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Donald W. Light, University of Medicine and Dentistry of New Jersey
For more than a quarter century, I have been mounting campaigns to redress injustices by the power elite. This form of public sociology is grassroots or advocacy work targeted at an elite to get them to do something or stop doing something. In a recent Social Forces article, I explained how such tactics can lead to original contributions to sociological theory, concepts, and methods, and that advocacy sociology can be a basis for promotion rather than demotion (www.jstor.org/pss/3598407). Below I spotlight one reason most of these campaigns have succeeded—targeting and challenging the power elite.
Halfway through my first exhausting campaign to reverse health insurance premium increases that discriminated against older, female, and minority policyholders in New Jersey, I realized that power rested in one person: the Commissioner of Insurance. He had approved what my evidence showed were large premium increases based on erroneous claims by executives at Blue Cross and Blue Shield of New Jersey (the Blues) saying that they would go bankrupt without them.1 Together with volunteers from the New Jersey Public Health Association, we mobilized a large coalition that included the AARP, NOW, the NAACP, the NJ Council of Churches, and others. We put together press kits and charts that led to good coverage and legislative debate but no actual change in the discriminatory premium hikes. We had to reach or overrule the Commissioner.
I decided that wasn’t enough and changed tactics and refocused our energy on assembling a pro bono legal team. The Blues claimed these were community rates, only demographically adjusted. We built a case for litigating the increases as violating the community rating clause of the Blues’ enabling legislation. We persuaded the Public Advocate to prosecute the case and our argument prevailed. A three-judge appellate court ruled that the increases violated Blue Cross’s enabling legislation, and rolled back the premium increases for about 600,000 covered individuals. In the next two years, Blue Cross executives tried other tactics, but, by now, the Commissioner paid closer attention and we assembled evidence for rejecting each of them.
Another recent campaign concerns the combined injustices of global poverty, the strengthening of patent protections far beyond what might reward innovation, and keeping new vaccines for rotavirus unaffordable to those who need them most. Rotavirus causes 2 million hospitalizations and 440,000 deaths a year, 82 percent of them among the poorest nations. The patent-holding global pharmaceutical companies price them at $60-$90 a dose. The Pan American Health Organization Vaccine Fund (PAHO) badly wanted to make these vaccines available to poor children, but the companies said their research and development costs (R&D) were so great that they could afford no less than $28—much more than the countries could afford.
Deconstructing the elite claims of inflated R&D costs to justify high prices, while keeping actual costs behind a firewall, had become a focus of my policy research. We assembled a team to pierce the firewall by researching the organization of R&D for these vaccines and interviewed those involved to substantiate the details and their costs, thereby assembling the first grounded estimates of R&D costs for the new generation of vaccines. Based on conservative estimates of manufacturing costs and sales in affluent markets, we concluded the companies had recovered all their R&D costs within 18 months and had per-unit costs of about $3. This work was accepted by the leading journal in the field, and the companies have not challenged our figures.2 Soon after publication, PAHO Fund negotiators were able to use the evidence and get the price lowered by 75 percent. This has enabled far more poor children to be immunized.
This kind of public sociology focuses on social justice.3 Intellectually, it can lead to original findings, concepts, and theory. Tactically, targeting the power elite can get results. Sometimes one has to show the elites that they are being used, for example when I worked with a small team in Ireland to show the minister of health that a large, commercial insurer was breaking up Ireland’s well-established, community-rated supplemental insurance plan. Sometimes, one has to demythologize the exaggerated claims made by powerful companies in order to change policy and rebalance power relations, and that can take a great deal of voluntary time and energy.
Donald Light is a Fellow of the Center for Bioethics at the University of Pennsylvania and a Professor of Social Medicine at the University of Medicine and Dentistry of New Jersey.