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

By Colleen M. Grogan; Michael K. Gusmano | Go to book overview

6
Medicaid Reform and Advisory Boards
WHO WILL ADVOCATE FOR POOR PEOPLE'S HEALTH?

The primary goals of this book are to highlight the problem of public silence in deliberations over public policy and to offer an explanation of why it occurs. Specifically, we are concerned with deliberations among members of state advisory boards. These boards are ubiquitous in American politics, but we know very little about the public conversations that might emerge from them. When they are used to inform health and social policy, these advisory boards are often composed of representatives from the vast network of nonprofit agencies that provide services to and/or advocate on behalf of the poor. Evaluating the substance of deliberations within these boards provides us with an opportunity to better understand the degree to which these agencies can offer an avenue for representation of otherwise disenfranchised groups.

Let us begin this concluding chapter, then, by reviewing briefly why the problem of public silence is important and summarizing our explanation of why it happened. After that, we will conclude by offering a few thoughts on what can be done.


THE PROBLEM OF PUBLIC SILENCE

To appreciate why public silence is problematic we have to remember why participatory processes are important. In chapter 1 we identify five benefits that could emerge from public discussion: (1) a greater understanding and more tolerance for opposing views, (2) a public-spirited way of thinking about social problems (as opposed to a self-interested view), (3) increased clarification and refinement of participants' positions on issues, (4) learning about the

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