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ILLNESS OR DISABILITY IS OFTEN USED AS AN ELIGIBILITY CRITERION BY PUBLIC PROGRAMS THAT DISTRIBUTE MONEY, SERVICES, PRIVILEGES, AND EXEMPTIONS. THIS ARTICLE EXAMINES A CENTRAL ASPECT OF ILLNESS-CERTIFICATION SYSTEMS: THE ROLE OF PHYSICIANS AND THE CONSEQUENCES OF USING CLINICAL DECISION-MAKING AS A RATIONING DEVICE.

Policy making is a political struggle over values and ideas. By exposing the paradoxes that underlie even seemingly straightforward policy decisions, Policy Paradox shows students that politics cannot be cleansed from the process in favor of "rationality." Author Deborah Stone has fully revised and updated this popular text, which now includes many paradoxes that have arisen since September 11. Examples throughout the book have been updated, and the prose has been streamlined to make a great read even better

In Charles Dickens's novel about capitalism run amok, a teacher asks: "Now, this schoolroom is a Nation. And in this nation, there are fifty millions of money. Isn't this a prosperous nation? Girl number twenty, isn't this a prosperous nation, and an't you in a thriving state?" "Girl number twenty" (the teacher doesn't dignify the pupils with names) later confides to a friend how she got it all wrong: "I said I didn't know. I thought I couldn't know whether it was a prosperous nation or not, and whether I was in a thriving state or not, unless I knew who had got the money, and whether any of it was mine. But that had nothing to do with it. It was not in the figures at all" (Hard Times [1854] 1997, 64).

Martha Derthick has long been my favorite bread-and-butter political
scientist. If you want to know how the U.S. federal government
really works, you can't do better than read her work. But re-reading
Policymaking for Social Security in 2003, I
discovered a Derthick I'd never known: Derthick the Paradoxical
Postmodernist.

Part of a symposium on the 25th anniversary of the publication of Martha Derthick's Policymaking for Social Security (1979) claims revisiting the text revealed Derthick to be a "paradoxical postmodernist." Paradox & ambiguity are seen as key to understanding the popularity of an ever-expanding program. In this light, several paradoxes in Derthick's work are delineated: the Paradox of Actuarial Uncertainty, the Paradox of Fiscal Discipline & Continuous Expansion, the Paradox of Political Neutrality, & the Paradox of Public Opinion. Ambiguity & paradox allowed advocates to fabricate the multifaceted fiction of Social Security as self-help perpetuated by liberals & now co-opted by conservatives to dismantle the program. The text's salience in the contemporary context is then considered. She is faulted for missing the impact of race, gender, & class conflicts, although her assessment that a lack of consciousness & political organization explains why people who are disadvantaged by any form of distribution do not protest the program is deemed correct. The irony of Social Security's mandate to be a redistribution program & liberal promotion as something other than social aid brought to light by the current drive to privatize Social Security is touched on, along with the issue of whether a politics based on fiction, rhetoric, ambiguity, & paradox can be considered democratic. J. Zendejas