The Politics of Heath Legislation: An Economic Perspective (3rd ed.)

Citation

Sen, K.C. (2009), "The Politics of Heath Legislation: An Economic Perspective (3rd ed.)", International Journal of Pharmaceutical and Healthcare Marketing, Vol. 3 No. 4, pp. 397-398. https://doi.org/10.1108/17506120911006074

Dr Paul J. Feldstein's The Politics of Health Legislation: An Economic Perspective (3rd ed.) provides a comprehensive survey of the economic and political factors influencing health legislation in the USA. In comparison to his previous book Health Associations and the Demand for Legislation, which concentrated on producer regulation, Dr Feldstein's current book also examines important issues such as the control of medical research and redistribution programs.

The book is divided into 13 chapters. The introductory chapter provides the historical reasons for the rise in medical expenditures. It also discusses the distinguishing features of legislation governing producer regulation, externalities related to market failures and redistribution. Redistribution legislation covers the topic of providing benefits to one group without making them pay the full costs of that service. In addition to providing a framework for the rest of the book, the first chapter has an interesting discussion of alternative theories for viewing legislation and their impact on the health care objectives of an improvement in efficiency and the goals of redistribution. Here, Dr Feldstein succeeds in setting the future discussion of health care legislation in a real life context. One of the books' highlights is a finely tuned balance between the provision of a theoretical framework and the discussion of real life issues.

In Chapter 2, Dr Feldstein describes the interest group theory of government. Here, he discusses the power of different producer and consumer groups in various legislative assemblies. He contrasts the economic theory of legislation with the public interest view of government. Chapters 3 and 4 examine the role of health associations and their influences on the demand for legislation. The author discusses the demand for deregulation with examples from different industries in the transportation, financial and telecommunication sectors. He shows that the decline of profits and anti‐trust concerns can lead to the decline of regulation in different industries. This chapter segues into the next (Chapter 6), which discusses the role of market competition in the US healthcare system. Chapter 7 is devoted to some important externalities dealing with the support of medical research and the tackling of epidemics and the environment. This chapter is particularly topical as it contrasts a previous government response to an anticipated swine flu epidemic in 1972 with its reaction to AIDS in 1981. While these cases are now over two decades old, Dr Feldstein's analysis of the principle influences is still pertinent in today's context.

Chapter 8 examines the different redistributive programs that exist in the USA. Here, the political clout of senior citizens group is contrasted with that of younger generations who do not have a right to vote. The book goes on to discuss the passage of Medicare in Chapter 9. Chapter 10 covers the legislation that affected redistributive health care up to the 2000s. Chapter 11 moves on to cover the Medicare Modernization Act of 2003. The highlight of this chapter is a section on what the future holds for Medicare. The author points that after 2011, estimated Medicare expenditure will start exceeding Medicare taxes by increasing amounts. Thus, Medicare financing is in urgent need of reform.

The two concluding chapters of the book deal with prospects of having national health insurance and the politics of health legislation. Dr Feldstein indentifies the most controversial impending health legislation issues as those dealing with redistribution issues. The reduction in the number of workers per aged person has declined from 16.5 to 3.4 between 1950 and 2000. This statistic is projected to decline to 2.2 by 2020. The author addresses the need to control rising health insurance premiums. He suggests that the competing public interest and self‐interest theories lead to different conclusions about future government legislation.

Overall, the book provides an excellent primer on the state of health legislation in the USA. It can also be used as a guide to analyzing the state of current health care in the country. Each chapter has study questions with suggested responses available in an online instructor's manual. The value of the book could have been further enhanced if Dr Feldstein had included a chapter summarizing approaches to health care legislation in other developed countries. Also, while the author recognizes the aging of the US population, he could also have addressed the role of legislation in discouraging unhealthy eating habits and sedentary life styles. The government's potential role in these endeavors could be constrained by externalities such as interest groups representing the fast food and processed food sectors. Potential solutions to these problems could have been valuable additions to the book.