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

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

Notes

Chapter 1. The Problem and Puzzle of Public Silence

1. To maintain confidentiality, we do not use her real name.

2. Although the more accurate term used today is “managed care orga- nization,” we use “HMO” because this is the term used most commonly in the popular press and by the public. Because this chapter, and the book, is not primarily about managed care or managed care organizations, we use the term that has the most ready, accessible meaning to a more general au- dience.

3. Eliasoph used this quotation to make her point that open, political talk among common citizens is important.

4. Some argue further that because the deliberation can be a creative process—with participants brainstorming and generating new ideas—the process may be able to overcome (or at least lessen) the impact of limited knowledge on decision making (Disch 1996; Fearon 1998; Gambetta 1998). For example, the process of discussion may reveal that there is no compro- mise on the known set of policy alternatives and therefore creates an incen- tive to think of new solutions. Thus the end result is not only new solutions but also consensus over the policy decision.

5. See the Kaiser Commission on Medicaid and the Uninsured website at http : //www. kf f. org/medicaid.

6. For details on these recent state Medicaid reforms, see the National Conference of State Legislatures website, http://www.ncsl.org/programs/ health/ (1115waivers.htm) (accessed June 27, 2006).

7. Actually, Medicaid managed care demonstration projects started in a number of states in the mid-1980s. They were primarily of a different form, called primary care case management, but they led the way for the flurry of waiver activity in the early 1990s. For more detail on these early waivers in the 1980s and the increased activity in the 1990s, see Hurley, Freund, and Paul 1993; Davidson and Somers 1998; and Thompson and Dilulio 1998.

8. Although not central to our purpose here, which is to understand how Connecticut's advisory board is similar to those set up in other states, it is interesting to note that the federal government's Department of Health and Human Services also created its own Medicaid Commis- sion in 2005 to consider short- and long-run Medicaid reforms. There is a

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