NEGATIVE FEEDBACK, POLICY COALITIONS, AND POLICY CHANGE
Alan M. Jacobs
Department of Political Science
University of British Columbia
C425-1866 Main Mall
Vancouver, B.C. V6T 1Z1, Canada
jacobs@politics.ubc.ca
R. Kent Weaver
Georgetown University and
The Brookings Institution
1775 Massachusetts Ave, NW
Washington, DC 20036
KWEAVER@brookings.edu
Abstract
The concept of policy feedback has become central to the study of policymaking. This
paper seeks to advance the analysis of policy feedback in three principal ways. First, it
argues that the current literature on policy feedback overemphasizes positive feedback at
the expense of negative feedback. Negative feedback effects, we contend, are common
and have important implications for policy development over time. Second, we theorize a
set of mechanisms through which the adverse consequences of policy can feed back into
politics to generate pressure for policy change. The paper focuses on mechanisms that
affect the formation of mass- and elite-level coalitions for and against policy change.
Third, we suggest important ways in which negative feedback mechanisms and their
effects depend upon specific features of the political and social context. A systematic
account of policy development over time must be informed by claims about to the
conditions under which negative, in combination with or in lieu of positive, feedback
effects are most likely to operate. A short account of the recent evolution of the U.S.
health care policy is employed to illustrate these analytical arguments. By illuminating
the causal logic and importance of self-undermining policy dynamics, the paper seeks to
contribute to a burgeoning literature on the endogenous sources of policy and institutional
change.
2
Over the past two decades, the related concepts of policy feedback and path
dependence have become central to the study of policymaking in democracies (see, e.g.,
Skocpol 1992; Pierson 1993, 1994; Hacker 1998, 2002). The key insight of this approach
is that past policy choices shape, and in particular limit, later policy choices and outputs.
The analysis of feedback effects has generated a large number of persuasive explanations
of current policy arrangements and of policy development over time.
This paper shares the perspective that policy feedback is an important influence on
public policy, but seeks to advance the analysis of policy development by illuminating
the importance of negative policy feedback and the mechanisms through which it
operates. It is widely recognized that public policies almost universally impose costs on
citizens as well as delivering valued benefits. What is far less widely acknowledged is
that degree to which those costs can generate political processes that undermine the status
quo and raise the likelihood of policy change.
In this paper, we argue that there are strong reasons, inherent in the logic of
policymaking in a democracy, to expect such negative policy effects to be common. At
the same time, there is nothing automatic about the translation of policy losses or policy
“failure” into political incentives or opportunities to enact policy change. We thus seek to
analytically unpack a set of mechanisms through which negative feedback is likely to
operate and influence governments’ policy choices. Our focus here is on the ways in
which policy losses can alter the coalitional politics of policy change: the processes
through which mounting policy burdens can both expand the group and mass-level
coalitions for policy change and diminish those opposed to it. The processes that we
identify operate through three principal channels: via the mobilization of social interests;
via mass-level political cognition; and via changes in the menu of available policy
alternatives.
Throughout the paper, we employ case examples to illustrate the broad relevance of
these feedback logics and their potential to generate policy change. We further
demonstrate the fruitfulness of analytical attention to negative feedback through a more
extended case study of a domain commonly associated with strong path dependence:
health care policy in the United States. As other analysts have demonstrated, the repeated
failure of attempts to introduce universal health insurance in the United States can be
substantially attributed to positive feedback effects of fateful choices (and non-choices)
made at points earlier in the 20th century (see, especially,Hacker 1998). At the same time,
we argue that the dramatic policy change represented by the passage of the Affordable
Care Act of 2010 can be substantially explained by the types of negative feedback
mechanisms that we identify. Through their effects on the alignment of organized
interests, on citizens’ assessments of the alternatives, and on the policy menu, the
mounting adverse consequences of the pre-reform system of medical insurance, we
contend, expanded the coalition of actors willing to support reform and diminished the
array of forces opposed to it – enabling enactment even in a system riddled with
institutional veto points.
The aim of this paper is not to emphasize the importance of negative feedback at
the expense of positive feedback. It is, rather, to expand our understanding of the ways in
which public policies can produce their own politics: of the ways in which policy choices
at t1 can generate consequences at t2 that can reshape the political prospects of policy
alternatives at t3. In short, we seek to highlight and unpack the ways in which such
2
endogenous processes can be self-undermining as well as self-reinforcing.1 An
understanding of policy development over time that integrates and analyzes both negative
and positive policy feedback can help to address one of the most important limitations of
a feedback approach focused solely on self-reinforcing dynamics: that it has difficulty
explaining major change without ad hoc reliance on exogenous shocks. In this sense, our
approach is in line with recent historical-institutionalist work concerned with identifying
endogenous sources of institutional change (e.g., Streeck and Thelen 2005; Mahoney and
Thelen 2009b).
In making the case for serious consideration of negative as well as positive
feedback effects, we seek to push analysts to do more than acknowledge that both types
of effects can occur. Any systematic account of endogenous policy development over
time must rest on an understanding of the conditions under which particular kinds of
feedback effects are most likely to operate. The literature on positive feedback has gone a
considerable distance toward identifying (or, at least, hypothesizing) those circumstances
most conducive to path dependence: policies, for instance, that encourage societal actors
to make investments with high fixed costs are understood to be more prone to selfreinforcement over time than those that do not (Pierson 2000; Patashnik 2008; Patashnik
and Zelizer 2009). Similarly, for each negative-feedback mechanism outlined, this paper
advances tentative propositions about the conditions under which it is likely to operate
most strongly.
The first section of the paper focuses on clarifying the concepts of positive and
negative feedback and their potential relationships to policy stability and policy change.
1
While our approach is different, our concern is similar to Greif and Laitin’s in exploring
the endogenous sources of institutional stability and change (2004)
3
The four sections that follow then theorize specific negative feedback mechanisms and
suggest the kinds of conditions most conducive to their operation. The sixth section
shows how this analysis can explain the evolution of U.S. health care reform policy over
the past two decades. The conclusion reviews the major implications of our arguments
and suggests directions for future research.
