Discussions

The first brown-bag lunch featured associate professor Dinshaw Mistry of the University of Cincinnati on “Diplomacy, Domestic Politics, and the Civilian Nuclear Agreement with India.” Most of the congressional fellows in his audience had participated in the Johns Hopkins School of Advanced International Studies September–October foreign affairs seminar (Harun Dogo, Pardee Rand Graduate School, American Australian Association Fellow Andrew Brookes, Asia Foundation and Thai diplomatic corps fellow Natee Vichitsorasatra, State Department Foreign Service officer Matthew Asada, Central Intelligence Agency analysts Adrienne Izzo, Dan Marambio and Gregory Becker, and senior space integration engineer from the Office of the Secretary of Defense Timothy M. Boudreaux). Professor Mistry focused on the unprecedented 2005–2008 process of bending the 1968 Nuclear Non-Proliferation Treaty (NPT) on behalf of India to achieve a new relationship with that country. Up to that point, the original nuclear powers of the United States, Russia, United Kingdom, France, and China were all signatories of the NPT, as were Brazil, Argentina, South Africa, Japan, and Germany in the 1970s and 1980s. Then, the only nonsignatory nuclear nations were India, Pakistan, and Israel that were denied trading rights until they signed the treaty. In 2000, Condoleezza Rice had stated that the United States “should pay closer attention to India's role in the regional balance…India is an element in China's calculation, and it should be in America's, too,” but if the assumption was that the agreement with India was going to be easy sledding, the assumption was off the mark. Between 2005 and 2006 there were nine open congressional hearings and two additional closed hearings. Editorial and op-ed pieces in newspapers such as the New York Times, Washington Post, Washington Times and The Wall Street Journal were largely supportive (Henry Kissinger, former Secretary of Defense William Cohen, and Senators Kerry and Domenici were examples), but with a significant degree of opposition from influential authors such as Thomas Friedman, Strobe Talbott, and former senator Sam Nunn. Although the agreement ultimately received congressional authorization, misgivings among NPT supporters remain in the United States. Furthermore, some question the degree to which the agreement cemented a new relationship with India over the long term.

The second lunch featured associate professor Takakazu Yamagishi of Nanzan University in Japan who contrasted the Japanese and US healthcare systems. His congressional fellowship attendees were drawn from the Atlantic Philanthropies Health & Aging and the Robert Wood Johnson Health Policy fellowships that included the University of Maryland School of Medicine's Dawn Alley, postdoctoral research fellow with Scott & White Healthcare Karon Phillips, program director with San Francisco's Family Service Agency Erica Solway, University of North Carolina Department of Health Policy and Management's Sally Stearns, Dartmouth Medical School's Julie Bynum, New York Presbyterian/Allen Hospital's Executive Director Mike Fosina, University of Texas School of Nursing's Tracie Harrison, Harvard Medical School's Lew Lipsitz, Arizona State University College of Nursing's Adriana Perez, University of Alabama department of medicine vice-chair for clinical affairs Nancy Dunlap, City College of San Francisco nursing instructor Liana Orsolini-Hain, Manatt-Phelps-Phillips attorney Arun Patel, Virginia State Health Policy Institute's professor of dentistry Carole Pratt, and University of New Mexico graduate medical education associate dean David Sklar. Although Professor Yamagishi's current research focus is on US veteran's healthcare, much of the discussion centered on his recent Johns Hopkins University Press book War and Health Insurance Policy in Japan and the United States: World War II to Postwar Reconstruction. A spirited discussion featured characteristics of the Japanese healthcare system including its universal coverage, integrated fee system, relatively low cost of treatment, free access to doctors, near absence of malpractice suits, but seriously overworked doctors who are also in short supply relative to the need. Although the Japanese healthcare system was terra incognita for most of the audience, it was fascinating the degree to which they engaged in the comparative systems conversation. They raised a host of issues including the requirement that US physicians, unlike the Japanese counterparts, are required to complete continuing education to attain required periodic recertification in their fields.

The same audience attended the third lunch on “The Role of Health Policy Experts in the Evolution of American Health Policy” by Centennial Center scholar Ulrike Lepont. Ms. Lepont is an honors MA graduate from both Sciences-Po and the Sorbonne in Paris and a doctoral candidate at the University of Montpellier in France. She had already interviewed close to 50 US academic and think-tank scholars who were engaged in health policy. This proved to enlarge her circle of contacts with APSA Congressional Fellows from a variety of health fields who were in the process of congressional interviews to secure their own legislative assignments that would provide new insights in the health policy field. The discussion focused on the evolution of prominent expert's ideas, the relationships with policy makers, and the professional and intellectual networks in which they worked. Ms. Lepont's research spans the 1970s through 2010 and concentrates on three types of medical experts: regulators (the prevailing Democratic Party approach which has reluctantly integrated their program preferences for the public option in the market-based framework), the micro-economists (more attuned to the Republican Party market-based approach), and the clinical or epidemiologists category which is only recently finding resonance in the policy realm. Ms. Lepont's conclusions suggest that experts have to adapt their own ideas to the prevailing political norms and that congressional policy makers tend to select experts that correspond to the policy maker's interests and values. Not surprisingly, even these tentative conclusions prompted a great deal of audience discussion and provided Ms. Lepont with a variety of new avenues of inquiry.

The final brown-bag lunch featured Anne Pluta on “The Changing Dimensions of Popular Presidential Communication: Washington to Obama.” This was tailor made for the political scientist congressional fellows including PhD candidate James Curry of the University of Maryland, assistant professor Janna Dietz of Western Illinois University, Rutgers PhD candidate Kelly Dittmar, Stanford PhD candidate Christopher Tausanovitch, Pardee Rand Graduate School PhD candidate Harun Dogo, Old Dominion University assistant professor Jesse Richman, American University assistant professor Jordan Tama, PhD candidate Caitlin O'Grady of the University of Oklahoma's Carl Albert Center, German Marshall Fund fellows Paul Maeser and Diana Gierstorfer, Hatfield fellow Darrell Lawrence, and several politically engaged health policy fellows. Invited guests provided particularly helpful research and framing suggestions invited guests, such as former congressional fellow Colleen Shogan whose book The Moral Rhetoric of American Presidents chartered a similar theme, were particularly helpful in suggesting research and framing ideas to Ms. Pluta.

Ms. Pluta is a PhD candidate at the University of California, Santa Barbara. Her dissertation focuses on popular presidential communication (speeches, letters, annual messages, inaugural addresses, veto messages, and messages to Congress) and the influence of institutions on this communication. Her research is enhanced by her graduate training as a historian. She is especially interested in nineteenth century presidents.