Policy formulation, as a phase of the overall public policymaking process, is described in Chapters 5 and 6 as two sets of interrelated activities— agenda setting and the development of legislation. Sometimes, these formulation activities lead to policies in the form of new or amended public laws, such as the enactment of P.L. 108-173—the Medicare Prescription Drug, Improvement, and Modernization Act of 2003—which amends Title XVIII of the Social Security Act to provide for a voluntary program ofprescrip-tion drug coverage under the Medicare program. Enactment of laws demarcates the transition between policy formulation and policy implementation, although the boundary between the two phases of policymaking is porous. The bridge connecting policy formulation and policy implementation in the center of Figure 7.1 is intentionally shown as a two-way connector between the two phases of policymaking.
Implementing organizations, primarily the departments and agencies in the executive branch of government, are established and maintained and the people within them employed to carry out the intent of public laws as enacted by the legislative branch. Legislators rely on the implementers to bring their legislation to life. Thus, the relationship between those who formulate and those who implement policies is highly symbiotic.
In short, health policies in the form of changes in public law must be implemented effectively if they are to exert their intended impact on the determinants of health. Otherwise, policies are only so much paper and rhetoric. When implemented, however, laws can change the physical or social environment in which people live and work, affect their behavior and even their biology, and influence tremendously the availability and accessibility of health services.
This chapter focuses on the rulemaking stage of the implementation phase of public policymaking. As can be seen in the shaded portion of Figure 7.1, policy implementation begins with rulemaking, which is the establishment of the formal rules (the term "regulations" is used interchangeably with the term "rules" in this context) necessary to fully operationalize the intent embedded in public laws. The second set of activities in policy implementation is associated with the operation of public laws, and this stage of implementation is covered in Chapter 8. As will be discussed in that chapter, if a policy in the form of a public law is intended to protect people from exposure to toxic substances in their environments, for example, its operation entails 239
Figure 7.1 A Model of the Public Policymaking Process in the United States: Policy Implementation Phase
Preferences of individuals, organizations, and interest groups, along with biological, cultural, demographic, ecological, economic, ethical, legal, psychological, social, and technological inputs
POLICY FORMULATION PHASE
Formal Enactment of
• Possible Solutions
Development ► of Legislation
Window of Opportunity*
*The window of opportunity opens when there is a favorable confluence of problems, possible solutions, and political circumstances.
Formal Enactment of
POLICY IMPLEMENTATION PHASE
Feedback from individuals, organizations, and interest groups experiencing the consequences of policies, combined with the assessments of the performance and impact of policies by those who formulate and implement them, influence future policy formulation and implementation.
POLICY IMPLEMENTATION PHASE
the activities involved in providing that protection. Such operational activities might include measuring and assessing dangers from substances in the environment or imposing fines as a means to prevent or restrict environmental pollution.
The implementation phase of public policymaking involves managing human, financial, and other resources in ways that make the goals and objectives embodied in enacted legislation achievable by those responsible for its implementation. The most important point in understanding policy implementation, as part of the larger process of policymaking, is that it is primarily a management undertaking. That is, policy implementation in its essence is the utilization of human and other resources in pursuing the objectives embedded in public laws.
Depending on the scope of policies being implemented, the managerial tasks involved can be fairly simple and straightforward, or they can require massive effort. President Lyndon B. Johnson once observed that the preparations made for implementing the Medicare program represented "the largest managerial effort the nation [had] undertaken since the Normandy invasion" (Iglehart 1992, p. 1468). No matter what the scale, however, the implementation of public laws always includes two separate but interrelated sets of activities—rulemaking and operation.
It is important to note the cyclical relationship between rulemaking and the operational activities involved with implementation of a law. As shown in the shaded portion of Figure 7.1, rulemaking precedes operation in the sequence of these activities, but the operational activities feed back into rulemaking. This cyclical relationship means that experience gained with the operation of policies can influence the modification of rules or regulations used in the implementation phase. In a practical sense, this means that the rules promulgated to implement policies undergo revision—sometimes extensive and continual revision—and that new rules can be adopted as experience dictates. This characteristic of policymaking tends to make the process much more dynamic than it would be otherwise.
Another characteristic vital to a comprehensive understanding of pol-icymaking is that authoritative decisions made within the executive branch organizations to implement public laws are themselves policies. Recall from Chapter 1 that authoritative decisions refer to decisions that are made anywhere within the three branches of government that are under the legitimate purview (i.e., within the official roles, responsibilities, and authorities) of those making the decisions. For example, rules promulgated to implement a law are just as much policies as are the laws they support. Similarly, operational decisions made by implementing organizations, to the extent that they require or influence particular behaviors, actions, or decisions by others, are policies. Furthermore, decisions made in the judicial branch regarding the applicability of laws to specific situations or regarding the appropriateness of the actions of implementing organizations are policies. Recall the definition of public policy, given in Chapter 1, as authoritative decisions made in the legislative, executive, or judicial branches of government that are intended to direct or influence the actions, behaviors, or decisions of others. By definition, policies are established within both the policy formulation and the policy implementation phases of the policymaking process.
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