DEFINING NEGATIVE FEEDBACK
As we will use the term, policy feedback describes the following causal process: a
policy chosen at t1 has effects at t2 that influences the relative likelihood of policy
alternatives (including maintenance of the status quo) being chosen at t3. Following
Pierson (2004), we define positive policy feedback as a processes in which the policy
effects at t2 increase the relative benefits (or reduce the relative costs) of the policy
arrangements to influential political actors as compared to the conceivable policy
alternatives. The historical-institutionalist literature commonly depicts mechanisms of
positive feedback as conducive to the outcome of stability – a process that, over time,
“makes it more difficult to reverse course” (Pierson 2004). As Thelen (2004) writes,
“…[I]ncreasing returns and positive feedback arguments…have been more helpful in
understanding the sources of institutional resiliency than in yielding insights into
institutional change” (27-28).
In parallel with the above definition of positive feedback, we then define negative
feedback effects as policy effects at t2 that raise the relative costs (or reduce the relative
benefits) of the status quo for politically influential actors. Consistent with the existing
literature, we understand these costs and benefits in broad terms: involving not just fiscal
4
impacts and economic costs and benefits imposed on particular groups in society, but also
the political risks and rewards faced by officeholders and the administrative ease or
difficulty with which policy options can be implemented. Indeed, we understand policy
change in a democracy as arising ultimately from processes that raise the benefits (e.g., in
terms of career or sincere policy preferences) or reduce the costs of policy change for
officeholders. Those relative benefits, however, will be substantially determined by the
relative costs and benefits of policy change (real or perceived) to coalitions of those
organized and unorganized constituencies on whose support officeholders depend or
whose welfare they seek to advance. We thus focus the analysis to come on the ways in
which negative feedback alters the alignment of coalitions favoring and opposing policy
change.
Prominent arguments in the discipline imply that feedback effects are largely
positive. In his seminal work on the logic of historical analysis, Pierson (1993, 2000,
2004) begins by noting a set of economic insights into the sources of increasing returns
and path-dependent development in market interactions (David 1985; North 1990; Arthur
1992). He then argues that political interactions display qualities that should make
positive feedback especially common in this domain. Such qualities include the
institutional density of political life, the prevalence of coordination problems, and the
opacity of outcomes. Moreover, Pierson contends, self-corrective mechanisms – such as
processes of competitive selection and effective learning, which may pertain in many
economic domains – are frequently weak or absent in politics. Foreshortened time
horizons and the status quo bias of political institutions, moreover, make reversal
unlikely even when actors recognize undesirable consequences of past choices. Taken
5
together, these observations – which lie at the center of much historical-institutionalist
analysis – suggest that positive feedback effects should be far more common in public
policy than negative ones.
At the same time, the public policy literature also supplies a range of examples of
self-undermining policy effects. Although Pierson’s (1994) early application of policyfeedback logic to retrenchment politics focused heavily on self-reinforcing dynamics –
especially the tendency of social programs to generate their own bases of political support
– his study also pointed to program features that facilitate the efforts who those that seek
to undermine the welfare state, such as service delivery based on state ownership of a
stock of physical assets (e.g., housing). Theda Skocpol (1992) has argued that the
patronage politics associated with Civil War pensions led both to the demise of that
program and to a truncation of options for later programs. Esping-Andersen’s analysis of
class development in the three worlds of welfare capitalism notes negative effects
associated with each type of regime: very high budget costs for the Scandinavian social
democratic model, social exclusion and high unemployment among younger workers in
continental welfare states, and high income inequality in liberal welfare states (EspingAndersen 1990, 1999). And, although he did not employ the concept of policy feedback,
Kingdon’s (1984) pathbreaking work on agenda-setting demonstrates that the “problem
stream”—the set of issues that policymakers feel pressured to respond to—is importantly
affected by negative outcomes associated with current policies. Patashnik (2008) has
demonstrated how major policy changes in the United States – from the 1986 Tax
Reform Act to the reform of agricultural subsidies – have become subject to erosion or
outright reversal by actors who bear their costs.
6
A number of analysts have also begun, on a more general level, to highlight the
centrality of self-undermining processes in politics. Mahoney and Thelen (2009a), for
instance, point out that institutions are arrangements with distributional implications: the
very existence of groups that perceive themselves to be losers under the status quo
implies that policies and institutions will routinely provoke their own political opposition
– a powerful negative feedback effect. An emerging historical literature seeks to explain
institutional change as arising from such endogenous processes of conflict and challenge
(Thelen 2004; Streeck and Thelen 2005; Clemens and Schneiberg 2006). A parallel
literature on institutional change from a game-theoretic perspective suggests that, even
where political institutions are “self-enforcing” (that is, providing incentives to act in
ways that are encouraged by the existing policy regime), they may be “self-undermining”
rather than “self-reinforcing”— weakening, rather than perpetuating, themselves over
time (Greif and Laitin 2004). Soroka and Wlezien’s (2010) cross-national study of
“thermostatic” effects in the relationship between public policy and public opinion,
moreover, suggests a broadly operating negative feedback process in democratic
accountability, in which policy moves in one direction can generate electoral pressure to
pull policy back in the other direction.2
In the following sections of this paper, we build on these general insights by
elaborating a set of reasons why negative feedback is likely to be a common feature of
policymaking in democracies, the causal channels through which it is likely to affect
policy, and the conditions under which those mechanisms are most likely to operate.
2
Distinct from arguments about self-undermining effects of policy are arguments about
the limits to self-reinforcing effects. See, e.g., Patashnik (2008) and Patashnik and Zelizer
(2009).
7
THE OBJECTIVE PROFILE OF POLICY GAINS AND LOSSES
In this and the next three sections, we present a set of reasons to expect negative
policy feedback processes to be prevalent and to frequently exert strong pressures on
politicians to enact policy change. Throughout these sections, we focus on how negative
policy consequences can shape the coalitional politics of policy change and stability: on
how and when increasing policy losses can both expand political coalitions favoring
policy change and diminish the ranks of those seeking to defend the status quo.
