The ratification and finally, the implementation of the details and provisions of the Patient Protection and Affordable Care Act (PPACA), or what is more popularly known as the Obamacare have been the topic of the hottest news and cause of public and private debates not just nationwide but also worldwide. The objective of this paper is to look at and review the PPACA in light of the important principles and concepts about public policy decision making presented by Lindblom in his highly influential work.
Obamacare and the Science of Muddling Through
Charles Lindblom authored one of the most influential articles related to policy making and public decision making. This work of his was entitled The Science of Muddling Through. In it, he explained the different ways, based on his personal and professional views, how bureaucrats make decisions when it comes to creating new or revising existing policies, especially those that carry the possibility of creating a significant social impact. The factor that he emphasized in his article was the rationality of the bureaucrats’ ideas and decisions. He presented and reviewed different approaches in public policy decision making including but not limited to the Rational Comprehensive Approach and his collective ideas on how to test whether an existing or a currently proposed policy is a good or a bad one.
According to Lindblom (1959), a sound policy must be based on a “clarification of values or objectives distinct from and usually prerequisite to empirical analysis of alternative policies”; policy formulation approached using a means to end analysis where the ends are isolated first and then followed by a process where the means to achieve them are planned and implemented; based on the fundamental idea of testing a sound policy that suggest that it (the currently proposed policy) must be the most appropriate means (among all other possible means) to the desired ends; the analysis and testing must be simple and comprehensive where all important and relevant factors are taken into account; and lastly, where the supporting theories are heavily and consistently relied upon.
The PPACA has been one of the highlight policies of the Obama Administration. Unfortunately, it has only been signed into law in 2010, after numerous delays. The cause of the numerous delays was the strong opposition of a significant number of members of the House and the Senate. Apparently, the main reason behind the opposition of the PPACA’s eventual ratification was the issue on the economic and fiscal sustainability issues that may arise as a result of the implementation of the details and provisions of the PPACA .
The main goal of the proponents of the PPACA was to introduce a policy (i.e. the PPACA) that would dramatically improve the quality, affordability, and accessibility of medical and healthcare services. With the PPACA, the policy makers (i.e. proponents) planned on doing this by expanding public and private insurance coverage and reducing the cost of healthcare for the government and individuals . However, the problem was that the proposed dramatic improvements in healthcare accessibility, affordability, and quality come at the expense of putting the already problematic situation on the management of the federal budget deficit at risk.
All in all, Lindblom’s article can help one easily understand Obamacare by serving as a criteria that policymakers can use in their policymaking activities. This is because in Lindblom’s article, he discussed key concepts on how policymakers can make rational decisions. So based on the key principles raised by Lindblom in his article, can the Obamacare be considered a sound or good policy? The clear answer is a no. This is because even though it attempts to create a significantly positive social impact in terms of healthcare management (i.e. its ends); it appears that the means that the policymakers have chosen to arrive at those ends would only lead to a whole new set of problems. In this case, the Obamacare has already violated one of the key principles of good policy as discussed by Lindblom.
Kay, J. (2009). History Vindicates the Science of Muddling Through. Financial Times.
Kocher, R., & Adashi, E. (2011). Hospital Readmissions and the Affordable Care Act: Paying for Coordinated Quality Care. JAMA.
Kocher, R., Emanuel, E., & Deparle, N. (2010). The Affordable Care Act and the future of clinical medicine: the opportunities and challenges. Annals of Internal Medicine.
Lindblom, C. (1959). The Science of Muddling Through. Public Administration Review.