Politics has become a synonym for all that is dirty, corrupt, dishonest, compromising, and wrong. For many people, politics seems not only remote from their daily lives but abhorrent to their personal values. Outside of the rare inspirational politician or social movement, politics is a wasteland of apathy and disinterest.
It wasn’t always this way. For Americans who came of age shortly after World War II, politics was a field of dreams. Democracy promised to cure the world’s ills. But starting in the late seventies, conservative economists promoted self-interest as the source of all good, and their view became public policy. Government’s main role was no longer to help people, but to get out of the way of personal ambition. Politics turned mean and citizens turned away.
In this moving and powerful blend of political essay and reportage, award-winning political scientist Deborah Stone argues that democracy depends on altruism, not self-interest. The merchants of self-interest have divorced us from what we know in our pores: we care about other people and go out of our way to help them. Altruism is such a robust motive that we commonly lie, cheat, steal, and break laws to do right by others. “After 3:30, you’re a private citizen,” one home health aide told Stone, explaining why she was willing to risk her job to care for a man the government wanted to cut off from Medicare.
The Samaritan’s Dilemma calls on us to restore the public sphere as a place where citizens can fulfill their moral aspirations. If government helps the neighbors, citizens will once again want to help govern. With unforgettable stories of how real people think and feel when they practice kindness, Stone shows that everyday altruism is the premier school for citizenship. Helping others shows people their common humanity and their power to make a difference.
“Finishing The Samaritan’s Dilemma, you not only want to give the book to your neighbors and send it to your congressional representatives but may find yourself wishing that, when the time comes for our next president to assemble a cabinet, Deborah Stone could be appointed our first Secretary of Compassion.”
– Francine Prose, Oprah Magazine
Unlike most texts, which treat policy analysis and policy making as different enterprises, Policy Paradox demonstrates that “you can’t take politics out of analysis.” Through a uniquely rich and comprehensive model, this revised edition continues to show how real-world policy grows out of differing ideals, even definitions, of basic societal goals like security, equality, and liberty. The book also demonstrates how these ideals often conflict in policy implementation.
In this revised edition, Stone has added a full-length case study as an appendix, taking up the issue of affirmative action. Clear, provocative, and engaging, Policy Paradox conveys the richness of public policy making and analysis.
“Since its debut, Policy Paradox has been widely acclaimed as the most accessible policy text available.”
-W.W. Norton & Co.
Learn more at www.policyparadox.com
For many years, the welfare state was expanding. In those times, advocates for many new groups of people were able to win through the political process the extension of benefits to their constituents. Definitions of need, worth, and eligibility were changed so that more people became “entitled” to payments. The opposite trend is in effect now. Most advanced industrial states have experienced some form of fiscal crisis, and their governments are taking a hard look at how they define who is eligible for support.
One major category is disability. But who is “disabled,” and who decides that? Though doctors certify disability for the state, Stone argues that “the concept of disability is fundamentally the result of political conflict about distributive criteria and the appropriate recipients of social aid.” The concept also has a social history and a social context today. Despite the very real stigma of the world “disabled” in other settings, being “disabled” for welfare purposes means being morally worthy. Like the “deserving poor” of English Poor Law, the “disabled” would work if they could. Isn’t disability something that can be measured scientifically and apolitically determined? That argument breaks down in the face of a simple example: blindness. Many blind people can work, yet because of the obviousness of the condition and sympathy it arouses, the “blind” have always been considered eligible for benefits without question.
The concern with “welfare cheats” is not a new one. The author reaches back several centuries to trace the fascinating history of this and other aspects of welfare policy in Germany, England, and the United States. What Stone finds are elaborate tests to weed out fraudulent applicants (beggars with faked afflictions) and changing criteria to distinguish the able from the “disabled.”
“Deborah Stone demonstrates that disability is a movable social boundary whose limits depend on cultural consensus. Her elegant analysis has important political implications.”
—Aaron Wildavsky, President, American Political Science Association
The Limits of Professional Power (1981)
Governments in advanced industrial societies are increasingly providing health services for their citizens, either directly, through the employment of health care professionals, as in Britain, or indirectly, through the financing of health services purchased privately , as in Canada, the United States, and West Germany. In either case, the government becomes highly dependent on the providers of health care, which in turn enhances the political power of the medial profession.
At a time when the United States is debating the merits of various health care programs, Deborah Stone’s carefully documented study is extremely valuable. She identifies three strategies employed by various governments to control the cost, quality, and volume of health care services. The first and most drastic measure, exemplified by the current British arrangement, is simply to hire medical professionals as salaried government employees. A second strategy is to impose government-mandated peer review on the profession. The third broad strategy is for the government to create and/or foster the development of competing centers of power, usually in the form of large groups of patients which are (in theory) strong enough and rich enough to bargain with physicians.
“The theme of professional participation in politics has sociological and political science interest; it is here that Stone’s work is so impressive, weaving the concerns about professional association, norms, and pressure-group power together into a a readable whole…. This book is a superb sequel to Alford’s Heath Care Politics. It is a careful rendering of a controversial policy arena on a cross-national basis, an important contribution to cross-national policy learning, and an interesting book of comparative policy analysis.”
–Theodore Marmor, Professor of Political Science and Public Health, Yale University