We begin, in the present section, by examining the objective profile of losses and
gains that public policies are likely to generate. The members of any coalition for policy
change must, in the first instance, face substantial costs under the status quo (as compared
to imaginable policy alternatives). We argue that, for reasons intrinsic to the logic of
policymaking, public policies will frequently generate high costs and, often, diminishing
returns for large segments of society. Policymaking coalitions, however, do not form
mechanically as a response to the profile of objective policy consequences. In the next
two sections, we turn to the pathways through which policy losses are likely to affect
policymaking coalitions operating at two levels: the electoral support base for policy
change at the mass level and the strength of pro- and anti-change coalitions of organized
interests. Finally, we consider negative feedback effects operating through the menu of
policy alternatives. As we argue, the menu of alternatives is itself partly endogenous to
the consequences of the status quo: political actors are more strongly motivated to search
for new policy alternatives where current policy imposes high societal costs. In
expanding the menu, policy entrepreneurs do not just go looking for “good” ideas: they
8
particularly seek out solutions with distributions of costs and benefits that are likely
maximize their appeal to winning group and electoral coalitions.
Prevalence of policy costs
We begin by considering the first step in a policy feedback loop: the set of
material costs and benefits that the policy produces for members of society. Claims about
positive feedback are typically premised on a particular understanding of the profile of
those costs and benefits, especially about their distribution over time. In particular,
arguments about path dependence frequently point to the tendency of some public
policies to generate increasing social or political returns over time (Pierson 2000).
Indeed, the expectation of political opposition to policy change – and the increasing force
of that opposition over time – is premised on the presence of high and increasing (or
more widely shared) policy gains. Network and coordination effects, learning effects, and
adaptation by actors may often make the policy status quo increasingly and more broadly
beneficial as time passes.
Yet there are also important reasons why policies will frequently yield a profile of
high, objective social losses that bear the potential to generate pressures for policy
change. The tendency of public policies to generate large social costs derive from at least
four fundamental features of policymaking as a social activity. First, state action often
embodies a distributive tradeoff. As Thelen (2003) and Mahoney and Thelen (see also
Knight 1992; 2009a) have noted, institutional and policy arrangements create both
winners and losers. Policy may impose “losses” in multiple senses. Most narrowly and
straightforwardly, a new policy that makes one group better off frequently does so at the
9
expense of leaving another group worse off – whether through the imposition of taxes,
the enforcement of constraints, or the withdrawal of public largesse. The distributive
character of policy choice means that losses may also be relative, rather than absolute: a
policy may deliver rewards to Group A but even greater rewards to Group B, leaving
members of Group A at a relative disadvantage vis-à-vis an arrangement that spread its
gains more evenly. And losses may be counterfactual, rather than actual: even Group B
may “lose” under the status quo as compared to the greater spoils that it might reap under
a readily imaginable policy alternative.
Second, policy choice is typically a collective activity, requiring policymakers to
win the assent of multiple actors representing diverse constituencies. Thus, as Pierson
(2004) himself points out, policies frequently represent compromise among competing
goals and policy logics. The program architectures that result from collective political
decision-making will frequently contain substantial complexity and incoherence rather
than a single policy logic. Unforeseen interactions among policy mechanisms may yield
outcomes that are both unexpected and unwanted by members of the policy’s enacting
coalition. In fact, the path-dependent nature of policy can itself be a source of unintended
incoherence: where past policy decisions are deeply entrenched, today’s policymakers
will frequently be forced to “layer” new structures over old (Schickler 2001; Thelen
2003; Hacker 2004), expanding the opportunities for institutional friction and for
outcomes that are undesired by either yesterday’s winning coalition or today’s.
A third problem is uncertainty. Even where a policy regime can be lent a coherent
design, the causal relationships connecting policy structures to social consequences are
often poorly understood (Blyth 2002; Pierson 2004; Jacobs 2011). While the immediate
10
effects of, say, tax rates on citizens’ income may be readily forecast, longer-term and
second-order outcomes – e.g., for economic growth – are much more difficult to forecast.
Governments’ capacity to deliver intended benefits and avoid costly errors is, for many
policy ventures, inherently limited by causal complexity combined with weak causal
knowledge.3
Fourth, even where future consequences are knowable, policymakers will often
place much greater weight on short- over longer-term social outcomes. A common
reason, intrinsic to policymaking in a democracy, will be short-run electoral pressure
(Nordhaus 1975; see also Geddes 1994; Jacobs 2011). Thus, policymakers will
sometimes seek to maximize near-term social benefits but pay little heed to the longerterm costs.
Our point here is not simply that policymaking is messy, or that policy ventures
can go awry. We wish to emphasize two more specific implications. First, these dynamics
imply that the returns to policy will often be diminishing, rather than increasing, over
time: as the layered complexity of a policy regime increases and as outcomes recede
beyond policymakers’ original time horizons and capacities for prediction, the likelihood
of adverse social outcomes mounts. Second, public policies will sometimes work out
badly for politically advantaged actors. It may not be a problem for path-dependence
arguments if increasing policy losses fall on the few, the poorly resourced, or the
3
We note that each of these last three characteristics of policymaking – collective choice,
uncertainty, and foreshortened time horizons – appears in Pierson’s (2004) arguments
about the path-dependent nature of politics. Pierson refers to these features as inhibiting
“self-corrective” mechanisms in politics and as undermining the case for an “actorcentered functionalist” account of institutions. Yet, as we argue, they also imply that
policymaking will sometimes be subject to diminishing rather than increasing returns
over time.
11
unorganized – those unable to exert political pressure for change. But our arguments
imply that public policies may work out poorly for those groups sufficiently privileged to
have shaped those policies’ original design. Compromise-driven and historically
generated complexity, causal uncertainty, and foreshortened time horizons create scope
for policy to generate consequences that are unacceptable to the influential actors that
fashioned it in the first place. Thus, well-resourced members of yesterday’s winning
policy coalition may become well-resourced members of tomorrow’s coalition for policy
change.
The limits of adaptation
Arguments about positive feedback, however, do not depend on policy costs being
low. A key mechanism of increasing returns, in many positive-feedback arguments, is the
adaptation of social actors to public policies over time. Where policy imposes costs on
actors, those actors may adjust their behavior and invest in patterns of activity in ways
that minimize the burdens that they face (see also Pierson and Trowbridge 2002; Pierson
2004). Manufacturers, for instance, may adapt to onerous pollution rules by installing
new equipment that allows production processes to comply with those legal standards at
lower cost. Thus, to say that policies impose costs is not necessarily to say that they will
expand the coalition for policy change and undermine the support base for the status quo:
via adaptation, even loss-imposing policy choices can reshape the political battlefield in
self-reinforcing ways.
