Do good stories make for good policy?

Abstract

�� First-person narrative accounts have long been a staple of policy debates. Reform advocates understand that policy wonks and academics may be persuaded with a regression analysis, but that the general public and legislators are more likely to be moved by a compelling story. Because of their simplicity and transparency, narratives can crystallize and mobilize public opinion, and force an issue to the top of the policy agenda. Personal stories are accordingly employed as a matter of routine by journalists, legislators, and advocates for every conceivable cause. Indeed, on Capitol Hill, the standard practice was described by the Los Angeles Times as “when studies don’t sway, bring on the victims” (Lawrence 1990). Health care policy is routinely influenced by stories. Stories about patients being refused treatment by emergency rooms led to a federal prohibition of patient-dumping. Stories about bad outcomes after rapid postpartum discharges led to a federal prohibition on “drive-through deliveries.” Stories about various forms of misconduct by managed care organizations have fueled the drive to enact a federal patients’ bill of rights and spurred most of the states to enact such legislation. Stories about senior citizens who travel to Canada and Mexico to buy prescription drugs have prompted some politicians to propose price controls and others to support a Medicare prescription drug benefit. Stories may be effective in mobilizing support for a policy, but it is quite a different question whether sound policies will result. When atypical or incomplete stories are used as the basis for public policy, “reform”