Policy Wonks Research Articles

Medicaid Politics and Policy

Medicaid Politics and Policy

Government Giveaways: Your Chevy or Your Mother?

Government Giveaways: Your Chevy or Your Mother?

The Lonely War

Nazila Fathi’s The Lonely War joins a number of similar journalist memoirsby Iranian or Iranian émigrés, including Roxana Saberi’s Between Two Worlds(Harper Collins: 2010), Ramita Navai’s City of Lies (Public Affairs: 2014), andMaziar Bahari’s Then They Came for Me (Random House: 2011), which wasrecently reissued as Rosewater and adapted into a film by The Daily Show’sJon Stewart. Fathi and Bahari mostly grew up in Iran, whereas Azadeh Moaveni and Roya Hakakian mostly grew up in the United States. Thus theyoffer a different sort of history, one that is less inclined toward nostalgia or narrativesof leaving and return.As a proverbial first draft of history, Fathi’s memoir appeals to a wide audienceinterested in current affairs, but also to policy wonks in both the mediaand politics. Fellow journalists seem captivated by such stories, particularlywhen they involve the author’s attempts to analyze civil society in the IslamicRepublic. Fathi’s work will also appeal to Iranians in the diaspora, others interestedin the Shi‘ah polity’s internal problems, and those concerned with questionsof social class in addition to gender in the Islamic Republic ...

Political Pitfalls in Policymaking: The Texas HPV Vaccine Policy Saga

Political Pitfalls in Policymaking: The Texas HPV Vaccine Policy Saga Dan Bustillos In late 2005, while completing a post–doctoral fellowship at Baylor College of Medicine studying cancer disparities, I was asked to participate in a large–scale state health policy task-force on cervical cancer, a disease whose burden is [End Page 6] felt disproportionately by certain minorities and socioeconomic groups. Back then we were poised to have the unprecedented opportunity to dramatically reduce the incidence of cervical cancer due to the imminent approval and release of vaccines to immunize young girls from certain strains of the Human Papilloma Virus (HPV)–the sexually–transmitted pathogen responsible for most cases of cervical cancer. As a member of the Cervical Cancer Strategic Planning Initiative’s (CCSPI) Policy Work Group, I attended policymaking conferences convened in Austin, which were funded and organized by various agencies and organizations like the Texas Department of State Health Services and the Texas Cancer Council. But even more prominent and insistent in our policy taskforce meetings than the perpetually understaffed state agencies was the charismatic and influential presence of Women in Government (WIG), a large non–profit advocacy organization that includes many of the nation’s female legislators (including several close to then Texas governor Rick Perry). In fact, it had been at WIG’s behest, at its Cervical Cancer Summit in 2005, that Texas was singled out as the proving grounds for a push to enact liberal HPV vaccination policies into state law. And so it was that a large group of disparate stakeholders, health care professionals, grassroots activists, academics, cancer survivors, health economists and health policy wonks were all convened in Austin to prepare comprehensive policy recommendations on what Texas could and should be done once Merck’s Gardasil–projected to be the first FDA–approved HPV vaccine–became available in a few months. Beginning at the end of 2005, the taskforce worked to deliver thoughtful policy recommendations we would deliver to Rick Perry’s office. These sessions were well–financed, well–support staffed and filled with people from all over Texas with plenty of expertise, but since the actual vaccines were still in development at Merck and GlaxoS-mithKline (GSK), and little was publicly known about their relative safety and efficacy, we required access to unpublished data from the ongoing vaccine trials in order to base our recommendations on the best science available. This, it turned out, was not as difficult as it may sound. Although in private drug development the data generated by trials is usually a closely guarded trade secret until disclosure is required for patenting or for FDA approval, Merck didn’t wait for us to ask. Several Merck representatives were among the attendees at every CCSPI meeting. At first, I assumed that due to the pharmaceutical company’s obviously important role as the sole possessor of necessary information for our deliberation, Merck was asked to attend from the start. It wasn’t until later that I found out that Merck was in fact the prime mover behind this policymaking process, and their influence had begun well before the WIG summit in 2005. And although Merck’s obvious conflict of interest (the company stood to make many millions if not billions from any aggressive state vaccination policies) caused us to restrict Merck’s involvement to being a source of vaccine information when we asked for it, the pharmaceutical giant remained a constant presence throughout our policymaking. The Policymaking Process Although the morbidity and mortality associated with cervical cancer is not trifling, the policy work group decided early on not to recommend for mandatory vaccination of age–appropriate girls in Texas (the only group for which the new vaccine was expected to receive initial FDA approval). This decision was based on a variety of factors including the lack of long–term safety and efficacy data for the vaccine at the time, and the widespread belief among the policy taskforce members that a vaccine mandate bill would have little chance of passing the conservative legislature of Texas, a state that had seen very vocal criticism of the vaccine ever since it had been announced. Instead, we opted for a policy recommendation that showed...