This logic of loss-reducing adapation hinges, however, on a very specific set of
conditions. It depends on adaptation being both feasible and relatively cheap – in
12
particular, cheaper for loss-bearing actors than just paying the policy’s current costs (e.g.,
fines for non-compliance). In some domains, an expectation of cheap adaptation may be
reasonable. It was relatively inexpensive for American employers developing
occupational benefit systems during and after World War II to layer those systems atop
Social Security, a decision that would later make them dependent on the continued
payment of Social Security benefits (Hacker 2002). By contrast, for manufacturers and
energy producers facing environmental regulation, adaptation may mean very costly
investment in physical capital – or may in fact be infeasible given existing technology,
short of divestment from the sector. For these firms, it may be cheaper to live with highly
visible current policy burdens, while seeking the repeal of those burdens, than to
reorganize their activities and physical plants to make the policy less burdensome. Where
adaptation is either impossible or relatively costly, the losers from (and potential
opponents of) the policy status quo at today will remain losers and potential change
agents tomorrow.
The above logics do not merely suggest that factors conducive to negative
feedback exist. They also point to specific conditions under which policy is more likely to
generate high social costs. The general qualities of policymaking processes that we have
identified are in fact variables, not constants. Policy should be more likely to generate
high and rising negative outcomes for powerful groups to the extent that (a) policy
enactment depends on the agreement of a large number of actors (i.e., where veto power
is more widely dispersed); (b) policy has been designed by actors facing near-term
electoral pressures rather than those insulated from such pressures (e.g., elected officials
in a competitive context rather than career bureaucrats or parties in a dominant electoral
13
position); (c) the policy endeavor involves an ambitious task of social engineering
characterized by vast causal complexity; and (d) social actors affected by the policy are
relatively “locked in” to current patterns of behavior or production, making adaptation to
policy losses costly or impossible.
GROUP MOBILIZATION AND POSITIONING
If influential coalitions for policy change are to form, then actors must do more
than bear losses: they must mobilize to reduce those losses. We conceive of mobilization
and coalition-formation in a democracy as operating at two levels: among organized
groups and within the electorate. We address group-level dynamics in this section and the
mass public in the next. Our focus in the present section is on (a) the tendency of policy
losses to reshape the organization of policy stakeholders and (b) the mounting pressures
on organized groups to join coalitions for policy change as the probability of change
rises.
The mobilization of opposition
The positive-feedback literature has articulated a number of ways in which public
policies may mobilize their own beneficiaries, enlarging the political-support basis of the
status quo. For instance, the creation of a new social program may encourage
beneficiaries of that program to organize in order to protect or expand it (Pierson 1993).
Public programs may also lend a group’s members resources, capacities, and political
orientations that allow and encourage them to become more politically engaged
(Campbell 2003; Mettler 2005).
14
While it is not hard to point to examples of this positive feedback dynamic, there
are important conditions under which it will fail to operate – and under which policy
losses may generate strong mobilization against past policy choices. First, the
beneficiaries of the status quo may not be the only well-organized stakeholders in the
policy domain. Many policy sectors set well-organized pairs of interests against one
another (Wilson 1980). Welfare-state reform politics in continental Europe, for instance,
frequently pits the interests of well-organized labor groups against those of wellorganized capital. If trade unionists represent a set of highly mobilized beneficiaries of
the status quo, organized business has been a powerful advocate for reforms that would
reduce the losses that it faces under current arrangements. Explanations of far-reaching
pension, unemployment-insurance, and welfare cutbacks in the 2000s in Germany, for
instance, attribute a central role to the demands and political influence of organized
business for measures to stabilize social contribution burdens (Schludi 2005; Jacobs
2011).
Second, as Thelen (2003; see alsoMahoney and Thelen 2009a) has emphasized,
the “losers [of political battles] do not necessarily disappear” (231): to the contrary, they
will often undertake enhanced collective efforts to reverse their losses. The post-1970 rise
of organized business in the United States represents a striking example of countermobilization in the wake of major policy defeats. While employers had long constituted
an important organized political force in American politics, they faced major unexpected
policy setbacks in the late 1960s and early 1970s, including a raft of new environmental,
consumer, and worker-safety rules that dramatically increased the regulatory burdens on
firms. The response to these adverse policy shocks was a massive expansion of corporate
15
collective action. The next decade witnessed a doubling in membership of the U.S.
Chamber of Commerce and the National Federation of Independent Business, a
quadrupling of the number of corporate PACs, and a proliferation of new foundations and
think tanks dedicated to the promotion of free-market principles (Vogel 1989; Hacker and
Pierson 2010). As Hacker and Pierson document, this “organizational counter-offensive”
paid handsome dividends for American capitalists across a broad range of policy
domains, from taxation to financial regulation and corporate governance.
Nor do business groups appear unique in their capacity to generate “counteroffensives” in response to loss. A wave of liberalizing and secularizing developments, in
the 1960s and 1970s, in the domains of cultural and reproductive policy in the United
States triggered a massive and enduring mobilization by American evangelicals (Liebman
and Wuthnow 1983). And environmental organizations across the developed democracies
have frequently enjoyed sharp expansions in membership and increased political clout
and policy success as the negative consequences of lax regulation become publicly
visible (Vogel 1993, 2003).
In sum, the distribution of collective action capacities in polities is neither fixed
nor uniformly reinforced by past policy trajectories. We should expect those who suffer
policy defeat at t1 to frequently redouble their collective efforts to win at later times,
reshaping the organizational landscape in ways that undermine the political foundations
of current policy. At the same time, the examples provided above suggest that the
prospects for counter-mobilization are not unlimited: it is more likely under some
conditions than others. Mobilization by U.S. business and evangelical groups was greatly
aided by pre-existing political advantages held by these groups: vast financial resources
16
in the former case, and a pre-existing array well-networked non-political organizations in
the latter. While environmental groups enjoy some growth in the wake of environmental
policy failure, their mobilizational successes have generally paled by comparison to those
of employer and religious groups – likely, because they enjoy smaller financial or
organizational advantages. We should expect negative feedback via counter-mobilization
to be most common, then, when the “losers” under the status quo possess a wealth of
latent political resources than can be converted to political purposes.
