We cannot verify your location
Browse Book and Journal Content on Project MUSE

Healthy Voices, Unhealthy Silence

Advocacy and Health Policy for the Poor

Publication Year: 2007

Public silence in policymaking can be deafening. When advocates for a disadvantaged group decline to speak up, not only are their concerns not recorded or acted upon, but also the collective strength of the unspoken argument is lessenedùa situation that u

Published by: Georgetown University Press

Series: American Governance and Public Policy series


pdf iconDownload PDF


pdf iconDownload PDF


pdf iconDownload PDF

p. vii

read more


pdf iconDownload PDF

pp. ix-x

This book deals with two enduring themes in most advanced democracies: the persistence of political inequality and the desire to shape “good” social welfare policy. Although these themes are ubiquitous in any public policy problem, we didn’t actually intend to address them. We started this project in the mid-1990s with an interest...

read more


pdf iconDownload PDF

pp. xi-xiv

This project started when we were at Yale University, where Bradford Gray, director of the university’s Institute for Social and Policy Studies at the time, encouraged us to examine the implementation of Medicaid managed care in Connecticut. Members of the Robert Wood Johnson Foundation’s Scholars in Health Policy...


read more

1 The Problem and Puzzle of Public Silence

pdf iconDownload PDF

pp. 3-20

Although the United States has the most expensive health care system in the world and offers a plethora of advanced medical technologies—many of which are life saving—there are many reasons advocates fight for improved health care services for the poor. Compared with higher income Americans, the poor are much less likely...

Part I: Explanations and Background

read more

2 Explanations for Public Silence: Inequality, Dependence, and Infeasibility

pdf iconDownload PDF

pp. 23-41

When suppression of the public voice occurs under an oppressive state or under very clear power inequities, the problem is deeply concerning but not analytically troubling. The suppression is so clearly due to fears about a retaliating state or some other powerful source that there is no puzzle. Indeed, upon reading in chapter 1 the story...

read more

3 Medicaid’s Persistent and Conflicting Goals: Equal Access, Quality Care, and Cost Control

pdf iconDownload PDF

pp. 42-66

Despite persistent hopes, the goal of providing the poor access to high-quality, mainstream medical care at reasonable costs has remained elusive for the last forty years, for reasons too large and complex to cover adequately in this chapter.1 Our main intent is to show, despite Medicaid’s failings, how these goals have remained aspirations...

Part II: Arguments and Findings

read more

4 The Political and Policy Difficulties of Discussing Unequal Access

pdf iconDownload PDF

pp. 69-90

Starting in August 1995, AFDC-Medicaid recipients living in Connecticut’s two largest counties were given the option to enroll in a Medicaid managed care plan.1 Recipients’ response to the new program was extraordinary: By the end of the month, nearly ten thousand Medicaid recipients had enrolled in eleven different Medicaid...

read more

5 Medicaid’s Policy Network and the Ties that Bind: Nonprofit Advocacy and Social Interactions

pdf iconDownload PDF

pp. 91-117

Concerns about the state’s budget, a political climate that made it difficult to criticize the new program, a lack of data to measure mainstreaming, and specific solutions that diverted attention from larger issues all contributed to the public silence over mainstream Medicaid access in Connecticut. Yet as we concluded in the previous chapter...


read more

6 Medicaid Reform and Advisory Boards: Who Will Advocate for Poor People’s Health?

pdf iconDownload PDF

pp. 121-130

The primary goals of this book are to highlight the problem of public silence in deliberations over public policy and to offer an explanation of why it occurs. Specifically, we are concerned with deliberations among members of state advisory boards. These boards are ubiquitous in American politics, but we know very little about the public...


pdf iconDownload PDF

pp. 131-136


pdf iconDownload PDF

pp. 137-149


pdf iconDownload PDF

pp. 151-156

E-ISBN-13: 9781589013391
E-ISBN-10: 1589013395
Print-ISBN-13: 9781589011823
Print-ISBN-10: 1589011821

Page Count: 170
Publication Year: 2007

Series Title: American Governance and Public Policy series
Series Editor Byline: Gerard W. Boychuk, Karen Mossberger, and Mark C. Rom, Series Editors See more Books in this Series

OCLC Number: 290559181
MUSE Marc Record: Download for Healthy Voices, Unhealthy Silence

Research Areas


UPCC logo

Subject Headings

  • Equality -- Heath aspects -- Connecticut.
  • Poor -- Medical care -- Connecticut.
  • Health services accessibility -- Connecticut.
  • Patient advocacy -- Connecticut.
  • Health care reform -- Connecticut.
  • Medicaid -- Connecticut.
  • You have access to this content
  • Free sample
  • Open Access
  • Restricted Access