Deborah Stone

Deborah Stone is a fellow at the Open Society Institute and holds an investigator award in health policy from the Robert Wood Johnson Foundation.

Recent Articles

Ad Missions

Insurance companies aren't just selling policies. They're selling ideology too.

I n a series of television ads sponsored by the Health Insurance Association of America (HIAA), Harry and Louise sit at the kitchen table discussing health reform. The ads are unremarkable, yet they have drawn the wrath of President and Mrs. Clinton. "It's time we stood up and said we're tired of insurance companies running our health care system," Hillary Clinton declared. Ira Magaziner termed the ads "unconscionable." Even some of the association's own insurance-company members took offense. New York Life called for a moratorium on the ads, and in the scuffle, Prudential became the fifth major insurer to pull out of HIAA. While everyone debates whether the ads really do distort the Clinton plan or whether they are good or bad for insurers, the real issue has escaped notice. Insurers' advertising campaigns are aimed at something far deeper than a presidential proposal. They are meant to shape Americans' understanding of the very idea of insurance and to influence our cultural...

Making the Poor Count

The poverty line came from a woman with a passion and a memory.

The poverty line is a stock figure of American statistical and political culture. Most of us are at least dimly aware that it is an official level of income used to separate the poor from the non-poor, that the government somehow sets it, that it changes from time to time, and that it is the topic of periodic political fights. Even those who know its arcane details, however, usually forget that our official measure of poverty was once crafted by a real person with a passion and a pencil. The person was Mollie Orshansky. In 1963, she published an article about poverty that set the U.S. government on a new path. "Children of the Poor" ran in the Social Security Bulletin , an otherwise rather dry publication of the Social Security Admini- stration's Division of Research and Statistics. By the time the decade was out, Lyndon Johnson had included her poverty estimates in his 1964 Economic Report of the President, the Office of Economic Opportunity had adopted her methods for determining...

When Patients Go To Market: The Workings of Managed Competition

A fter a generation of deadlock, there is finally a broad consensus that the health system is broken, and a rare political opportunity to fix it. The present system manages to be simultaneously inflationalry, arbitrary, cumbersome for providers, and unreliable for consumers. But despite the opportunity for reform, we are on the verge of a disasterous mistake. Increasingly, it appears that the Clinton administration will embrace some variant of "managed competition." The strategy seeks to achieve universal converage and cost containment while simultaneously avoiding either public financing of the entire scheme or a bruising political confrontation with the health-industrial complex. This logic seems clever, but managed competition is a therapy based on the wrong diagnosis. It doesn't begin to address the deep structural and cultural causes of our health system breakdown. And even though many of managed competition's intellectual creators draw on lessons from failures of past health...

Sex, Lies, and The Scarlet Letter

O nce when I was about nine, I wandered into my aunt's kitchen during Thanksgiving to find all the grown-up women whispering, hugging, and crying. When they explained to me what was going on (Auntie Cookie had just found out she was going to have another baby and they were crying from happiness), they confirmed a story I already knew--the one about how babies just happen, and women to whom they happen are considered very lucky. How else to explain the crying? A few years later, when my friend Phyllis told me her parents were "trying to make" another baby, I had the crashing revelation that human actions create babies. Reading about unwed mothers and welfare these days, I can't help but think the nation is in need of a crash course in sex education. According to an article by Barbara Dafoe Whitehead in the Atlantic Monthly last October, we've got lots of public school sex education programs, but they're teaching the wrong thing. Under the guise of "family life education," she wrote,...

Bedside Manna

Marcus Welby was a myth; doctors have always cared about money. But the for-profit managed care industry makes no pretense: It's offering physicians money to make decisions that are plainly not in the interests of patients.

EDITOR'S NOTE: This article draws on material that will appear in more extended form as "The Doctor as Businessman: Changing Politics of a Cultural Icon," Journal of Health Politics, Policy and Law , vol. 22, no. 2, 1997. F or more than 150 years, American medicine aspired to an ethical ideal of the separation of money from medical care. Medical practice was a money-making proposition, to be sure, and doctors were entrepreneurs as well as healers. But the lodestar that guided professional calling and evoked public trust was the idea that at the bedside, clinical judgment should be untainted by financial considerations. Although medicine never quite lived up to that ideal, the new regime of managed care health insurance is an epic reversal of the principle. Today, insurers deliberately try to influence doctors' clinical decisions with money—either the prospect of more of it or the threat of less. What's even more astounding is that this manipulation of medical judgment by money is no...