American political culture and the search for lessons from abroad

The American health care system appears to suffer from higher costs and less access than the health care systems of other industrialized nations. This perception has set social scientists searching for "lessons from abroad." This paper places the dialogue about health system lessons within the context of American political culture. It sketches out some of the distinctive dynamics in the American policymaking process. Those dynamics help explain the problems we face, the programs we have pursued, and the alternatives we have foregone. The same political process which shaped past policies is likely to frame any lessons we try to import from abroad.     

Obesity, courts, and the new politics of public health

Health care politics are changing. They increasingly focus not on avowedly public projects (such as building the health care infrastructure) but on regulating private behavior. Examples include tobacco, obesity, abortion, drug abuse, the right to die, and even a patient's relationship with his or her managed care organization. Regulating private behavior introduces a distinctive policy process; it alters the way we introduce (or frame) political issues and shifts many important decisions from the legislatures to the courts. In this article, we illustrate the politics of private regulation by following a dramatic case, obesity, through the political process. We describe how obesity evolved from a private matter to a political issue. We then assess how different political institutions have responded and conclude that courts will continue to take the leading role.     

Power to the people? Restoring citizen participation

This article investigates a lost ideal--citizen participation in health policy. We begin by mapping the different types of participation. We then suggest what direct citizen action has achieved in the past, why it ought to be restored today, and how we might go about reviving it. A changing social environment--marked by globalization, immigration, a culture war, and managed care--could be addressed by robust, local, democratic health reforms. Finally, we contrast the top-down health sector with education and crime policies that take communities far more seriously.