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Critical Thinking Resources for Health Care Policy

Brookings Institution

Brookings is the oldest and one of the best-known of the Washington-based “think tanks,” tracing its origins back to 1916 and founder Robert Somers Brookings, a wealthy St. Louis businessman. Its scholars generally have very strong academic credentials.

Reports from the institution and its scholars can be viewed by research programs, policy centers and research projects. They fall mainly into the categories of competitiveness, education, migration, health care or energy security.

Brookings says it is funded by “foundations, corporations, and individuals, and to a lesser extent by endowment income.”

Comments: Brookings has a well-earned reputation for scholarly excellence. Its reports are, for the most part, clearly written and can be fine guides to understanding how government programs work, or don't work. It has a reputation for leaning slightly to the left.

Political Leanings: Liberal

Census Bureau

The Census Bureau’s website offers far more than its up-to-the-second clocks with estimates of the U.S. and world populations. There is, of course, a general summary of the most recent census. A link from the home page brings up the American FactFinder, which allows the user to retrieve complete census breakdowns of the U.S. population by age, race, home ownership status and many other categories within cities, counties, states or even ZIP codes. The FactFinder is also the place to find complete data sets organized according to congressional district boundaries. The Statistical Abstract of the United States offers an extensive, text-based explanation of the census data, including information about immigration. Census provides annual updates of U.S. household income, as well as data on Americans living in poverty and persons with and without health insurance.

Comments: The Census Bureau provides a wealth of information on Americans, and the website is a valuable research tool.

Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention was founded in 1946 to help control malaria and has since become a major player in the public health arena.

Its website includes a wealth of information and official statistics. The Morbidity and Mortality Weekly Report section offers CDC reports and recommendations on everything from influenza to the West Nile virus. The organization’s National Center for Health Statistics is an invaluable tool for researchers looking for health-related data. CDC also releases an annual report on health trends in America. Although very detailed and informative, the document is a daunting 543 pages long. Therefore, we recommend that readers first see the website’s “Hints for Easy Use.”

Fast Stats A to Z is an excellent index that organizes data by key terms and can help users navigate the intricate website. In this section one can also find an interactive map that provides state-by-state data. Useful information on births, deaths and marriages can be found under the National Vital Statistics System.

Comments: The Centers for Disease Control is an authoritative and trustworthy source for health statistics.

Centers for Medicare & Medicaid Services

The CMS, an agency within the U.S. Department of Health and Human Services, primarily administers Medicare and works in partnership with the states to administer Medicaid, the State Children’s Health Insurance Program (SCHIP) and other programs. The agency is responsible for the implementation of the Medicare Modernization Act of 2003, which extended a new prescription drug benefit to senior citizens.

On the agency’s website, consumers can search to see whether the health programs cover specific medical procedures or services, find data about Medicare and Medicaid enrollment, and find news on newly implemented regulations and policies.

A good place to start for official statistics on Medicare is the “overview” section of the most recent Medicare Trustees Report. The site also offers Medicare Facts & Figures and Medicaid Facts & Figures, which are periodically updated.

Comments: Be wary of press releases you may find on the site from high-level political appointees, which tend to reflect administration policy. However, nuts-and-bolts statistics regularly issued by CMS career professionals, especially the Medicare Actuary, are generally trusted by all sides.

Congressional Research Service

The Library of Congress houses the Congressional Research Service, “the public policy research arm of the United States Congress.” The CRS performs independent, nonpartisan and objective research for members of Congress and their staffs on a nearly endless array of issues. The Librarian of Congress appoints the director of the CRS, which has a large, knowledgeable staff and receives a sizable budget.

The CRS no longer releases its reports to the general public, but many can be found fairly easily online. The U.S. State Department and independent groups including the Law Librarian’s Society of Washington, D.C., and the National Council for Science and the Environment post the full text of some CRS reports relating to each group’s area of interest. The Open CRS Network website has a search engine that combines the resources of several, though not all, of these sites. The public can also purchase reports from some websites. And if time permits, individuals can request paper copies of specific reports directly from their senator or representative.

The CRS is acclaimed for its objective and thorough analyses. Authors are aware that they are writing for an audience that includes both Republicans and Democrats, and they are meticulous about avoiding partisanship.

FactCheck.org

According to its website, FactCheck.org is a “nonpartisan, nonprofit ‘consumer advocate’ for voters that aims to reduce the level of deception and confusion in U.S. politics.” Its staff monitors factual accuracy in American politics, looking at what’s being said in TV ads, debates, speeches, interviews and the like.

The website has three main outlets for its work: Articles, the FactCheck Wire (for shorter items or ones of less national interest) and Ask FactCheck (in which the group’s staff members answer questions sent in by readers, often about chain e-mails on political subjects). The group debunks myths, falsehoods and exaggerations by politicians and outside groups involved in election campaigns and public policy debates. Examples of FactCheck.org’s work include stories about misinformation spread during public policy debates such as the one on overhauling the health care system, and inaccurate claims made during election campaigns such as John McCain’s position on Medicare or Barack Obama’s birthplace. The group’s work is often cited by other media organizations.

FactCheck.org is funded by, and is a project of, the Annenberg Public Policy Center, which was established by the Annenberg Foundation with a $20 million endowment in 1993. The Annenberg Foundation also made additional grants to support FactCheck.org’s work. The APPC accepts no funding from business corporations, labor unions, political parties, lobbying organizations or individuals. In 2010, FactCheck.org began accepting donations from individual members of the public. Its does not accept any funds from corporations, unions, partisan organizations or advocacy groups.

Political Leanings: None

Kaiser Family Foundation

The Kaiser Family Foundation, a research-based health care philanthropy, describes its mission as “to inform discussion and debate on major issues that affect millions of people, especially the most vulnerable and disadvantaged, and to elevate the national level of debate on health issues.” Its reports are intended as tools for lawmakers, the media and the public to promote greater understanding of health care financing, including how to use Medicaid and Medicare. It is an independent philanthropy that receives no outside funding and is not associated with Kaiser Permanente or Kaiser Industries.

The foundation regularly releases the results of public opinion polls and surveys. An affiliated website, kaisernetwork.org, offers reports and webcasts on many issues related to health policy.

Comments: Widely respected, Kaiser’s studies focus on public health for the poor and those without medical insurance. Its surveys and analyses are comprehensive and well-documented.

Political Leanings: None

National Conference of State Legislatures

A bipartisan organization for state, commonwealth and territorial legislators and their staffs, the National Conference of State Legislatures “provides research, technical assistance and opportunities for policymakers to exchange ideas on the most pressing state issues.” The organization advocates the interests of state governments.

The NCSL’s website contains information about the issues state governments are facing, such as education, environmental protection, transportation, criminal justice and state-tribal relations. Visitors to the site can access various reports, including summaries of which states enacted certain types of legislation on, for example, gambling or immigration. The site also contains information on state elections and election laws.

The “GrassCatcher” page is a daily roundup of state and policy news. Visitors can listen to NCSL’s podcast and request a personalized daily or weekly e-mail on specified policy topics.

Comments: The website is a good resource for information on the status of state laws on various subjects.

National Governors Association

The National Governors Association was formed in 1908 and represents all 50 state governors as well as those from five U.S. territories. The NGA’s Office of Federal Relations in Washington, D.C., lobbies for policies that reflect the governors’ views, and its Center for Best Practices is a consulting firm that helps governors “develop and implement innovative solutions to public policy challenges.” The Center for Best Practices issues policy reports and writes Front & Center, a weekly newsletter on what the NGA and its governors are doing. It also funds state projects. For instance, it supported 15 states in developing programs to fight childhood obesity. Reports on these projects can be found on the Center’s part of the NGA site.

The public can access information on individual governors and issues of interest to the NGA on the website.

To be part of the NGA, states must pay dues, which help fund the organization’s activities. The Center for Best Practices is financed primarily through federal and private foundation grants and partially through the NGA’s Corporate Fellows Program, which accepts $20,000 from companies that then act as resources for the center. That program is designed to increase dialogue between the public and private sectors.

Comments: The NGA is bipartisan but writes about issues from the perspective of state governors. It vigorously promotes its members’ proposals and accomplishments.

Public Citizen

Public Citizen is a consumer advocacy group that was founded in 1971 by Ralph Nader, a liberal activist and later a Green Party presidential candidate. The group says it works for “openness and democratic accountability in government, for the right of consumers to seek redress in the courts; for clean, safe and sustainable energy sources; for social and economic justice in trade policies; for strong health, safety and environmental protections; and for safe, effective and affordable prescription drugs and health care.”

The organization has six divisions: Auto Safety, Congress Watch, Energy Program, Global Trade Watch, Health Research Group and Litigation Group. It has been instrumental in a number of high-profile consumer advocacy causes. Public Citizen activists helped in the push to get airbags required in all vehicles, for instance, and the group fought to get Reye’s Syndrome warnings on aspirin bottles. Toy safety has been another area of focus for the group. Its worstpills.org site offers detailed information about pharmaceuticals the group considers unsafe, but full access to this information requires a paid subscription.

The Public Citizen website can be an invaluable source of information on consumer safety issues, and in some areas the group does its own research. Its Center for Auto Safety, for example, developed its own roof crush test for cars.

Public Citizen is pro-consumer and often critical of corporations and government. Don’t expect to see the views of the private sector represented here. The group does not accept donations from corporations, professional associations or government agencies, though it has received contributions from labor unions. In 2008, more than half of its funding came from individual donations, with about one-sixth coming from grants. Public Citizen’s Form 990 tax records are available on its website.

