Public Interest Lawyers and New Governance: Advocating for Health Care

Abstract

The article places the emerging role of the public interest lawyer in the context of the broader changes taking place in American governance. This new role is illuminated through a case study based on the experience of healthcare lawyers in the regulatory framework of Wisconsin.

The analysis proceeds in four steps. The initial section outlines the classic model of public interest law in the context of the post-New Deal era. It then lays out three broad "movement" changes in governance: a movement of authority downward from the federal government to the state and local level; an outward movement of responsibility for designing, implementing and enforcing social programs from government to market and non-governmental actors; and a movement outside the regulatory box, away from the traditional regulatory framework. The analysis then describes how these changes in governance have encouraged an emerging model of public interest advocacy which emphasizes collaboration, linked local action, and a diffusion of roles and practices.

A central section of the paper describes a case study of how state-based consumer advocates responded to managed care. They represented the interests of consumers to ensure quality services and assuage the fears of consumers in the managed care context. The consumer advocates used the techniques of creating state-based collaboratives and sharing expertise with health care professionals. They also participated in networks across states to link the local actions. They also moved away from traditional regulatory approaches in favor of endorsing mechanisms that influenced internal structures of managed care organizations and used market data-driven systems.

The article concludes with a discussion of the risks of new governance. There is a legitimate concern that these new strategies will be detrimental to public interest clients and society.