Welfare State Eras, Policy Narratives, and the Role of Expertise: The Case of the Affordable Care Act in Historical and Comparative Perspective.

This article presents a way of understanding the linkage of expert and public opinion through a focus on policy narratives, which serve as deliberately crafted rhetorical bridges between expert discourses and broader cultural experiences. Across advanced nations, the dynamics of this bridging functi...

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Publicado en:Journal of Health Politics, Policy & Law Vol. 43; no. 3; pp. 427 - 454
Autor principal: Hughes Tuohy, Carolyn
Formato: Artículo
Publicado: Duke University Press Jun2018
Materias:
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Jun2018
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      pub: Duke University Press
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        atl: Welfare State Eras, Policy Narratives, and the Role of Expertise: The Case of the Affordable Care Act in Historical and Comparative Perspective.
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        au: Hughes Tuohy, Carolyn
        affil: University of Toronto
      su:
        United States
        Health planning
        Human rights
        Insurance
        Policy sciences
        Public opinion
        Witnesses
        Consumer activism
        Patient Protection & Affordable Care Act
        State health plans
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        subj:
          Health planning
          Human rights
          Insurance
          Policy sciences
          Public opinion
          Witnesses
          Consumer activism
          United States
          Third Party Administration of Insurance and Pension Funds
          All Other Insurance Related Activities
          Other Insurance Funds
          Patient Protection & Affordable Care Act
          State health plans
      keyword:
        Affordable Care Act
        policy analysis
        policy narratives
        politics of health policy
        Affordable Care Act
        policy analysis
        policy narratives
        politics of health policy
      ab: This article presents a way of understanding the linkage of expert and public opinion through a focus on policy narratives, which serve as deliberately crafted rhetorical bridges between expert discourses and broader cultural experiences. Across advanced nations, the dynamics of this bridging function has differed in different phases of policy development (such as welfare-state establishment, retrenchment, and redesign), depending on the state of discourse in each realm. In the establishment phase in which most programs of universal health care coverage were adopted, expert discourses were relatively synchronized with but subservient to broader policy narratives about collective and individual rights and responsibilities. The United States, in contrast, pursued its final sprint toward universal coverage in a later phase, in which the policy analysis community had greatly expanded and expert discourses had evolved to focus on specialized issues of system redesign. The resulting highly complex technical design did not readily align with an epic narrative of public purpose. Advocates instead relied principally on two narrative lines: an aggregation of anecdotes that was vulnerable to the simpler opposition narrative of an overweening state, and a crusade narrative that met the opposing narrative of patriotic resistance on its own terms but could not allay partisan polarization.
      pubtype: Academic Journal
      doctype: Article
      src: R
    language: English
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