Well-written laws always include clearly articulated goals and objectives that the law is intended to achieve, although clear goals and objectives are only part of the makeup of a good policy. When those with implementation responsibility know what the law is really intended to accomplish—what its goals and objectives are—it is easier to operate the programs and procedures embedded within it. In contrast, when the goals and objectives of a policy are not clear or when they are multiple or conflicting, successful operation is made more difficult, if not impossible, to achieve, even before the effort begins.
An example of the problem of multiple, conflicting goals and objectives within a single law can be found in the National Health Planning and Resources Development Act of 1974 (P.L. 93-641). Congress hoped this massive policy would fulfill many of the goals and objectives it had previously attempted to attain through a wide variety of earlier, more focused policies. As outlined in Section 1513 of P.L. 93-641, its multiple goals included the following:
• improving the health of people;
• increasing the accessibility (including overcoming geographic, architectural, and transportation barriers), acceptability, continuity, and quality of health services; and
• restraining increases in the cost of providing health services.
As has been noted regarding the multiple goals embedded in P.L. 93641, "the legislation proposed every health system desideratum its authors could imagine" (Morone 1990, 272). This expansive set of inherently contradictory goals eventually doomed the policy; Congress repealed it in 1986.
Multiple goals and objectives embedded in a single policy can make its implementation extremely difficult, especially if they conflict or are not mutually supportive. In one study, managers of the Medicare program report that they are often torn by the competing demands imposed by the multiple goals and objectives established for the program (Gluck and Sorian 2004). This study notes that these managers are simultaneously required under Medicare policy to do the following:
• serve Medicare beneficiaries' healthcare needs;
• protect the financial integrity of the program and preserve the solvency of the Medicare trust funds;
• make sure payments to providers are adequate to ensure their participation in the program;
• ensure the quality of services provided to program beneficiaries
• guard against fraud and abuse in the program's operation;
• work with numerous private contractors, ensuring their quality and keeping them satisfied with the relationship; and
• work with states, respond to congressional oversight, and serve the political and policy priorities of the executive branch.
This means, for example, that "Medicare managers must ensure adequate participation in Medicare by healthcare providers, but also see to it that providers meet performance and quality standards" (Gluck and Sorian 2004, 65).
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