perts,” I must confess that I, too, have had such thoughts. Moreover, those of us who strive for “objectivity” as our central credo point to the large lobbying “war chests” of these same professional interests and their national organizations. There is also the question of whether any training other than economics, or possibly political science, has any relevance to the policy process. For those of you who are not economists, this thought might be slightly incredible. Could anyone even think this? I'm afraid there was a sizable group in the 1960s and 1970s who believed this was true.

Finally, there is the question of a proper appreciation of the policy process. How can one really advise decisionmakers if he or she does not understand the process by which policy is made and the issues that are important in the policy process? Here, too, I have been guilty of believing that professional training in how to perform complicated open-heart surgery does little to provide any special insight into how to restructure the tax code to finance health services for the poor, or into what role the federal government should play in revamping the health care delivery system.

Yet, despite these admittedly self-interested misgivings of my youth, I have come to appreciate the fact that the United States could truly benefit from the expertise of individuals who understand both how health services are delivered and how health policy is made. Individuals educated to appreciate and apply the analytic tools of various disciplines must be a part of the policy advisory process. Even more so, I now understand that no one discipline has the corner on the market regarding insight into public policy. No one paradigm is sufficient for addressing the policy challenges we face in the health arena. The sheer magnitude of the clinical, organizational, operational, economic, and political considerations involved in health care policy requires that a diversity of perspectives are thoughtfully addressed in evaluating any policy option. Unfortunately, this is often not the case, and the result is a constellation of interests polarized between policy experts who know the inner workings of the policy world and health care professionals who actually deliver health care. This polarization is not in our nation's best interests. In the same way that the advent of managed care no longer allows the physician to make decisions independent of larger considerations about the most cost-effective use of limited resources, current policy-making demands an integrated approach that reflects the insights of both those who actually deliver care and those who understand the financial, political, and social aspects of policy development.

The future of our health care system depends on policy decisions that reflect the problem-solving strategies of different disciplines and perspectives. We need a cadre of trained professionals who can appreciate both the clinical and the practical implications of a certain policy option, along with its political and economic implications. Fortunately, a growing number of



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement