PART I: INTRODUCING THE THEORY AND THE CASES
Chapter 2: Theoretical Framework
Chapter 2 is the theoretical heart of the book, and will be of most interest to students of comparative politics, comparative public policy and the welfare state. It fleshes out the conceptualization of the key dependent variables of this study: the scale and pace of policy change. I define a policy framework as a particular type of institution – that is, a set of collectively-enforced expectations – for which the mechanism of enforcement is the authority of the state. The defining characteristics of a policy framework are how it structures the process of decision-making about the allocation of resources and how it legitimates these arrangements.
The policy framework shapes resource-allocation by affording various interests different positions within the structure of influence, and by establishing the arsenal of instruments through which these interests inform, sanction and otherwise deal with each other. The framework legitimizes these arrangements (and accordingly their outcomes) by embedding certain ideas or organizing principles grounded in broader social understandings of need, risk, rights and obligations. Using the health care arena as the focus, I explain at some length the consequential implications of the balance of interests among the state, private finance and the medical profession, and the mix of hierarchical, exchange-based or peer-control modes of governance. As for legitimating principles, I discuss why different expectations about the function of the state – owner, operator, payer, regulator, delegator and so forth – and about the conditions of entitlement and obligation – citizenship, group membership, workplace status, need and so forth – are definitive of the design and functioning of the welfare state.
Turning to the definition of pace, I first locate the present study within the broad literature concerned with timing and sequence as causal factors in policy change (as variously presented in theories of path dependency, process sequencing and punctuated equilibrium). In this regard I show how competing forces of positive and negative feedback from previous decisions drives a pattern of cycling through the available policy repertoire in “normal” times. I then turn to the importance of understanding timing as a matter of strategic judgment within windows of opportunity. I distinguish between the pace at which policy changes are hardened against subsequent change through legislative enactment, and the pace at which they are knit into the policy arena through the implementation process.
Finally, I present in greater detail than in Chapter 1 my argument about the considerations that go into the strategic decisions of political actors about how much policy change to attempt, and at what pace. I summarize these considerations in a highly stylized decision tree that forms the conceptual spine of the empirical chapters to follow.