Rachel Kahn Best

Disease Politics and Medical Research Funding Three Ways Advocacy Shapes Policy

In the 1980s and 1990s, single-disease interest groups emerged as an influential force in U.S. politics. This article explores their effects on federal medical research priority-setting. Previous studies of advocacy organizations’ political effects focused narrowly on direct benefits for constituents. Using data on 53 diseases over 19 years, I find that in addition to securing direct benefits, advocacy organizations have aggregate effects and can systemically change the culture of policy arenas. Disease advocacy reshaped funding distributions, changed the perceived beneficiaries of policies, promoted metrics for commensuration, and made cultural categories of worth increasingly relevant to policymaking.

Logics of Redistribution: Determinants of Generosity in Three U.S. Social Welfare Programs

Social policy scholars disagree about which factors best predict U.S. welfare state generosity. We argue that this disagreement is an artifact of study designs. Researchers usually study either the totality of a state’s social expenditures or one specific program. These approaches overlook the fact that individual social programs were born of different circumstances and serve different constituencies. Comparing state-level policies for Temporary Assistance for Needy Families (TANF), the Children’s Health Insurance Program (CHIP), and the Supplemental Nutrition Assistance Program (SNAP), our findings suggest that these programs are governed by distinct logics of redistribution. Racial characteristics drive TANF generosity. Economic forces best predict CHIP generosity. SNAP generosity is a function of political factors. Qualitative data from Congressional hearings confirm these findings. These results adjudicate between conflicting accounts of the contemporary welfare state and also highlight which aspects of a program’s design make it most susceptible to the effects of racial bias and to partisan politics.

Disease campaigns and the decline of treatment advocacy

In the past fifty years, disease advocacy organizations have multiplied and gained political influence, but they have often been reluctant to ask the government to intervene in health care provision. This article asks why. Using original quantitative and qualitative data on the goals and political claims of over one thousand organizations from 1960 through 2014, I find that many early disease advocacy organizations prioritized health care access. But unfavorable political climates discouraged new organizations from focusing on access to treatment. When health care became particularly controversial, even organizations with health care-related missions refrained from pursuing this goal politically. Eventually, politically active organizations began to drop treatment provision from their missions. Over the decades, the troubled politics of health care reshaped the field of disease advocacy, diminishing its focus on medical treatment.