Medical policy

This study explored the work of nursing and the social influences of eugenic policies established during the Progressive Era (1890-1930) on the writing and passage of the Social Security Act of 1935. The research questions: "Did eugenic philosophy and practice influence the Social Security Act of 1935 in relation to Maternal Health Policy?" and 'What was nursing's influence on the Social Security Act of 1935?" required the social history research method. Data were evaluated with the conclusion that eugenic policies did influence the writing and passage of the Social Security Act. Also, that nurses, and other women, played a specific, important and constructive role in developing the Act. During the late 1800s and early 1900s prominent leaders of business, science, philanthropy, and social reform supported the eugenic agenda to assure the wellbeing of hard working "Anglo-Saxon" American citizens. Industrialization and scientific advances in medicine gave Americans the impression that the "production" of healthy, intelligent children could be controlled, efficient, and predictable. Better breeding as a means for social improvement, which fueled the eugenics movement's use of science to solve social problems through governmental involvement, had two sides. Positive eugenics increased information on health and illness prevention, and established well baby clinics; however, negative eugenics advocated controlled reproduction through sterilization of persons considered "unfit." By 1935, twenty-eight states had eugenic sterilization laws. Noted reformers during this time (Lillian Wald, Jane Addams, and Florence Kelley) worked with Presidents Theodore Roosevelt and Woodrow Wilson to establish the Federal Children's Bureau. The Bureau had a direct influence on the maternal and child health policy established by the Social Security Act of 1935.

In 1993, a group of unionized bedside nurses took control of their state nursing association. In 1995, they disenfranchised themselves from the American Nurses Association, which historically had billed itself as - THE voice of the profession of nursing. This study utilizes a case study format to look at who they are, what their intentions are, and what their vision is for the future of the profession. Twenty questions were submitted to key participants identified by the California Nurses Association (CNA). The questions were organized into three main areas: the period leading up to the disenfranchisement, the period of growth after the takeover up until the historic passage of the ratio laws and whistle blower protection, and the period after the passage of the laws wherein the association began a national movement. This movement continues to evolve, and in December, 2009, the CNA (now the National Nurses United) became the largest nursing organization in the country. As the title of the study implies, one intention of the study is to look at the implications for the profession of nursing and the inevitable political implications for the national healthcare debate. Another purpose is to introduce this group to the academic and professional nursing communities, which until now have largely ignored them. Still another purpose is to lay out a blueprint for other state nursing associations who may wish to empower themselves, to analyze the process by which this group has grown to political prominence. No other nursing association has been able to duplicate their political success. Finally, the study raises many crucial questions which nursing academics and nursing leaders must address if nursing is going to able to utilize our only real political power, the power of numbers. Uniting the field, or at least growing the association to significant numerical strength, is the only way nursing can become an equal partner in the national healthcare debate.

Breast and prostate cancers are the most commonly diagnosed forms of cancer in women and men in the United States. The federal government has played an active role in dedicating resources toward breast and prostate cancers since the early 1990s, when policy actors successfully lobbied Congress to adopt policies that increased awareness and spending. Using theories of social construction, I argue that the key to their success was the ability of these policy actors to socially construct the illnesses of breast and prostate cancers into politically attractive public issues that appealed to federal policymakers. Through the use of embedded collective case study and content analysis of newspaper coverage and congressional data, this dissertation demonstrates how the social constructions of these illnesses impacted the way that breast and prostate cancers were treated as they moved through the policy process. The way in which social construction influenced the types of policies that were adopted to deal with these illnesses is also examined. Because social construction is a multidimensional and dynamic process, several different elements of this process were examined in this dissertation: the ways that policy actors attracted attention to these illnesses, how gender influenced advocacy efforts, the symbolic aspects of these illnesses, and the way the illnesses were defined on systemic and institutional agendas. Since this dissertation examines two different policy issues, the similarities and differences in breast and prostate cancer policymaking were analyzed. I found that discussing breast and prostate cancers in relation to their social constructions provides support for the importance of symbolism and non-rational policy-making processes.

My study focuses on oscillating political context to find what factors are conducive to the proposal and ultimate success of executive-generated, liberal health care policy. When it comes to initiating policy change, most of the existing literature concentrates on individuals in Congress or local level politicians. Beginning with the advent of the so-called "Modern Presidency" during the early years of the twentieth century, the President has increasingly played an active role in government, particularly with respect to legislation--he can be considered a "policy entrepreneur." I use data on variables from 1959 to 2004 and employ the Two-Stage Conditional Maximum Likelihood Model. I find that a more liberal President is likely to propose health care legislation that necessitates increased government involvement. I also determine that Congress is more likely to approve a liberal Presidential proposal when the government is unified and public opinion polls indicate people are more receptive to government intervention.