How to Unleash Climate Action: Values, Politics, and the Inevitability of the Clean Energy Future

The issue of climate change is personal and global at the same time, and defusing its threats is an enormous undertaking. The shift to clean, efficient energy systems must come from changes in our companies, cities, states, countries, and each one of us. Some changes are technological, some are behavioral, and all require a tremendous commitment to action. The challenge comes from overcoming the loud and powerful opposition from the fossil fuel industry; climate deniers on the conservative soapbox; intransigence from some people and complacency from others. The National Resources Defense Council (NRDC).has learned that it is not enough to be policy wonks. We have to be more informed about what inspires people to act on climate change; we need more partners across different sectors; and we have to be more strategic in how we communicate.

Block Granting Medicaid: A Model for Twenty-First Century Health Reform?

Block Granting Medicaid: A Model for Twenty-First Century Health Reform?

Intra-Africa trade: Going beyond political commitments

Among Africa’s policy wonks, underperforming trade across the continent is a favoured subject. To unravel the puzzle, they reel off facts and figures at conferences and workshops, pinpoint trade hurdles to overcome and point to the vast opportunities that lie ahead if only African countries could integrate their economies. It’s an interesting debate but with little to show for it until now.

Appalachia and “The Commons”: An Introduction

The very existence of "Appalachia" as a region is a construct, something "invented" by federal bureaucrats, policy wonks, various media, fictional writers and poets, and scholars over the last 50+ years. Through these primarily non-indigenes' impact, Appalachia has achieved both a heuristic materiality as well as a disembodied imaginary identity (Powell 2007). Central to this process of Appalachian geogenesis has been the multi-billion dollar funding of projects by the Appalachian Regional Commission (ARC), a federal agency. Thousands of local organizations and university research teams have embraced the ARC definition of this region to solicit funds for various infrastructure and economic development projects since the 1960s, such that most now accept the ARC definition as the definition of the region (Couto 1995). ARC Appalachia is far too inchoate, expansive, and culturally variable, however, for anthropologists to use in a meaningful way when researching systemic issues related to political disempowerment, precarity, and physical well being-exactly the issues addressed in this issue.

Politics, Health, and Health Care: Selected Essays

Politics, Health, and Health Care: Selected Essays

The battle of Bretton Woods: John Maynard Keynes, Harry Dexter White, and the making of a new world order, by Benn Steil

Benn Steil The battle of Bretton Woods: John Maynard Keynes, Harry Dexter White, and the making of a new world order Princeton: Princeton University Press, 2013. 472pp., $19.75 (hardcover) ISBN-1 3: 978-0691 149097The popular narrative holds that the United Nations Monetary and Financial Conference, held at Bretton Woods, New Hampshire in 1944, was a mutually beneficial partnership between Britain and the United States to create a stable global monetary order. As the Council on Foreign Relations' Benn Steil shows in this historical account, however, such thinking has been a convenient fig leaf covering emergent American global ambitions and the British Empire's precarious international position. Steil also uses the conference as a canvas upon which to paint the larger picture of transatlantic relations, exploring the diplomatic and economic context for an emerging multilateral vision for monetary and trade governance. His work plays upon this myth of Anglo-American partnership, critically examining its usefulness to both parties, but ultimately offering a more nuanced portrait of partisanship, politics, and the high-stakes game of economic diplomacy played to great effect against the uncomfortable relationship between the great British economist John Maynard Keynes and the head of the American negotiation team, Harry Dexter White, who was later revealed to be a Soviet mole.White was a consummate political insider, a man of limited means and significant ambition who worked his way up in the US Treasury after failing to land a tenure-track position at Harvard University. A policy wonk, his mastery of the technical details that would become the new global monetary order rivalled even that of Keynes himself. Keynes, on the other hand, was a man of wealth and privilege his name a byword for genius. Even so, throughout the Second World War, Keynes would overestimate American sympathy for Great Britain. London might have been perceived popularly as a repository of culture and an incubator of democracy, but it was also an economic rival whose colonial relationships interfered with American exports and undermined monetary stability (96 97). Keynes did not fully comprehend the public antipathy for perceived British highhandedness in global economic affairs, and this as much as White's political skill proved to be his undoing.At the Bretton Woods conference, both Keynes and White determined to carve out for their respective governments the maximum amount of freedom for creating and enacting domestic economic policies to their future political advantage. White assured the dominant place of the dollar in the postwar economic order. Keynes manoeuvred for political space between the contractual details of lend-lease, the US Treasury's ambitious goals, and the proposed international financial institutions, which would either help or hinder Britain in the reconstruction of its war-ravaged economy (133). …

