• A defence of policy blogging

    In a recent post about policy blogging, I asked

    So, health policy bloggers: If Reid, Boehner, and McConnell can’t sway public opinion, despite the audiences they command, what do you hope to accomplish?

    I answered that

    By developing new and powerful ways of helping people understand their situations, public intellectuals and politicians can prepare people to take effective action to improve those situations.

    But I wanted to know how other bloggers would respond. Keith Humphreys answered that his blogging engages:

    readers [who include] journalists, elected officials, Congressional and White House staffers, police officers, health care system managers, teachers, judges, economists, social workers, physicians, university administrators, business leaders, civil servants, policy analysts and many other people who regularly face up to the challenge of designing, analyzing and implementing public policy… Add up all the people who implement public policy, study it, or just know a lot about it, and you get a sadly small number, way too small to ever kid myself that my blogging could move mass opinion in a country of over 300 million people. But what it clearly can do is put good information and ideas into the hands of people who matter in and care about the public policy world.

    I concur. I made a related point a couple of years ago in a blog conversation with Austin (his comment here, Kristen Rosengren’s here, further comments of mine here and here). Referring to this schematic…


    …I commented:

    Let’s simplify the world of health policy discourse to four strata of participants: decision makers, their policy staff, policy intellectuals and journalists, and academics. There is an insider culture grounded in a network of peer interaction within each stratum. The arrows are meant to suggest patterns of communication between strata, and examples of the media that support them.

    Policy blogging speeds communication in the channels denoted by the double headed arrows. Through blogging, academics and policy intellectuals can write on the issues of the day for journalists and policy staff. The latter can use our words and thoughts to inform decision makers. This is absolutely worth doing.

    Keith also wrote about the personal rewards of blogging.

    [Blogging] can also provide me with an opportunity to learn from my readers and thereby come to a better understanding of the policy issues I care about. The public at large will likely never know (or care) about this ongoing exchange of wonky material within a small community. But I do, and that’s enough to keep me going.

    Just so. I wrote a while back.

    Scientific blogging can enable you to find the invisible college of people who care about an intersection of disciplines that you care about, and you may have believed that you were the only one who cared about.

    As Keith suggests, we write for a larger audience than just the policy elite. Here is an extraordinary visualization of the larger invisible college of scientific collaboration.

    It’s extraordinary in part because it shows so clearly who is not in the community.

    Policy blogging should transport information back and forth across the membrane encapsulating the scientific community. We are not ‘dumbing down’ our disciplines, but rather acknowledging that over and above the barrier of technical detail, science strips a fact from its lived context. To make science accessible, we need to return facts to a lived context by writing imaginatively so that a fact

    awakens and enlarges the mind itself by rendering it the receptacle of a thousand unapprehended combinations of thought.

    So that’s my defense of blogging. I hope to be read not as a partisan of secular liberalism, though I am, but as someone aspiring to be a good science writer.


    • Bill
      How do you return facts to a lived context with just the folks included in your schematic above.

      I think about myself. I dont know where I fit it, but as as a policy participant,/activist, blogger, and practitioner (read: real world experience, aka “context”), I have something to add–but I am not on the hierarchical ladder. I would say the same for patients and other clinicians who have a huge voice in the blog space. I hope I contribute as much as I take away.

      When has anyone on the list above told someone they have a terminal disease; cant get care because of lack of insurance; told someone “no;” or cried with a family at the bedside. Surely that counts for something. Lived context.


    • I second Brad’s comment, and suggest that life is much different outside the Beltway. I would also expand to include similar sentiments with respect to those who PPACA relies upon to maintain coverage – employer-sponsored plans. Simply, no one with practical experience in delivering health coverage through employer-sponsored plans, where, in 2009-2010 the majority of non-elderly Americans obtain their coverage, was ever really at the PPACA table.

      PPACA was sold as expanding health coverage without cost – at least based on the assertions that it would not add “one dime” to expanding the deficit. Employers, for the most part, have simply accepted the increased costs of expanded eligibility, reduced cost sharing limits, elimination of pre-existing condition exclusions, 100% preventive services coverage, etc. – without confirming the added costs to employees. So, most employees think health reform’s improvements are free – simply because it is hard to discern the change in expense, and even if it were known, it is pretty much a futile exercise given the inability to avoid the mandated changes. Similarly, as we have heard from Secretary Sebelius and President Obama, if PPACA stumbles, it will be because of Republicans, insurance companies and large corporations – not from any inherent design flaws in PPACA.

      There has been very little, if any discussion, about who is to shoulder the 2+T annual spend. No one wants to discuss the difference between the incidence and the impact of the various new taxes that are a part of PPACA. Certainly, this is federal budget neutral if all the assumptions are realized, just not YOUR budget – if you are a large employer, an employee, a patient, or a taxpayer (or a member of future generations of taxpayers).

      Similarly, the CBO simply projects employers won’t, in total, change their position – that there will not be a dynamic employer response. Those projections ignore the likely continuation of the erosion of employer-sponsored coverage from 2000 – 2010, the potential shift to increased part time employment, the embrace of ever higher point of purchase cost sharing plan designs, etc. For example, the comments about the “high cost health plan” tax were all about the policy goal of reducing spend on health care (by reducing the tax preference for employer-sponsored health coverage), not so much on the much more likely outcomes:
      – A shift of costs to employee point of purchase cost sharing, without tax preferences such as Health Flexible Spending Accounts,
      – An ever larger embrace of Health Savings Account – qualifying high deductible health plans, coupled with a shift of Health Savings Account funding to occur outside of cafeteria plans (raising FICA and FICA-Med and perhaps some local income tax revenues, but not truly reducing health spend),
      – A likely increase in the use of multiemployer health plans, given the special consideration incorporated in the IRC 4980I structure, and
      – A further reduction in employer-sponsored coverage – the high cost health plan tax only applies to employer-sponsored plans, not to coverage in the public exchanges – where a few years after the tax takes effect, employers will recognize the IRC 4980H $2,000 tax (even indexed) will be much less expensive than the combination of employer-contributions towards health costs and the IRC 4980I penalty tax.

      Simply, at a minimum, you need representation from those you intend to rely upon to make the structure work as designed and as priced.

    • Brad and BenefitJack,
      Thanks. The discussion at the end of the paper — the stuff that begins “we write for a larger audience than just the policy elite” — was assuming that we were writing for a larger audience than what’s described in the figure. I’m sorry that wasn’t clear.

      • I understand you write for many types of folks.

        However, I wanted to convey the schematic has missing links in the chain. I am a conveyer as much as a conveyee,

    • I would add one more layer to your policy strata- Private Sector- in my opinion, people like Karen Ignani have much more influence over health policy than some White House staffer.