Healthy Voices, Unhealthy Silence: Advocacy and Health Policy for the Poor

Acknowledgments

This page intentionally left blank Healthy Voices, Unhealthy Silence Advocacy and Health Policy for the Poor C O L L E E N M . G R O G A N and MI C H A E L K. GU S M A N O Georgetown University Press / Washington, D.C. As of January 1, 2007, 13-digit ISBN numbers have replaced the 10-digit system. 13-digit 10-digit Paperback: 978-1-58901-182-3 Paperback: 1-58901-182-1 Georgetown University Press, Washington, D.C. www.press.georgetown.edu© 2007 by Georgetown University Press. All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher. Library of Congress Cataloging-in-Publication Data Grogan, Colleen M. Healthy voices, unhealthy silence: advocacy and health policy for the poor / Colleen M. Grogan and Michael K. Gusmano. p. ; cm. (American governance in public policy series) Includes bibliographical references and index. ISBN-13: 978-1-58901-182-3 (pbk. : alk. paper) ISBN-10: 1-58901-182-1 (pbk. : alk. paper) 1. Medicaid—Connecticut. 2. Patient advocacy—Connecticut. 3. Health care reform—Connecticut. 4. Poor—Medical care—Connecticut. 5. Health services accessibility—Connecticut. 6. Equality—Heath aspects—Connecticut. I. Gusmano, Michael K. II. Title. [DNLM: 1. Medicaid—economics—Connecticut. 2. Advisory Committees—Connecticut. 3. Health Care Reform—economics— Connecticut. 4. Health Policy—economics—Connecticut. 5. Health Services Accessibility—economics—Connecticut. W 250 AC8 G874h 2007] RA412.3.G76 2007 368.4’2009746—dc22 2007007010 ∞ This book is printed on acid-free paper meeting the requirements of the American National Standard for Permanence in Paper for Printed Library Materials. 14 13 12 11 10 09 08 07 9 8 7 6 5 4 3 2 First printing Printed in the United States of America Contents Preface ix Acknowledgments xi Introduction 1 1 The Problem and Puzzle of Public Silence 3 Part I Explanations and Background 21 2 Explanations for Public Silence: Inequality, Dependence, and Infeasibility 23 3 Medicaid’s Persistent and Conflicting Goals: Equal Access, Quality Care, and Cost Control 42 Part II Arguments and Findings 67 4 The Political and Policy Difficulties of Discussing Unequal Access 69 5 Medicaid’s Policy Network and the Ties that Bind: Nonprofit Advocacy and Social Interactions 91 Conclusion 119 6 Medicaid Reform and Advisory Boards: Who Will Advocate for Poor People’s Health? 121 Notes 131 References 137 Index 151 ...