Academic journal article The Hastings Center Report

Policy as Product

Academic journal article The Hastings Center Report

Policy as Product

Article excerpt

Morality and Metaphor in Health Policy Discourse

   There ... is no art that hath bin more canker'd in her principles, more
   soyl'd and slubber'd with aphorisming pedantry then the art of policie.

   --Milton

Zygmunt Bauman has suggested that in modernity, morality has been taken up in public discourse as though it were simply a product of "ethical industry."[1] In a similar way, a key discourse in contemporary policy theory in the United States relies on the notion of policy "entrepreneurs" who "market" policy innovations and create "demand" for these "products" as businesspersons do.[2] This paper takes up the project of considering what it means to talk about health policy as product, and what kind of ethics and policies emerge from such a conceptualization of policymaking. The aim is to point to aspects of our common language and ask: What is left out? What is left in? Who is best served? What is rendered invisible?

It may also be important, at the start, to say something about what this paper will not do. The paper offers a modest critique of our current habits of language with reference to health policy, but it does not attempt to lay out some comprehensive "fix" for the "problems" our language habits may create. There are dangers in overly prescriptive attempts to alter the flow and pattern of language, not the least of which is the risk of inadvertently trivializing that which one might wish renamed.

Language is not, after all, something we merely memorize, a matter of remembering certain words and applying them to certain things and not to others. Rather, we find ourselves using words because they already mean something to us and to those around us; they are evolving forms of meaning that are already part of our shared culture. Most often, words transparently come, without much deliberation on our part. We ache when we cannot find words; we feel a visceral relief when we see a hitherto inchoate experience put into words. But we cannot arbitrarily and independently decide to call a stone a shoe and still expect language to do its job of helping connect us to one another.

This paper's aim, then, is not to lay out a new language system that will somehow make us "more moral," but merely to draw attention to the way metaphors based in the language of economics and business increasingly and invisibly supplant other metaphors in U.S. health policy discourse, and to contribute to the conversation about how this may constrain our vision of the good in relation to policymaking.[3]

If, as Charles Taylor and others have convincingly argued, language has a constitutive function as well as a descriptive or representational one,[4] then the words we use and the common ways we talk about what we do have a great deal to do with who we are and how we act toward others. Words, in this view, do not merely label things; they maintain and modify the kinds of common understandings that set up our possibilities for action in any particular situation. Words not only reflect, but shape what is real to us; they also shape us, as any wise parent knows.

This is especially true and perhaps easiest to see in the case of metaphor, which, as George Lakoff and Mark Johnson showed, is central to and ubiquitous in our language of everyday experience.[5] Lakoff and Johnson illustrated their thesis with the conceptual metaphor `argument is war,' which appears in such phrases as "he attacked his opponent's claims," "those claims are indefensible," and so on. "It is important to see that we don't just talk about arguments in terms of war," they observe. "We can actually win or lose arguments. We see the person we are arguing with as an opponent.... Many of the things we do in arguing are partially structured by the concept of war" (p. 4).

By contrast, they suggest that we consider a culture where argument is viewed as a dance in which participants perform. In such a culture, people would experience arguments very differently. …

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