- Louis de Secondat in the early 18th century. In his renowned publication “Spirit of the Laws”, he divided the hierarchy of authority into three categories that include Legislative, executive and the judiciary. This model inspired the experts that drafted the United States constitution. By definition, the doctrine of separation of powers refers to distinct division of branches of power to ensure that responsibilities of different branches do not overlap. In the United States, the executive is responsible for implementing policies that have been enacted by the legislature. On the other hand, Judiciary monitors and interprets the laws entrenched in the constitution to ensure that every organization company or individual adheres to the statutes. The major importance of this doctrine is that it ensures transparency and accountability of responsibilities among employees and the helm of leadership.
Despite its distinct distribution of powers, separation of powers doctrine has not yielded promising results. Bureaucracy has been the impending factor leading to intentional overlap of powers among different departments. Consequently, service delivery has not been effective, and the output has continued to decline marginally. In the health sector, health policy defines the responsibility of different departmental heads in order of their ranks. Unfortunately, high ranking health practitioners have continued to abuse the bestowed powers at the expense of the junior employees and the society at large.
8. Describe two of the three specific roles played by the judicial branch of the government?
The judiciary is a key arm of the government safeguards the statutes entrenched in the federal constitution of the country. It is the third branch of the government hierarchy of separation of powers. The judiciary has distinct functions that include enforcement of law and order, interpreting contentious clauses on behalf of the government .The judiciary role of enforcement of law and order involves punishing law breakers based on the punishment stipulated against the violated rule of law. The judiciary performs this role by constituting different branches to represent different services. For example, the judiciary enforces the health sector laws and disputes in the employment sector through the industrial court.
In addition, the judiciary is responsible for resolving contention between different clauses in the constitution. Therefore, it is the last resort for the government and the public in seeking an in-depth analysis and interpretation of the law. The judiciary may use different approaches for interpreting the clauses in the constitution. One of the approaches is to revoke a policy that has been enacted by a public or private enterprise. The Supreme Court may declare a policy to be null and void, and henceforth the policy ceases its effect. Additionally, it may advise the relevant authority to stop implementing the policy within a specified grace period during which all relevant parties are advised to consult widely among each other and seek legal interpretation from the relevant department of the judiciary. Therefore, the judiciary acts as the government’s supervisor to ensure all entrenched rules are adhered to without bias.
9. Define the terms “Premium, “deductible” and “cost-sharing” in health insurance plan?
A health insurance plan is a legal agreement between the insurer and the individual or his or her sponsor. The contract documented entails the health policy that the individual is insured against and the terms of payments of the premium. Health insurance plan could be stipulated to cover an individual’s lifetime or within a certain period. In case the risk insured against occurs, the individual is compensated amount equal to the value of the loss incurred. The insured pays a certain stipulated amount known as Premium on annual or monthly basis to cater for the insurance policy.
Premium is the amount of money paid by the policy holder to the insurer as payment coverage of the health insurance plan. The insured and the insurer may agree on the modalities of payment that could either be on monthly, quarterly, semi-annually or annual basis. However, most insurance companies prefer a monthly basis payment method to ensure that the insurer can cater for its operational expenses.
Deductibles refer to the amount that the policy holder is supposed to pay each year after which the insurer pays its share of the compensation. The insurer may have to be treated several times before reaching the equivalent amount of the deductible, when the insurer initiates the payment for the agreed insurance policy.
Cost-sharing entails the policy rule of insurance that requires the insured to pay a certain percentage of the total insurance cost that is not covered by the insurance company. The aim of this strategy is to mitigate moral hazard contributed by human error. Cost-sharing is categorized into copayments, co-insurance and deductibles. Coinsurance refers to a percentage of the total cost of the insurance policy that the insured is required tom pay. Coinsurance cost is an extra payment besides copayment. For instance, the insurer my accept to cater for the 75% of the medical cost and thus require the insured to pay an extra amount equivalent to 25%. On the other hand, copayment refers to the fixed amount of money that the insured is obliged to pay initially before the insurance company pays for the intended service. It is worth to note that copayment is made every time the insured seeks the services of the insured policy.
10. How does moral hazard relate to health insurance?
Moral hazard refers to the intentional action by the insured to interfere with the occurrence of the insured risk with intent to gain more from the insured value. For example, an individual may obtain a partial life endowment policy against terminal diseases such as lung cancer. The insured may accelerate the rate at which he smokes and thus aggravate the effects of tobacco on the cancer symptoms. This is a moral hazard that has cost the insurance companies much money. Moral hazard results from information asymmetry between the insured and the insurer. Consequently, the insurance has embarked on investing in resources that would help monitor the behavior of the insured to mitigate the adverse effects of moral hazard.
Additionally, all insurance companies adopted the concept of cost-sharing in a bid to mitigate the effects of moral hazard and personal negligence behavior by the insured. For example, risky health insurance policies incur higher premiums than the less risky insurance policy. The amount difference between the risky and the less risky policy is equivalent to the uncertainty of individual negligence or interference. One of the core principles of insurance states that the insured shall not be directly involved in the occurrence of the risk. This stipulated rule is covered in the principle of proximate cause. Additionally, the insured shall only be compensated for only the amount equal to his or her loss. Therefore, if an individual is insured against health risk, he or shall only be compensated an amount equal to his loss. However, it is challenging to quantify the amount of loss incurred in a health hazard.
11. Identify four common demand shifters and explain how each factor shifts demand?
Change in price of substitutes: increase in price of a related good result in a subsequent rise, in demand of the other good. For example, if the premium of an insurance company rises, prospective clients will shift to another company offering the same policies at a lower price.
Change in individual income: A decrease in consumer’s income may prompt the insured to change his health policy to a lower-priced policy thus leading to decrease in demand. A rise in income may influence the individual policy holders to adopt high-premium policies that could cover longer periods. This action results in a decrease, in demand of the lower priced health policies.
Change in consumer tastes and preference: All consumers of goods and services are rational and, therefore, will choose the insurer of their choice depending on the insurer’s physical characters. For instance, demand of a new insurance company that offers varieties of policies may rise than that of an old insurance company whose products and modalities of operations are analogous.
Expected change in price of a good or a service: If prospective policy holders anticipate that policy laws would change in the recent future, they may opt to delay subscription to an insurance policy thus resulting in reduced demand. Additionally, insured policy holders may delay in renewing their policies in anticipation of a reduction of premiums.
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