Editorial

First, allow me to introduce this special issue on Policy, Politics, and Discourse, guest-edited by Professor Thomas Streeter of the University of Vermont, which brings various discourse-analytic approaches to bear upon key official documents shaping public communication policies. There is a tendency for critical scholars in the communication field as elsewhere to content themselves with critique. The researchers here share a concern to develop analysis directly relevant to communication policy-making. It is not entirely a fresh step for this academic journal, but represents a sustained contribution to that end. It hopefully reminds us that public policy should not be the preserve of lawyers, political scientists, and policy wonks. Second, this issue marks the end of my term as Editor-in-Chief. I wish to thank all those whose research articles have appeared during my term, or will appear over the next year, for their many-faceted contributions. In particular, those who have served as reviewers, for which task at present there are no rewards other than the crucial one of building scholarly collegiality and excellence. I would like to register my especial gratitude to Ms. Irina Khaldarova, doctoral candidate in Communication at Helsinki University, for her stellar service as my editorial assistant. And finally I would like to welcome Radhika Parameswaran of Indiana University as my successor in the editor's chair—a terrific appointment.

Reflections on Two Decades of Bioethics: Where We Have Been and Where We Are Going

The American Journal of Bioethics (AJOB) emerged at a time when bioethics, though still a young discipline, was described by some as at a critical crossroads.1 Commentators noted that bioethics began as a scholarly, reflective, academic enterprise but was increasingly focused on providing practical services to institutions and clients, and worried whether the field could productively and coherently accommodate both bioethics scholars and practitioners.2 Ten years later, bioethics remains a field comprised of some who are primarily scholars, some who are primarily practitioners, and some who are scholar-practitioner hybrids. Bioethics scholarship rests on a foundation of moral philosophy, but also incorporates law, policy studies, empirical studies, analysis of government or international guidelines, standards of practice, case studies, and more. As for most, my perspective of where the field has been and where it is going is colored by my own experiences. My background education is both practice based (nursing) and conceptual (philosophy) – and I consider it a privilege to be a ‘hybrid’ bioethicist- involved in both bioethics practice and bioethics scholarship. For this essay, I chose to discuss 4 short cases to reflect on bioethics over the last decade and speculate about the next decade. Although based on my own experiences, each case has been embellished for clarity and effect. My future scenarios are deliberately optimistic, yet of course, they are simply guesses, an exercise inspired by “Choose your own adventure,” a popular children’s book series that allows the reader to create the story ending.3 It is conceivable, however, that my future predictions are too optimistic and due to constricting resources or shifting societal priorities or values, the growth and influence of bioethics will lose speed. It is also possible that with increasing numbers of certificate, masters, and doctoral programs in bioethics, the future bioethicist will be much more specialized than today; there will be distinct career paths for scholars and practitioners and policy wonks, and ultimately fewer hybrids. Losing some of the rich diversity of perspectives that comes with bioethicists trained in different disciplines would be unfortunate. At the same time, specialization and focused expertise has the advantages of allowing bioethicists to engage and integrate in complex areas of science, health care, and policy. Now for the cases:

What Does Obama’s Re-election Mean to South Asia

While the world watched the closely contested Presidential elections in the United States in much anticipation, most observers and policy wonks in South Asia were bracing for change or continuity in the foreign policy that the new administration in Washington would herald. Although India received scant mention during the third Presidential debate which was focused exclusively on foreign policy, Pakistan and Afghanistan gained ample attention but with a caveat. There was little differentiated gap between the positions of the two candidates – President Obama and Governor Romney – on ending the war in Afghanistan. It is therefore no surprise that with President Obama's re-election, many in South Asia are bracing for continuity in US foreign policy. However, with his likely focus on legacy and attention towards other hot spots, there are imminent dangers of other South Asian countries taking a back seat in the US foreign policy priorities.

