however, that the years 1992 to 1994, and the battle for passage of national health care reform represented an historical and unique opportunity to observe both the highs and the lows of public policy formulation. No matter what side of the issues one was positioned, the years of the Clinton health plan debate provided invaluable lessons on how things get accomplished or fall apart in a political environment around issues of major change—in this case, national health care reform.
For the RWJ Health Policy Fellows, one of the seminal lessons learned from the rise and fall of the Clinton Health Security Act (Clinton HSA) focused on how information is produced, packaged, used, and disseminated to color or position a particular issue and to affect the final outcome—in both positive and negative ways. Although this area may be old hat to Madison Avenue and the media, the use of information by key stakeholders to both shape and shake public perception and opinion was an illuminating if not transforming experience for policymakers and health policy researchers traditionally operating outside the hothouse of the Washington political scene. Symbolized perhaps most startlingly by the now-famous Harry and Louise ads developed by the insurance industry, the 1992 to 1994 policy and political season marked a uniquely rich opportunity to learn about information and information trading as critical drivers in the ultimate success or failure of a legislative initiative.
It was with this in mind that a group of RWJ Health Policy Fellows decided that it might be useful to develop a number of case studies focused on major national or state health care initiatives and to look more closely at how information is used and conveyed and to what degree it influences the outcome. The case studies selected and presented in this volume—the adoption of the successful Japanese just-in-time (JIT) manufacturing strategy to information development and trading on Capitol Hill; funding of graduate medical education (GME) as proposed in the Clinton HSA; the campaign for statewide health care reform in Missouri; the development of New York State legislation phasing out the state's hospital rate-setting system with a more market-oriented approach for funding GME and other public goods such as care for the uninsured; the recent congressional debate over reauthorization of the National Institutes of