More ways than one: Federal strategies to equalize access in education and health care

Abstract

Studies that compare programs from different substantive areas of policy are rare phenomena in the program implementation literature. Yet comparison is at the heart of the scientific method and is essential to the development of generalizations that might serve as guidance to the framers of policy. In part, this gap in the research literature can be attributed to the understandable reticence of scholars who have developed expertise in one substantive area of policy, such as education, to move into new and unfamiliar terrain. However, perhaps a more significant reason is the tendency of analysts to view programs in terms of their specific objectives, which are usually multiple and ambiguous, rather than in terms of the generic forms of government action-the strategies of interventionthey represent. Consider, for instance, the parallels between the development of federal policy in education and health care. Significant federal involvement in both delivery systems are post-World War II developments. The major turning point in political climate and constraints-the passage of the Elementary and Secondary Education Act (ESEA) and Medicare-came only a decade and a half ago (1965) as part of the initiatives of the Great Society. A major purpose of both ESEA and Medicare was to ensure that specific disadvantaged population groups had equal access to the existing delivery systems. Many of the subsequent programs in the two areas share the emphasis on equal access. Moreover, the constraints on federal involvement in education and health care are similar. The extensive diversity and structural decenANNE H. HASTINGS prepared this manuscript while a research fellow at the Brookings Institution, Washington, D.C. She is currently senior analyst, Advanced Technology Inc., Reston, Virginia.