Policy feedbacks and the impact of policy designs on public opinion

A recently developed analytic approach--policy feedback effects--provides health policy analysts with a crucial new tool for understanding the politics of health policy. Three cases--senior citizens' opposition to the Obama health care reform, tax breaks for employer-provided health insurance, and the Medicare Part D prescription drug program--demonstrate how policy designs affect subsequent policy outcomes. To differing degrees, the three cases show how public policies can create constituencies with particular understandings of their benefits who attempt to thwart reform; can highlight or reduce the visibility of the government role in health care, shaping attitudes about the worth of government action; and can provide half solutions that fail to maximize beneficiary welfare but that deflate momentum for policy improvements. The cases illustrate a general pattern revealed by wide-ranging research on policy feedback effects: the designs of public policies influence preferences and alter patterns of political mobilization, effects that feed back into the political system, shaping the political environment and the possibilities for future policy making.