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Health Policymaking in the United States
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BB Longest Jr. Ann Arbor: Health Admin Pr; 1994. $38.00. ISBN 1-56793-017-4. Order phone 708-450-9952.
Rarely has so much intellectual energy been focused on health policymaking at the federal, state, and local levels in the United States. Despite the lack of a legislative agenda, market integration, managed care, and intensified competition are reshaping the health policy landscape.
The age-old adage that one should not watch sausage being made certainly applies to health policymaking! What is needed is a special lens through which to view this "sausage-making" policy apparatus. Longest may have hit on just such a lens; ground to near perfection, it allows us to view policymaking from a safe distance, but a distance from which we still can clearly see what is happening.
His remarkable book is efficient in its presentation while preserving a broad scope and giving a broad overview of health policymaking in the United States. According to the preface, the book is an expansion of Longest's lectures at the University of Pittsburgh, done because, the author notes, his students found this particular model of health policymaking to be helpful.
Do we need yet another book describing health policymaking in the United States? I'll leave that to others to decide. However, Longest helps the reader clarify the policymaking quagmire through his particular lens and viewpoint. For example, helpful schematic drawings at the beginning of each chapter march us through the policymaking process. A particularly helpful and intriguing aspect of the book is the clever chapter appropriately titled "The Other Side of Policymaking," which shows us the unintended consequences of the policymaking process and helps us to understand terms such as environmental scanning and other consultant-like language often used in the health policymaking arena. It is a fun chapter to read.
In addition, a useful appendix provides a chronologic history of the health policymaking laws in the United States from 1798 to 1993, an efficient one-stop-shopping summary of complex legislation that has helped to shape the health policy landscape.
Sausage-making is a smelly and dirty business. Health policymaking is politically supercharged and complex. Longest's lens clarifies and focuses the core ingredients.
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