Comments: Public Citizen's research is often thorough and detailed, though the group has an anti-corporate, pro-regulatory point of view.

Political Leanings: Liberal

Quackwatch

Quackwatch is a website that attempts to combat misinformation about medical topics. In its own words, the group combats “frauds, myths, fads, and fallacies” regarding health-related products and services. The site includes book reviews, overviews of testing on medical treatments, and a section on supplements and infomercials. Quackwatch articles are thoroughly footnoted with many links to original sources.

Articles can be browsed by categories including chiropractic and weight loss, and there is a section on the history of “quackery.” A site search engine helps find specific articles.

The organization was founded by Dr. Stephen Barrett, a retired psychiatrist. He and a team of expert volunteers write the articles and administer the site. Quackwatch has been on the Internet since late 1996 and has existed since 1969, when it began as the Lehigh Valley Committee Against Health Fraud. Funding comes mainly from small individual donations made through PayPal or Amazon, profits from the sale of publications, and commissions from sales on two sites to which Quackwatch refers traffic.

Quackwatch offers well-documented information about dubious medical products, nutritional supplements, "cures" and weight-loss products, as well as various "alternative" medical procedures.

Regulations.gov

Regulations.gov was set up in 2003 to better equip citizens to find, view and comment upon the vast array of federal regulations.

After Congress passes laws, federal agencies are responsible for enforcing them. They use regulations to accomplish that task, spelling out in detail how specific statutes are to be implemented. Each new proposed regulation must go through a notice-and-comment process, meaning that an agency must publicly announce a proposed regulation and then allow citizens the chance to weigh in. Keeping track of these draft rules once was a daunting project, as there are thousands of federal regulatory agencies. Regulations.gov simplifies the process by collecting proposed regulations from each federal agency and offering a forum for submitting comments on them.

The site also catalogs existing federal regulations, so that anyone wanting to check the wording of rules that were issued to implement, say, the Bipartisan Campaign Reform Act can find them here.

The site can be searched by keywords, phrases or rule numbers. A short glossary of regulatory terms is provided, as is an extensive user guide. The site also includes an RSS feed that provides up-to-the-minute notice of new federal regulations.

Comments: The basic keyword search is straightforward, but the most powerful search functions require considerable knowledge of the regulatory process. If you know what you are looking for, Regulations.gov offers one-stop shopping. It is less useful for casual browsing and novices.

USA.gov

USA.gov calls itself “the official U.S. gateway to all government information.” The U.S. General Services Administration’s Office of Citizen Services and Communications oversees the website, which offers a library of links to government agencies, information about particular laws and regulations, and data and statistics. Visitors can get pertinent links classified by topic and access links to state and local governments as well.

Comments: USA.gov can be a good place to begin for researchers who are unsure of where to look first.

Wikipedia

Wikipedia is an online encyclopedia where articles may be written or edited by any user who creates a free account. It offers a vast amount of easily accessible information; the English version contained more than 3.2 million articles as of March 2009. But it can’t guarantee accuracy and sometimes has been dramatically wrong.

Individuals who write and edit articles for Wikipedia are volunteers. In theory, they bring a vast collective knowledge to bear and quickly discover and correct any biased or inaccurate entries. Advocates say this bottom-up approach produces a product that rivals traditional, top-down encyclopedias in which articles are written by individual experts chosen by professional editors. Indeed, a study in the December 15, 2005, journal Nature reported that in a sample of 42 entries on scientific topics, its experts found 162 errors in Wikipedia compared with 123 errors in Britannica. However, Britannica later challenged the Nature study as “fatally flawed” and filled with “flagrant errors.”

The weakness of Wikipedia’s anybody-can-edit policy was demonstrated dramatically when a false biographical entry on John Seigenthaler Sr., former editorial director of USA Today, went uncorrected for four months in 2005. It claimed Seigenthaler had a role in the assassinations of former President John Kennedy and his brother Robert. Those false claims were the work of a 38-year-old employee of a Nashville delivery service, Brian Chase, who had posted the libels as a joke and who later apologized to Seigenthaler. Numerous other instances of false Wikipedia entries have come to light since.

Wikipedia’s own founder, Jimmy Wales, publicly cautions students against citing it as an authoritative source. In June 2006, at a conference sponsored by the Annenberg Public Policy Center of the University of Pennsylvania, he said that he gets about 10 e-mails a week saying, “Please help me. I got an F on my paper because I cited Wikipedia.” Wales said those comments make him think to himself: “For God sake, you’re in college; don’t cite the encyclopedia.”

Wikipedia is “pretty good,” Wales said, “but you have to be careful with it. It’s good enough knowledge, depending on what your purpose is.”

Comments: Wikipedia is a useful resource when beginning research on an unfamiliar topic, but it's not always reliable. Information needs to be checked against original sources, but this is often difficult due to a frequent lack of footnotes.

Political Leanings: None