Editor's Note: In the Marketplace for Ideas Affecting Public Policy

In his book Inquiry and Change, Charles Lindblom pondered the challenges of democratic policy making in an era in which neither the general public nor their elected representatives seemed to grasp the pressing social issues of the day. Writing at the end of the 1980s, Lindblom (1990: vii-viii) warned of a wide range of "problems, threats and missed opportunities," including "nuclear destruction, environmental warming, third-world squalor, depletion of natural resources, nutritional deficiencies, irresponsible government . . . widespread drug use, racial conflict, and severe educational inadequacies."

Lindblom's diagnosis of the problem? He traced these policy-making failures to the inability of contemporary democracies to effectively probe their own misunderstandings, to learn from their past mistakes, and to identify, explore, and debate new ideas for societal change. His proposed solution? To recast governing institutions so that they had a greater capacity for inquiry and adaptation. This transformation would be based on a more lively and probing "competition of ideas," producing a "government by discussion" that developed its insights from a "free market in ideas." Lindblom (ibid.: 68) concluded that "one can find the key to good problem solving, as well as good government in a democracy, in the interaction of mutually challenging minds."

However, the Lindblom of 1990 was no naïve advocate of pluralism. He recognized that contemporary democratic discourse fell well short of his idealized "self-guiding society." Indeed, much of his book was a careful (albeit not always coherent) itemization of what economists might term market failures in the exchange of policy-relevant perspectives. Lindblom's idealized marketplace for ideas guaranteed a place for heterodoxy and dissent. Yet he recognized that even in those countries that putatively encouraged free speech, most social institutions were designed to breed conformity and reinforce orthodoxy. Lindblom's notion of a free market in ideas was precisely that—a forum that gave all parties the capacity to advocate for their positions. Yet he realized that in practice the political arena was dominated by the ideas of academic, political, and economic elites who had access to resources and controlled the media through which ideas were disseminated. Lindblom's ideal market for ideas required a form of "truth in advertising," whereby proposals for social change were purveyed based on their known attributes and consequences, rather than their purported aspirations. Yet he acknowledged that in practice policy-relevant ideas were often "sold" under misleading auspices, with confusing claims and hidden by-products.

These market failures will come as no surprise to even the most casual observer of contemporary politics. They will seem particularly familiar to those who follow recent health policy debates. Lindblom did not recount these shortcomings in hopes that they could be eliminated from political discourse; he explicitly eschewed aspirations toward any form of "ideal speech situation." He explored these barriers to a free market in policy-relevant ideas because he saw them to be consistent impediments to effective communication among elites, the lay public, and social scientists. More constructively, Lindblom considered it the obligation of policy scholars and policy analysts to consider how these impairments to more thoughtful governance could be addressed, so that their consequences could be made less pernicious or inequitable.

It is from this perspective that I encourage readers to view the articles in this issue of the Journal of Health Politics, Policy and Law. Although none of these contributions explicitly explores the marketplace for policy ideas, each examines a particular set of ideas that plays an important role in contemporary health policy debates (albeit, in some cases, by their omission). Although each of the articles makes use of very different empirical methods, each reaches a similar conclusion: that the implications of some of the most important ideas that permeate our thinking about health policy are often overlooked or misunderstood. Although none of these articles is intended to identify the sort of impairments to policy debate that evoked Lindblom...