In lieu of an abstract, here is a brief excerpt of the content:

Journal of Health Politics, Policy and Law 29.6 (2004) vi, 1035-1044


[Access article in PDF]

Inside Each Black Box of Health Policy:

An Exciting Surprise!


Click for larger view		 Figure 1
[End Page vi]

Some people find health policy boring. Readers of this journal will undoubtedly consider this claim to be amazing, even unbelievable. Nonetheless it's true. I have proof, courtesy of our good friends in Hollywood.

It seems that in the spring of 2003, the people in charge of Miramax Films and Miramax Books decided that there was a gap in the "chick-lit" market. To fill this literary vacuum, they sought a work of fiction that would do for our nation's capital what Bridget Jones's Diary had done for London (Kuczynski 2004). And who better to write such a novel than someone with lots of experience inside the Beltway? So they quickly signed a contract with one of Al Gore's daughters, Kristen. (Ms. Gore was at the time a scriptwriter for the animated Fox series Futurama. This experience boded well for the enterprise, since that show regularly provided its viewers with the most sophisticated social satire this side of South Park.)

One year later, Ms. Gore had completed a 486-page manuscript featuring a twenty-something health care analyst for the junior senator from Ohio. The book's early reception was a bit mixed. Although the Miramax crowd was excited by its potential, they pushed for cutting much of the health policy detail. Media reactions ranged from "zzz" to Jay Leno's evaluation: "'It's about a Capitol Hill staffer who works with a congressman on a health care subcommittee.' Mr. Leno noted, 'Apparently, that boring gene doesn't fall far from the tree'" (Kuczynski 2004: E1).

Clearly health policy has a somewhat unflattering image, mediawise (as does the Gore family tree, but that's a matter for another day). Perhaps [End Page 1035] this might be alleviated a bit were we all to assign Ms. Gore's book in our health policy courses. Since the novel is purported to include "cold-eyed romantic encounters, epic drinking, seedy campaign-trail sex, pot-smoking octogenarians and treachery worthy of the sudsiest soap opera" (ibid.) as well as cameo appearances by Willie Nelson and Queen Nefertiti, it's likely to convey a rather colorful sense of the career opportunities available to our students. Given prospects like this, I'm certainly ready to change plans for my next sabbatical.

But I think that the image problems for health policy run a bit deeper, stemming from the ways in which media mavens and the general public think about the policy process in general and health policy in particular. For them, the high point of health policy drama involves the sort of backroom markup sessions, extended political wrangling, and deceptive cost projections that accompanied the ill-fated enactment of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Admittedly, policy deliberations of this sort did make for some interesting media coverage. And the stories that emerged in the press certainly did capture the duplicitous nature of the Bush administration's approach to policy making.

Nevertheless, thinking in these terms seems to me to offer far too narrow a window into the sorts of issues, political interactions, and substantive concerns that shape the contemporary health policy agenda. Though the insider deliberations associated with Medicare reform made for some interesting stories, there was very little about the process or its outcomes that was particularly surprising. By contrast, when viewed in its full scope, contemporary health policy is full of surprises. Matters that seem to be common sense (e.g., an ounce of prevention is worth a pound of cure, competitive markets make for efficient allocations of resources) turn out frequently to be quite wrong. And perhaps most strikingly, even the most mundane health policy issues often have exciting aspects hidden within; even the most obscure health policy concerns often resonate with far larger issues relevant to societal justice, effective policy design, or our understanding of political deliberations...

pdf

Share