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Narrative Matters

Using And Misusing Anecdote In Policy Making

PREFACE: During the 2000 presidential campaign, Al Gore’s questionably accurate tale of his dog paying less than his mother-in-law for the same drug, and years ago, President Ronald Reagan’s similarly creative story about a nonexistent "welfare queen," share common thread. They underscore the power of stories to dramatize political positions, despite the moral and informational hazards of personal narratives as policy currency. The policy anecdote is an omnipresent form of policy discourse that Health Affairs attempts to capture in a responsible and literary way in the Narrative Matters column. With support from the Kellogg Foundation, in March 2000 Health Affairs convened a group of writers, health policymakers, editors, and journalists to explore the role of the personal essay in the making of health policy. The following commentaries from that conference by John McDonough and Barbara Sharf address the power and the pitfalls of the personal story in the health policy process. McDonough, former politician, and Sharf, a professor of communication and humanities, derive strikingly similar conclusions from quite different vantage points.

In 1991 I was a legislator in the Massachusetts House of Representatives arguing against deregulation and market-based health care as a means of controlling health costs. I carried a nine-inch pile of evidence everywhere—to hearings, press conferences, meetings, and floor debate. Half the pile was made up of empirical, peer-reviewed studies demonstrating the efficacy of state-run hospital rate setting programs. The other half consisted of peer-reviewed studies failing to identify improvements in cost or access from managed care. By contrast, deregulation advocates —corporate benefit managers, insurance and hospital executives, and union welfare fund trustees—had no empirical evidence to support their . . . [Full Text of this Article]

When A Story Is Off Base

 

Anecdote’s Inescapable Humanity

 

Values Versus Data

 

Using Stories Wisely

 

How Do You Know That?

 

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