Adaptive Expectations and Group Positioning
As Pierson (2004) points out, one common source of positive feedback in politics
are adaptive expectations: the frequent importance, in politics, of “picking the right
horse.” Political expectations can thus have a self-fulfilling quality to them, often
yielding compounded advantages for those actors already perceived as powerful and
reinforcing current arrangements. Yet adaptive expectations, like a number of feedback
mechanisms, are distinctly double-edged. Particularly in the later stages of coalitionbuilding process, adaptive expectations can amplify negative feedback dynamics bringing
status-quo-winners into the coalition for policy change. Adaptive expectations can never,
by themselves, generate policy change; but they can accelerate processes of negative
feedback and dampen opposition from groups with high stakes in the status quo.
As public and elite demands for policy change gather force, organized stakeholders
and their allies in office will often face pressures to join what they expect to be the
winning side. One reason – identified by Kingdon (1984) as a “bandwagon effect” – is
that those on the winning side of a policy battle get to write the rules. Once the likelihood
17
of policy change reaches a certain threshold, groups and officeholders with a stake in the
status quo may join the coalition for change in order to ensure themselves a seat at the
table as the new policy regime is crafted. A bandwagon effect appears to have pushed a
number of powerful groups – particularly, hospitals and drug companies – to support the
Obama health-reform initiative, in exchange for influence over key elements of the deal
(Hacker 2010).
A second motive for joining forces with advocates for policy change is the
reduction of policy uncertainty. Where economic actors must make long-range
investment plans, they may prefer a certain but less-preferred policy change over the
uncertain prospect of maintaining a more profitable status quo. As Belfry (2010)
demonstrates in her study of Canadian environmental policy, intensified public concern
about the threat of climate change during the 2000s generated enormous uncertainty
about the future price of carbon and, in turn, about the returns to long-range energyintensive investments. In order to lock in a degree of certainty for long-range planning,
the Canadian energy sector – followed by the business community as a whole – shifted
over the decade from firm opposition to strong backing for a modest level of carbon
pricing, resulting in the adoption of carbon-taxation or cap-and-trade schemes by the
largest Canadian provinces.
As this illustration suggests, decisive support for policy change may come from
precisely those actors from whom, in a world of purely positive policy feedbacks, we
would expect entrenched resistance: actors making inflexible investments the value of
which depends on policy. The rigidity of social actors’ choices, however, is distinctly
double-edged: if the legacy of actors’ past investments may generate vested interests in
18
the status quo, the need to make future fixed investments and an aversion to downside
risk will sometimes generate coalitional bandwagons that amplify pressures for policy
change. Along with enhanced influence over the new rules, the management of
uncertainty can be a compelling reason for threatened winners to acquiesce in seemingly
adverse policy change.
POLICY FEEDBACK AND ELECTORAL COALITIONS:
LOSSES IN MASS COGNITION
Even where strong organized coalitions for policy change have been formed,
elected officials may still hesitate to enact reform if they fear punishment from voters
who value the status quo. We might expect the electoral risks to be especially great when
citizens have developed high material stakes in current arrangements that would be
manifestly threatened by policy change. This is precisely the electoral conundrum that
Pierson (1994) describes in his seminal study of welfare-state reform politics in Britain
and the United States. Thus, the likelihood of policy change in response to a costly statusquo depends not only on the formation of group coalitions, but also on the presence of
change-permitting electoral coalitions: a sufficiently large or pivotal segment of the
electorate that demands or is willing to accept reform. Pierson (1994) identifies one set of
mechanisms through which change-permitting electoral coalitions can arise: through
strategies of elite policy design that render the costs of change difficult for voters to
perceive or to trace back to the politicians responsible. Here, we focus instead on
mechanisms through which voters can be persuaded of the need for policy change. Our
discussion centers on the implications for negative feedback of two cognitive dynamics
19
commonly identified in the literatures on mass policy attitudes: a negativity bias in
perception and judgment and the effects of elite framing.
Negativity Bias
Numerous studies in psychology and political behavior have documented a
negativity bias in information-processing: people’s tendency to attend more closely to,
recall more readily, and weigh more heavily negative or threatening information than
positive information (Lau 1985; Klein 1991; Vonk 1993; Weyland 1998; Soroka 2006).
Related to this bias is a well-known human aversion to losses relative to the status quo as
compared to the prospect of equivalent gains (Tversky and Kahneman 1991). As political
analysts have pointed out, these twin biases have important implications for citizens’
policy attitudes: in particular, citizens are often thought to be more sensitive to policy
losses than to policy gains (Weaver 1986; Pierson 1994).
Arguments about positive feedback often draw strength from an application of
these cognitive mechanisms. In his seminal study of welfare-state reform, Pierson (1994)
argues that the negativity bias makes social-program retrenchment more difficult: even if
program cutbacks promise gains for taxpayers, it also imposes losses on beneficiaries –
and the latter will weigh more heavily in constituents’ minds than the former. In a more
general form of this logic, a loss-averse electorate should generally be biased against any
policy change that will generate a combination of sizeable gains and sizeable losses.
This logic, however, offers too narrow an understanding of the potential effects of
these cognitive biases on policy development. The negativity bias and loss-aversion can
operate to generate public opposition to a costly status quo as readily as it can yield
hostility toward loss-imposing policy change. The central reason is that stability in policy
20
does not imply stability in social outcomes: where policies yield diminishing returns (for
reasons discussed above), they will commonly impose mounting costs on constituents.
Maintaining pension benefits, in the context of aging populations, has required most
OECD countries to increase payroll tax burdens over the last 30 years. Where current
policy makes citizens and businesses progressively worse off over time, they are likely to
attend to and react against those losses relative to prior circumstances – and the electoral
incentives to enact policy change will rise.
Elite framing
At the same time, voters are known to be largely inattentive to matters of public
policy and are unlikely to arrive at clear verdicts on current policy on their own
(Converse 1964; Zaller 1992; Kuklinski and Quirk 2001). Rather, as findings in political
psychology make clear, citizens’ policy attitudes are frequently given shape by elites’
rhetorical strategies: by the framing efforts of politicians and other political elites (Nelson
et al. 1997; Chong and Druckman 2007). The importance of framing effects means that
voters need not take automatic notice of the costliness of the status quo; elites may make
the case for policy change for them.
Elites opposed to the status quo will commonly introduce frames that try to achieve
three things. First, elite frames will commonly make the costs of current policy salient to
the broad public, thus depicting the status quo as a loss-imposing arrangement. Second,
frames will typically connect outcomes to policy, indicating which programs are
responsible for those losses. Third, elite rhetoric will introduce a policy alternative and
paint it as the loss-avoiding option.
