This paper addresses policymaking issues in the approach and implementation of the 1997 Budget Act, for which a congressional hearing was held about the implications of this act on healthcare policies. The policymaking process is compared with the traditional textbook version, which represents some of the complexities involved, but hardly approaches the number of considerations that are truly involved. A brief history and explanation of the health care system in the US is also included. 10 pgs. Bibliography lists 8 sources.