title: Three meanings of capacity; or, why the federal government is most likely to lead on insurance access issues.
abstract: This essay considers on what health policy issues the federal government is best able to lead. Positive leadership requires knowledge, power, and will. The federal government has different supplies of each for different aspects of quality of, cost of, and access to health care. Here I review technical capacity to attain desired ends, define the institutional strengths and weaknesses of the federal government, and outline current dynamics of the national political process. This analysis suggests both prospects for and some characteristics of successful policy. The federal government is more likely to lead on insurance than on other health policy issues because its supply of relevant knowledge and power is relatively high on insurance issues and the political barriers are lower than conventional wisdom suggests. But that leadership could take the form of either the expanding or contracting of access to insurance.
authors.affiliation: Center for Policy Studies, Case Western Reserve University, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: White
mesh_terms: D003659:Decision Making, Organizational; D003695:Delivery of Health Care; D035082:Federal Government; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D007857:Leadership; D008484:Medicaid / Q000331:legislation & jurisprudence; D006278:Medicare / Q000331:legislation & jurisprudence; D011050:Policy Making; D011057:Politics; D011787:Quality of Health Care; D014481:United States; D037041:United States Government Agencies