21
Framing, of course, can cut two ways: while group leaders and politicians who
favor the status quo will have an incentive to frame it as a success and to frame change as
a serious risk, those opposed to current policy will have an incentive to frame it as a
disaster. Yet the existing literatures on policy accountability and agenda-setting suggest a
set of conditions under which anti-status-quo frames are likely to be most effective. First,
frames depicting the status quo as loss-imposing will be more persuasive to relatively
inattentive voters when policy costs are distributed in particular ways: especially, when
they are highly concentrated on easily identifiable groups (Arnold 1990; Pierson 1994).
Politicians seeking to portray the status quo as a state of diminishing returns are likely to
have greater success when the losses are made perceptible by their heavy per capita
burden or incidence on well-defined and tightly networked groups. Second, Kingdon
(1984) points out, negative focusing events – such as plane crashes, industrial accidents,
or company bankruptcies – can turn the public’s attention to adverse social outcomes that
would otherwise persist unnoticed (see also Birkland 1998). By increasing the visibility
of a policy’s costs, focusing events can be a key informational resource for those seeking
to depict the status quo as a loss-imposing arrangement.
Third, elites’ capacities to frame policies per se as sources of loss-imposition
depends on how easily adverse consequences can be connected to state action. As
Deborah Stone (1989) argues, causal stories are often contested: whether a negative
social outcome, such as rising inequality, is the result of inexorable market forces or of a
remediable inadequacy in public policy is often a matter of fierce of debate. Which causal
story is most plausible, however, depends in part on the structure of existing policy. As
Pierson (1994) demonstrates in his analysis of British and American retrenchment
22
politics, the structure of public programs can affect the clarity of the causal linkages
between a policy and its consequences, making it easier or harder for constituents to trace
social outcomes back to the policy choices responsible for them (see also Arnold 1990).
In sum, the negativity bias cuts two ways: it can make citizens fiercely defensive
of what they have, or it can make them all-the-more eager to abandon the “sinking ship”
of the status quo. The key question is whether and when change-seeking politicians can
persuade voters that the policy ship is sinking. Elites will be far better equipped to craft
electoral coalitions for policy change where policy losses are made perceptually salient
by their distribution or by dramatic events and where the link between state action and
adverse outcomes can be simply depicted.
COALITIONS AND THE EXPANDING MENU OF ALTERNATIVES
Broadly speaking, positive feedback has been conceived of as a process that
progressively narrows the range of options available to decision-makers. As Pierson
(2004) puts it, “once actors have ventured far down a particular path, they may find it
very difficult to reverse course. Political alternatives that were once quite plausible
become irretrievably lost” (10-11). Once-conceivable alternatives become less
technically, financially and administratively feasible and even cognitively available over
time.
However, the set of imaginable alternatives – the set of available policy ideas that
could plausibly work – is subject to change. Over time, new policy instruments are
conceived of, technological change makes new tools available, and ideas from other
jurisdictions enter the debate. Crucially, moreover, a key driver of policy-intellectual
23
development is the set of perceived social consequences of existing policy. Where status
quo policy is perceived to generate adverse social outcomes, politicians, bureaucrats, and
policy experts become more likely to undertake a search for new alternatives to address
those problems. In other words, the policy menu is not forever narrowing: negative policy
effects often provoke efforts to expand the range of available and workable alternatives.
This search for additional options may involve drawing on theoretical and policy models
developed within academia, borrowing and lesson-drawing from other jurisdictions –
often importing ideas from other countries – or efforts by policymakers themselves to
invent new alternatives. In the environmental sphere, for example, U.S. regulators in the
1970s seeking to improve air quality without choking off growth plucked proposals from
the economics literature for tradable permit schemes that promised, via market
mechanisms, to reap pollution abatement at the lowest possible cost (Baumol and Oates
1971).
These searches for new alternatives, motivated by some actors’ dissatisfaction
with the status quo, often do more than simply add options to the menu. They can also
expand the political coalitions for policy change (and shrink those opposing it) by altering
the social and political net costs of change. They can do so in at least three ways. First, an
expansion of the policy menu can make change less costly to potential opponents by
enhancing the social efficiency with which new policy benefits can be produced.
Leveraging market mechanisms, for instance, the U.S. sulfur-dioxide trading scheme was
able to generate large improvements in air and water quality in the Great Lakes region at
considerably lower economic cost than would have been associated with options
24
previously on the policy menu. As a result, opposition to SO2 controls considerably
weakened (Ellerman 2003).
Second, new policy options can change the distribution of costs and benefits
across groups in ways that minimize the size of the opposing coalition. We discuss a clear
instance of this effect – the use in the United States of an individual health-insurance
mandate to create gains for potential reform opponents – in our case study in the next
section. Third, new policy options can help reduce elected officials’ accountability for the
costs of change by expanding blame-avoidance opportunities. Often, the search for new
policy options turns up policy mechanisms that will make the costs of policy change
either less visible to citizens or harder for citizens to trace back to the politicians
responsible. Notional defined contribution (NDC) pension reforms are a classic case in
point. Although current and future pension beneficiaries are often considered vested
interests par excellence in accounts of positive policy feedback, NDC reforms render the
size of future benefit cuts uncertain and delay them in time by tying them to an automatic
formula based on economic and demographic trends, insulated from the discretionary
judgments of particular officeholders. They thus make it harder for citizens to punish
politicians for cutting future benefits (Brooks and Weaver 2005) – and, in doing so,
enlarge the effective change-permitting electoral coalition.
Under what conditions are policy losses likely to generate such expansions of the
policy menu? Existing theories of politics do not offer tremendous leverage on the
questions. One plausible hypothesis, however, is that political systems are likely to vary
in their capacity to generate new alternatives, depending on (a) the overall level of policy
expertise and (b) whether it is concentrated in the hands of government or more broadly
25
diffused in the society. In the United States, for instance, where “losing” groups have
ready access to a wealth of academic and other policy expertise, and to institutions that
set broad societal discussion (e.g., the media) and governmental action agendas (e.g.,
government expert commissions, legislative committees), the generation of a broadened
set of alternatives in response to policy losses is more likely.
