Dr. Schlesinger examines ways in which perceptions and values in the form of four metaphors for health care affect public attitudes and the policymaking process. The metaphors represent four dominant ways in which people view the health care system: 1) as a societal right; 2) as a community responsibility; 3) as a professional service; and 4) as a marketable commodity. The project operates on and tests the belief that Americans formulate their goals for the health care system in terms of these four metaphors, providing the primary standards against which government health policies are judged. It further explores whether the many failures of contemporary policymaking can be traced to flaws in the ways that particular metaphors are linked to policies or to conflicts among competing metaphors. A conceptual framework for interpreting the role of these four metaphors in popular thinking and policymaking is developed through historical review of their role in shaping federal policy as well as application of the model to current health policy issues.

Mark J. Schlesinger is a professor in the division of health policy and administration and director of graduate studies at Yale University School of Public Health. He is also a member of the National Advisory Committee of the Investigator Awards in Health Policy Research program, and served for four years as editor of the Journal of Health Policy, Politics and Law. Dr. Schlesinger was previously on the faculty at the Kennedy School of Government and Harvard Medical School, and received his graduate training in economics at the University of Wisconsin. Dr. Schlesinger's research explores the determinants of public opinion about health and social policy, the influence of bounded rationality on medical consumers, the consequences of for-profit organizations in American medicine, as well as the impact of managed care for consumers and health care professionals.