Justice Roberts's Health Care Stewardship

AbstractThe issues before the Supreme Court, arising as they did out of multiple cases and divergent appellate court rulings, were quite complex, and its final decision will be parsed rather differently by lawyers, health policy wonks, and economists (or metaphysical philosophers, in Chief Justice John Roberts's memorable phrase). This essay will focus on one singular element: did the final ruling enhance or detract from our collective power to exercise stewardship over our health care resources?Clearly Americans diverge on key features of a desirable society and on the wisdom of using government to achieve even mutually desirable goals. But before politics settles the fate of the Affordable Care Act (and perhaps also the federal role in health policy for the foreseeable future), we should focus on what the Court has allowed us to consider: if we want it to, federal power may constitutionally be marshaled to compel insurers to end discrimination against the sick and to offer more transparent products so the marketplace will better serve consumers.

Long-Term Care Reforms Live On With Court Ruling

Long-Term Care Reforms Live On With Court Ruling

Making “Health in All Policies” a Reality Requires You!

Making “Health in All Policies” a Reality Requires You!

The Road Trip of 1975: How Far We Have Come, How Close to Austin We Remain

In March of 1975, perhaps four or five of us students from U Wisconsin- Madison climbed into a station wagon, rented for us from the UW car pool by the Department of Languages and Literatures, and traveled south toward the sun in Austin, Texas.We leftin the dead of night. The thought of real spring weather, the increasingly warm temperatures as we headed south, and the long drive made us giddy enough. But we were also nervous and excited about the fact that we would soon meet faces and bodies to match some of the famous names we knew . . .I had largely moved to as a French PhD student, because, as I often say, the faculty in Studies-literature especially- would invite you to their homes. And you could actually MEET the writers and filmmakers you were studying. You could ask them questions, and they'd answer you (more or less), whereas in French, the writers we studied were mostly dead, and none of the living had ever come-during my years, at least- to Madison.It was also obvious that African literature, as we then called it, mattered. These texts we were reading and debating were part of something real, something critical. They clearly made a difference. This was proven to us in the worst way: Writers, like political leaders, could censored, jailed, tortured, exiled or murdered.So, a historic occasion was brewing and we students would a part of it. We would in fact, if I may shiftmetaphors, getting in on the ground floor.I don't remember much in the way of detail, except that I would the guest of a UT graduate student, Patsy. I slept on her floor. She was a wonderful hostess.It was only the second professional meeting I'd ever attended, the first being the 1974 ASA meetings in Chicago when the ALA was born. It had seemed a radical break at the time, even though it was presented as a caucus more or less, which is to say that we would all still attending ASA but would hold a separate meeting in addition, where no longer overshadowed by political science and policy wonks, could come into its own. I didn't grasp then what a difference this would make and how much the ALA would shape me professionally and personally, nor how invested I would become in this little association, how it would give institutional credibility to the work we do, how it would enable women to also be somebody.Students might in awe of these household names (household, among Africanists at least), but they were never treated like junior members: They were full-fledged participants in the debates, on the Exec Council right from the beginning. And so were women. Although it would take twelve years before the election of the first woman president of ALA.The theme of the Austin meeting was Contemporary South Literature. Among writers and scholars from West Africa, there were Chinua Achebe, Emmanuel Obiechina, Romanus Egudu, Pol Ndu, KofiAwoonor, Ama Ata Aidoo, and a Wole Soyinka protege, Biodun Jeyifo. From East Africa: Peter Nazareth and Ali Mazrui.What I remember most clearly of that first iteration, of course, was the overwhelming presence of South Africans-Dennis Brutus, Cosmo Pieterse, Mazisi Kunene, Ezekiel Mphalele, Wally Serote, Oswald Mtshali, our own Daniel Kunene. Many of these giants would presidents of ALA over the following decade. And the ALA's next twenty years, with all their excitement, discovery and growth, would painfully tethered to the evolution of South politics.The tyranny at home in South Africa reached over and shaped the course of the ALA, located in the U.S. in those years. Individuals were silenced, expelled from meetings and membership on the basis of positions they took in or trips they took to South Africa. It was wrenching. But such was the acuity and urgency of the South debacle, standing in for the whole continent, that it is hard to imagine how it could have been otherwise. …

