The history of health care policy and politics in nursing and the health care delivery systems in the USA is extensive. In 1935, President Roosevelt signed the Social Security Act, which led to the creation of two nationwide programs that would ensure the welfare of older adults and the unemployed (Fadlallah et al., 2017). The law also introduced federal grants to the states to support programs for the older population and people with disabilities, mainly blind individuals. The Act established a social security program that enabled older adults over 65 years of age to receive public health coverage by payroll taxes (Porche, 2021). This law also introduced the state-administered unemployment insurance program and the Dependent Child Assistance Program that would assist families headed by single mothers.With time, the Social Security Act underwent further changes. For instance, the Social Security Amendments of 1965 established two major health care programs, such as Medicare and Medicaid, that provided public health coverage to people older than 65 (Porche, 2021). Thus, as both programs are sponsored by the US government, they serve the health care needs of citizens. Furthermore, the history of health care policy is closely related to the historical reform of Barack Obama that has become the peak of the long struggle of American democratic forces, starting with President Roosevelt, for the creation of the national health care system in the United States (Porche, 2021). As it can be seen, for decades, the issue of reforming the existing health care system has been one of the most pressing in the USA.
The socio-economic and financial conditions influence the most important decisions in the formation of the American health care system. In fact, the health care policy has been formed in the conditions of political struggle and public debate around reforms in this area. However, main attention should be paid to the analysis of the failed Bill Clinton’s Health Insurance Reform Bill (Porche, 2021). Today, the structure of health policy covers a complex set of legal, social, and ethical issues (Fadlallah et al., 2017). Its aim is to protect and promote citizens’ health, and the US government supports this intension by respecting human rights. Since the USA is a country with quite diverse society in terms of ethnicity and cultures, many groups have different approaches to policymaking. In this regard, health politics are made in accordance with cultural diversity. In fact, policymakers set goals for the improvements in the health care sector and determine the necessary decisions, plans, and actions that are necessary to achieve these goals (Porche, 2021). Therefore, a well-developed policy in health care can contribute to achieving set goals, as it defines the core values that underlie it and determines a long-term vision and mid-term targets.
The process of health care policy involves several steps. Firstly, it is necessary to identify the issue under consideration (Fadlallah et al., 2017). Next, policy makers gather information on the possible ways to solve this problem andf the work on solutions should begin. Since the material resources of the state are limited and the number of problems requiring attention and investment is quite numerous, the government is forced to choose only the most effective projects (Porche, 2021). Next, after gathering information on issues, policy makers develop strategies on how to address the defined problem. In this case, the authorities compare which alternatives should be accepted and which – rejected. Finally, the policy is ready to be adopted by the government, which bring changes in the state. The next step of this development process is implementation that occurs from the federal level to the local one. Eventually, the policy becomes a law. However, each policy needs an evaluation that allows assessing it and its outcomes. Admittedly, the process of developing health care policy is the result of a complex, contradictory interaction between the executive and legislative authorities of the United States with the active participation of the expert community, interest groups, and other stakeholders (Porche, 2021). Therefore, the understanding of the process of policymaking allows to identify the entire range of areas of practical implementation of a policy, its scale, spheres, the boundaries of application, and the degree of its influence in the health care delivery system in the United States.