Healthy Voices, Unhealthy Silence: Advocacy and Health Policy for the Poor (American Governance and Public Policy) Review

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(More customer reviews)Colleen M. Grogan (Associate Professor in the School of Social Service Administration at the University of Chicago) and Michael K. Gusmano (Assistant Professor of Health Policy and Management, Mailman School of Public Health, Columbia University) Healthy Voices, Unhealthy Silence: Advocacy and Health Policy for the Poor is a serious-minded scrutiny of state-level health care advocacy for the poor, particularly with regard to Medicaid, and how public silence can have a devastating effect. When advocates for a disadvantaged or a disempowered group do not speak out, the weight of their argument is lessened, and the consensus of the more powerful interests gains ground, a process that is ultimately harmful to deliberative democracy itself. Examining the principles of deliberative democracy, agenda setting, and nonprofit advocacy, Healthy Voices, Unhealthy Silence reveal instances where the silence threatens to become deafening, offers advice to restore balance to the participatory process, examines how capable nonprofit organizations are at influencing policy debate, and much more. Highly recommended.

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Public silence in policymaking can be deafening. When advocates for a disadvantaged group decline to speak up, not only are their concerns not recorded or acted upon, but also the collective strength of the unspoken argument is lessened - a situation that undermines the workings of deliberative democracy by reflecting only the concerns of more powerful interests. But why do so many advocates remain silent on key issues they care about and how does that silence contribute to narrowly defined policies? What can individuals and organizations do to amplify their privately expressed concerns for policy change? In "Healthy Voices, Unhealthy Silence", Colleen M. Grogan and Michael K. Gusmano address these questions through the lens of state-level health care advocacy for the poor. They examine how representatives for the poor participate in an advisory board process by tying together existing studies; extensive interviews with key players; and, an in-depth, first-hand look at the Connecticut Medicaid advisory board's deliberations during the managed care debate.Drawing on the concepts of deliberative democracy, agenda setting, and nonprofit advocacy, Grogan and Gusmano reveal the reasons behind advocates' often unexpected silence on major issues, assess how capable nonprofits are at affecting policy debates, and provide prescriptive advice for creating a participatory process that adequately addresses the health care concerns of the poor and dispossessed. Though exploring specifically state-level health care advocacy for the poor, the lessons Grogan and Gusmano offer here are transferable across issue areas and levels of government. Public policy scholars, advocacy organizations, government workers, and students of government administration will be well-served by this significant study.

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