CASE ILLUSTRATION:
VARIABLE FEEDBACKS AND HEALTH CARE REFORM
The evolution of the postwar U.S. health insurance system illustrates many of the
analytical points made in this paper. Most importantly, a focus on negative feedback and
variable returns to the policy status quo over time can help to explain both the persistence
of health care reform on the broad national “discussion agenda” and its cyclical
appearance on governmental action agendas, generally during Democratic
administrations.
The current public-private patchwork of health financing in the United States was
never “chosen” by any single actor (Hacker 1998), but “layered” on by shifting
policymaking coalitions across multiple points in time. Most historical analyses of U.S.
health policymaking have focused on feedbacks that have reinforced the status quo.
These include fears of Americans with health insurance that an increased state role might
make them worse off (Skocpol 1996; Hacker 2002), and the high profitability of the
status quo for well-organized and well-resourced health care payors and providers
(Hacker 1998). Further, gaps in Medicare coverage helped to stimulate membership in
AARP, by allowing the organization to provide discounted “Medigap” insurance as a
26
selective benefit, and the huge AARP membership has helped, in turn, to make real or
perceived Medicare cutbacks politically toxic (Pierson 1993). In addition, “[p]rogram
design …sends messages — positive or negative — to recipients about their standing as
citizens, influencing beneficiaries’ sense of political efficacy and entitlement” (Campbell
2003)—messages that have deepened U.S. seniors’ sense of deservingness regarding their
current Medicare benefits.
All of these effects are real and powerful and have helped hold the post-1965 health
care arrangements in place, against multiple high-level national efforts at reform. But
these path-dependent processes have co-existed with powerful negative feedback
mechanisms that have gradually expanded the coalition for policy change over the last
three decades. First, layered policy complexity has generated massive and moundting
objective losses. The multiplicity of payers and complex institutional relationships in the
system have hobbled many cost control efforts, leading to total health care expenditures
in the United States that are far higher as a share of GDP than those of any other country.
Importantly, this fragmented system of financing – especially, through its tendency to
drive costs upward and price patients out of the market for services – has generated
growing adverse consequences for highly mobilized stakeholders -- for instance, by
squeezing the profits of premium-paying employers. Growing cost pressures on both
public and private payors have, in turn, led them to try to reduce their costs by reducing
or eliminating coverage and cutting payments to providers.
The costs of the status quo have also increasingly fallen on large segments of the
electorate. As employment-based coverage declined, the proportion of Americans who
lack health care coverage, are underinsured, or face the risk of losing their insurance has
27
grown (DeNavas-Walt et al. 2011). Many workers who retain coverage have faced
sharply increased out-of-pocket costs through higher premiums, deductibles and coinsurance. Employers have also increasingly driven their employees into managed care,
which is widely perceived to reduce choice and result in denial of care (Thorpe 1999). In
this densely interconnected system, moreover, losses imposed on the average individual
quickly translate into losses for other, better-organized actors: governments and hospitals,
for example, have been increasingly saddled with the burden of providing services to
those lacking insurance (Hacker 2010).
To a substantial extent, the enactment of major reform in 2010 was made possible
by the willingness of well-organized groups -- winners of prior policy battles but now
absorbing major unforeseen losses -- to join coalitions for policy change or withdraw
from those opposing it (Hacker 2010). Adaptive expectations also appear to have been at
work: in the 2009-10 round of reform, groups such as health insurers and pharmaceutical
manufacturers, facing an evidently high probability that health care reform would pass,
chose to negotiate favorable treatment for their industry in exchange for neutrality or
support for reform (Oberlander 2010).
High objective losses also expanded the electoral coalition permissive of reform. In
both the Clinton and Obama rounds of health care reform, politicians and interest groups
offered conflicting framings about the nature of the policy problem, as well as who was
to blame for policy failures, and the likely consequences of policy alternatives vis-à-vis
the status quo. Among reform opponents, these efforts were aimed not just at changing
public opinion but also in creating among media and political elites the perception that
there was a groundswell of public opposition to reform proposals (West et al. 1996). But
28
the increasing losses and risks of the status quo, combined with the hard economic times,
substantially buttressed the framing efforts of reform advocates in the late 2000s. As
worker premiums and copayments rose, employers withdrew coverage, and job losses
mounted, even those who liked their current health coverage were at increasing risk of
losing it. Thus, in framing pro-reform messages, Democratic leaders were able to
leverage voters’ loss aversion for their own purposes, depicting reform as protection
against losses that were likely to emerge under the status quo. While the Affordable Care
Act was never widely popular, these pro-reform framing opportunities likely helped make
it less unpopular than it would otherwise have been, creating electoral conditions just
hospitable enough for Democratic leaders to hold their caucuses together in Congress on
key votes. Ultimately, even most conservative congressional Democrats signed on,
providing a powerful boost to reform.
Negative feedback processes also had a powerful impact in expanding the menu of
policy alternatives. Rather than truncating policy menus, the extremely high costs and
incomplete coverage of the mixed health care system in the United States led to a
decades-long search for reform alternatives that could address coverage gaps and
skyrocketing costs while overcoming strong opposition from entrenched interests,
notably employers (especially small business), providers and insurers. These new policy
options have included an employer mandate and managed competition under the Clinton
administration (Skocpol 1996), and an “individual mandate” proposed by Republicans
and enacted in Massachusetts in 2006 under Governor Romney. Ultimately the
development of the individual mandate to purchase health care, and its adoption in
Massachusetts, was a critical step toward legislative enactment of the Obama health care
29
package. Perhaps most importantly, this option changed the potential distribution of costs
and benefits for key health reform actors. Although private insurers in the U.S. were
natural opponents of a greater government role in health-care financing, an individual
mandate to purchase insurance helped to dramatically soften their opposition to reform by
guaranteeing them millions of new customers, helping to offset the costs associated with
tighter regulation of underwriting practices (Hamburger and Geiger 2009; Quadagno
2011).