Launching the War on Poverty: An Oral History (review)

Reviewed by: Launching the War on Poverty: An Oral History Jeffrey Helgeson Launching the War on Poverty: An Oral History. By Michael L. Gillette. (New York: Oxford University Press, 2010. Pp. 480. Illustrations, notes, bibliography, index. ISBN 9780195387278, $24.95 paper.) Michael L. Gillette has assembled an invaluable insider’s view of the planning, funding, and implementation of President Lyndon B. Johnson’s War on Poverty. Readers of the Southwestern Historical Quarterly will be particularly interested in this second edition of the book, which not only reveals the influences of Texas and the South on the making of antipoverty policy, but which also benefits from its use of LBJ’s tape-recorded White House telephone conversations. LBJ’s insights supplement interviews completed between the 1960s and the 1980s with forty-nine policymakers. Together, they provide a unique view of the best intentions, achievements, and limits of one of the farthest-reaching and most controversial flurries of federal social legislation in U.S. history. Launching the War on Poverty offers a spirited defense of the antipoverty policies created between 1964 and 1967. Gillette’s emphasis on the enduring influence of the War on Poverty runs counter to much of the recent historiography of late twentieth-century politics, which focuses on the rise of the New Right and the concomitant collapse of liberalism. Yet Gillette insists that the War on Poverty remains relevant because every major program founded through the Office of Economic Opportunity (OEO) other than Neighborhood Youth Corps has survived nearly fifty years. Even the most controversial notion of “citizen participation has gained a wide acceptance, and a former community organizer occupies the Oval Office” (402). Gillette also highlights the limits of U.S. antipoverty policy. The poverty warriors themselves looked back from the 1970s and 1980s with a critical eye. They noted that they had underestimated how difficult it would be to eradicate poverty, oversold the potential of federal action to reduce poverty in the short run, and never had enough funding to carry out their grand plans. Moreover, for policy wonks in the audience, Gillette’s subjects detail the bureaucratic challenges of innovating and coordinating programs in a new government agency like the OEO. Gillette’s interviews paint a complex picture of LBJ’s influences on the War on Poverty. He was “a modern populist,” Gillette argues, who had learned the importance of helping the poor from his experiences as a schoolteacher in rural Texas and in his experiences with the New Deal’s National Youth Administration (xvii). The president gravitated toward the fight against poverty, and believed in the importance of the government in that fight. As one close advisor put it, LBJ was “the last New Dealer, in the sense that he would do anything to feed the kids . . . and for old folks,” and he would support clearing obstacles to civil rights [End Page 324] (388). Yet there were limits to his vision. He would not tolerate the “maximum feasible participation” of the poor in the War on Poverty to challenge the political status quo. “I’d a whole lot rather have [Chicago Mayor] Dick Daley . . . handling millions of dollars” than private organizations, LBJ said in 1964 (90). And as it became clear that some local people would use antipoverty agencies as means to challenge their representatives for influence in their communities, Johnson was inflexible. “To hell with community action,” he declared. Johnson had to be convinced by Bill Moyers and others that they had to “prove that a community can get together to solve its problems” (148–149). It is easy to get lost in the details of these interviews, but that is a small price to pay for a book that gives the reader such a unique view into American public policymaking. There is no better measure of the contingencies that shaped antipoverty policy than these interviews’ insights into the personal prejudices and rivalries, academic assumptions, individual aspirations for power, regional alliances, and even wagers on the golf course that determined the course of antipoverty programs. Jeffrey Helgeson Texas State University-San Marcos Copyright © 2012 The Texas State Historical Association

Politics, quality and cost effectiveness

This newsletter has been written in the midst of the party political conferences. I was somewhat sceptical when informed I was expected to go to these, regarding them as perhaps a jamboree for policy wonks and the like. This scepticism was reinforced by several respected senior colleagues who counselled that the College was about improving standards and should not become embroiled in the 'dark arts'. I reflected on this advice but concluded that in order to do the former, national political engagement was essential. Hence I have embraced my attendance with enthusiasm although perhaps not with all-out fervour.

The D&T Report

The D&T Report