TERM PAPER:  The Health Security Act  of 1993  as Policy History

One valuable feature of this course is that through the writing of a research paper you will instantly become an expert on the history of a current public policy, national health care policy.  This will qualify you to better understand (and lecture others on) the nature of the issue, the politics around it, a century of past policy efforts on it, and how history shaped your current policy, the Affordable Care Law (and, of course, the continuing efforts of political opponents to undo it). This sheet offers further direction on the assignment and some ideas on writing to help you convey the expertise you build in the most persuasive manner.

  1. TASK – Write an 1800 word (roughly seven to eight page) paper explaining the defeat of the effort to make a national health care policy in 1993-94.

Want more prompting?   One way to turn a simple question into a more intriguing historical challenge is to do what you’re doing with each policy history we are examining: set the issue in its historical context to see what was propelling it at the time.  For example (and you are welcome to take this as the prompt for your essay):

In the early 1990s polls regularly identified medical care access and coverage as the primary public policy concern of Americans.  Yet a high-priority Presidential initiative, drawing upon the nation’s “best and brightest” health policy minds and attentive to concerns of key “stakeholders” was thwarted in its effort to make policy.  Analyze and explain that:  why and how, despite public demand, was national health care policy thwarted in 1993-94?

Another tactic for focusing your assignment is to respond to what others have emphasized in explanation of the policy. For example, you are welcome to respond more closely to one of the interpretations that follow:

– Some scholars stressed the circumstances surrounding the issue as decisive in stopping any health care policy in the 1990s.   How did the historical context  — the “structured contingencies” in historian Charles Rosenberg’s argument, or “the background conditions that pushed the probability of success in one direction or another” in Hugh Heclo’s view – shape the 1993-4 Health Security Act  effort and its outcome?  What in the context was most important, and how decisive was the context in determining the history of the policy:  that is, was the context so powerful  — and how was it so powerful — that it was decisive in thwarting policy reform? 

– Your REMEDY AND REACTION author Paul Starr, who participated in the Clinton policy commission, has pointed out that one prominent line of interpretation of the HSA’s failure identifies the policy’s own advocates (the Administration and reformers) as most responsible for the demise.  Analyze that: Is that right? How were they decisive, and how decisive were they?  What did they do (or not do) in their policy processes and tactics, policy decisions, and presenting their ideas — that determined the course of the policy’s history?

– Other historians (like Michael Katz, Colin Gordon) argue that what made the HSA “dead on arrival” was less due to policy advocates’ strategies and more due to the effect of previous & existing policies, the existing pattern of provision of health insurance, and private interests’ aims and strategies.  Analyze that: How did these factors shape the policy history, and how decisively?  

Per the syllabus, the paper is due seven short weeks from now on November 25. The paper must include citations/notes to your sources and a bibliography.

  1. THE SOURCES –  Draw your evidence from your assigned book REMEDY AND REACTION, and articles and sources I have posted on the History 172B Gauchospace page [or in 172B TERM PAPER READER, if class chooses]. Use and reference at least three of these sources.  It is not necessary to go beyond the sources provided, though if you have found further sources that you would like to pull in to your history, they may be acceptable with my PRIOR APPROVAL (and ONLY with prior approval, at least 2 weeks prior to due date; you must bring them to class or my office hours for review).  It is not necessary to dig into primary sources – that is, participants’ or first person observers’ reports — for this paper, though you are welcome to do so and will find some key examples among the Gauchospace sources.

      Cite your sources in the paper.  Use endnotes or footnotes to cite authority for statements you make in the text when the idea or information is not your own.  You should cite opinions, original arguments, and unique facts as well as direct quotations.  To get a sense of when to foot- or endnote, look at the use of notes in the course readings (see for example RAILROADED, IMPOSSIBLE SUBJECTS or REMEDY AND REACTION).  For note style and further rules on noting, consult Kate Turabian, A Manual for Writers of Term Papers (Univ. of Chicago Press, latest edition, online).

  1. THINK ANALYTICALLY – This assignment asks you to write an analytical essay

explaining the history of this policy.  The key to analysis is asking and answering questions:  How did context, or reformers’ decisions, or prior policy (or the weather, or bears…) affect the  policymaking in 1993?  (Start with the prompt and/or alternate questions in the TASK paragraph above).  Starr’s book REMEDY AND REACTION is a good example of an analytical history, organizing the history by chapters that introduce and explain particular factors in particular periods.  Think critically, too:  For example, it may be a group’s concern for other issues, or for increasing its political power, or for gaining some other anticipated political results rather than the provision of health care policy, that guided the intentions and policy aims of participants.   Be sure your argument (the paper’s thesis) is declared clearly in your introduction to the essay.