Learning the Balance Between Policy and Politics

    • May 18, 2007

The Problem: How can a mid-career health professional interested in better understanding and contributing to the formulation of national health policy get exposure to the process at an intimate level in Washington? Can the skills and knowledge attained around national health policy issues be applied to executive positions in medical higher education?

Grantee Background: Robert Miller had nearly 20 years of clinical practice as a head and neck surgeon at Tulane University, New Orleans. He had also been chairman of the department of otolaryngology for nine years and was chief of staff at Tulane Hospital.

Grantee Perspective: At the time Miller entered the Health Policy Fellows Program in 1996, he viewed the fellowship as an opportunity not only to increase his understanding of health policy at the local and national levels—which he believed would serve him well as an even higher-level administrator (his ultimate goal)—but also to network with successful professionals in the health care arena. He stressed that, while some fellows use the experience to propel their careers in health policy, others like him use it to build the skills and knowledge that will make them more effective leaders and executive decision-makers.

Miller worked in the office of Sen. John Breaux (D-La.), who was a member of the Finance Committee that has jurisdiction over Medicare and who had just become the ranking minority member on the Special Committee on Aging. Miller had the opportunity to contribute to three pieces of legislation: Medicare coverage for diabetics, colorectal cancer screening and hospice care; a demonstration model for Medicare, based on the Federal Employees Health Benefit Plan (a bill that never became law); and the budget bill, most of which had to do with Medicare. He also was responsible for interacting with Sen. Breaux's physician constituents.

Results: Having worked on bills that passed and that did not, Miller saw how consensus-building among interest groups is essential to political action. “I had never really appreciated the careful balance between policy and politics that makes Washington the interesting place that it is,” Miller wrote in his final evaluation report for RWJF. “I return to the ‘real world' with a better understanding of the interactions of policy and politics.”

That skill has served him in post-fellowship positions as vice chancellor of the Tulane Medical Center, which he held for two years, and then as dean of the School of Medicine at the University of Nevada. In both roles, he said, his knowledge of the legislative process has helped him deal more effectively with the state Legislature. Furthermore, the skills of negotiation and consensus-building have been especially important in his position as dean, where he reports that he took a leading role in creating a comprehensive medical center in Las Vegas from 1999 to 2001.

Miller has helped to promote the Health Policy Fellows Program by publishing two articles on the program in medical journals and counseling prospective applicants. He has made presentations to later classes of fellows and attended alumni gatherings in Washington.

“Many fellows have stated that the fellowship year was the best year of their lives,” Miller says. “Well, if it is possible, mine was even better.”

RWJF Perspective: Since 1973, the Robert Wood Johnson Health Policy Fellows Program has given exceptional mid-career health and behavior science professionals an opportunity to better understand health policy at the federal level. After an extensive orientation, fellows seek work placements in government—most choosing a congressional office—where they contribute to research, drafting legislation, briefings and other vital policy-related activities.

“The RWJF Health Policy Fellows Program is a flagship program for the Foundation and one important way we seek to improve the health and health care of all Americans,” says Michael Painter, JD, MD, senior program officer and himself a 2003 RWJF Health Policy fellow.

“It is critically important that health care professionals—physicians, nurses, behavioral scientists and others—realize that they can and must play important roles in promoting impactful, positive, informed change. The program provides a great way to help them learn how to do that and to learn firsthand the important relationship between politics and policy.”

“I absolutely could not do what I'm doing today without that experience,” he adds.