The health care policy example also points to the critical importance of
institutional structures in conditioning the prospects for policy change in response to
adverse social consequences. The U.S. system of multiple veto points within Congress
and between branches of government, and the need for a legislative super-majority in the
Senate to avoid a filibuster, makes it much easier for strong interests to block change –
even when the status quo is imposing broad losses on society. This is thus an institutional
context in which we would least expect negative feedbacks to result in institutional
change. Institutional obstacles were evident in 1993, when the Clinton administration was
unable to even get a health care bill to the floor of either chamber of Congress (Steinmo
and Watts 1995). Even in 2010, the Obama administration’s success depended on a
fleeting filibuster-proof Democratic supermajority in the Senate in late 2009 (Jacobs and
Skocpol 2010).4 Of course, separation of powers in the United States also means that the
health reform Act remains, at the time of writing, vulnerable to a challenge in the courts.
4
With the loss of that super-majority in January 2010, following the election of Scott
Brown in Massachusetts’ special Senate election, House Democrats were forced to
approve the already-passed Senate version and then use the budget reconciliation
procedure to (which circumvented the possibility of a Republican filibuster) to enact
changes agreed upon by the majority leadership in both chambers.
30
It is nonetheless striking that -- even in a political system riddled with veto points, and in
a policy field densely packed with well-organized stakeholders – the adverse social
consequences or prior policy choices generated sufficient pressure to bring about major
legislative change.
CONCLUSION
The literature on feedback effects and path dependence has had a powerful impact
on political science over the past two decades. This article has attempted to build on these
previous insights while adding important complements and qualifications to three
common features of arguments about policy feedback. The first of these is a tendency,
when studying the endogenous influences on policy development over time, to pay
almost exclusive attention to positive rather than negative feedback. There are good
reasons to expect self-reinforcing dynamics to emerge with some frequency in political
life. But there are also strong reasons to expect public policies to generate negative
feedback, including their tendency to create losers and to produce undesirable effects
unforeseen by their creators.
Second, we have argued that additional attention should be paid to the nature of the
processes through which both positive and negative feedbacks are framed and political
coalitions mobilized. These processes are often heavily contested, and alliances among
the bargaining leverage of contestants may shift over time.
Third, we have called for better specified – particularly, more conditional –
arguments linking policy choices at t1 to policy choices at a later time. The dependence of
feedback effects on other factors is implicit in many accounts, but it is rarely theorized
31
explicitly. Yet the emergence of feedback effects as well as their impact on policy
stability or change often hinge on the social, economic, political, and institutional
conditions under which they occur, in ways that we can readily theorize. Indeed, even the
direction of feedback effects can turn on such interactions. One analytical advantage of
conditional arguments is that they allow for a well-structured integration of both sets of
influences. Conditional arguments can also provide crucial analytical leverage in
explaining the balance between positive and negative feedbacks and, thus, accounting for
major change. We see a more detailed formulation and testing of conditional relationships
to be a productive next step in the study of policy feedbacks.
The case of health care in the United States over the past twenty years suggests the
utility of the analytical framework developed in this paper and the importance of
politically-constructed negative feedbacks in leading to policy change. Rising costs and
coverage gaps played a key role in giving health reform a recurrent place on the U.S.
agenda. Interest groups and politicians competed over how those feedbacks were framed
and the priority given to them, and politicians and interest groups attempted to mobilize
perceived losers from the status quo as well as winners. Visible negative feedbacks
stimulated a search for new policy alternatives by experts, politicians and interest groups.
In a complex political environment featuring high institutional hurdles to change, the
ability of the Obama administration to buy off potential opponents, adaptive expectations
by key groups, and a temporary Senate super-majority all played critical roles in giving
turning negative feedbacks into legislative success for the Obama administration where
the Clinton administration had failed.
32
We close by pointing to two potential elaborations of the theoretical framework
presented here, suggested by the health-care case. First, the case suggests that substantial
attention should be paid to feedback effects on the state and its capacities, as well as on
social actors. Most importantly, these would include the fiscal strain that past policy
choices may place on current governments – a major driver of governmental interest in
health reform, at federal and state levels, in the United States (see also Campbell and
Morgan 2005). In general, negative feedback effects on state capacities should be
especially important in the field of social welfare policy, where governments are saddled
with fiscal commitments that are massive relative to the size of public budgets. Second,
the health care case suggests important interactions between social consequences and the
policy predispositions of governments – an important role, that is, for politicians’ own
policy preferences and for the character of their particular support bases. While the
objective effects of current health policies have not varied substantially across
Democratic and Republican administrations, the priority given to reform certainly has.
Whether officeholders advance proposals for policy change in response to objective
problem pressure will often depend, in part, on what counts as a “problem” in their
normative worldview or for the constellation of organized interests upon which they
depend for political support.
33
REFERENCES
Arnold, R. Douglas. 1990. The Logic of Congressional Action. New Haven: Yale
University Press.
Arthur, W. Brian. 1992. "On Learning and Adaptation in the Economy." Santa Fe: Santa
Fe Institute. Working Paper 92-07-038.
Baumol, William J., and Wallace E. Oates. 1971. "The Use of Standards and Prices for
Protection of the Environment." Swedish Journal of Economics 73:42-54.
Belfry, Kaija. 2010. "The Third Man: Investor Influence on Business Preferences for
Climate Change Policy Instruments in Canada." In Annual Meeting of the
Canadian Political Science Association. Montreal, Quebec.
Birkland, Thomas A. 1998. "Focusing Events, Mobilization, and Agenda Setting."
Journal of Public Policy 18 (1):53-74.
Blyth, Mark. 2002. Great Transformations: Economic Ideas and Institutional Change in
the Twentieth Century. New York: Cambridge University Press.
Brooks, Sarah M., and R. Kent Weaver. 2005. "Lashed to the Mast? The Politics of Ndc
Pension Reform." In Pension Reform: Issues and Prospects for Non-Financial
Defined Contribution (Ndc) Schemes, ed. Robert Holzmann and Edward E.
Palmer. Washington, D.C.: The World Bank.
Campbell, Andrea Louise. 2003. How Policies Make Citizens : Senior Political Activism
and the American Welfare State. Princeton, N.J.: Princeton University Press.
Campbell, Andrea Louise, and Kimberly J. Morgan. 2005. "Federalism and the Politics of
Old-Age Care in Germany and the United States." Comparative Political Studies
38 (8):887-914.
Chong, Dennis, and James N. Druckman. 2007. "Framing Theory." Annual Review of
Political Science 10:103-26.
Clemens, Elizabeth, and Marc Schneiberg. 2006. "The Typical Tools for the Job:
Research Strategies in Institutional Analysis." Sociological Theory 24 (3):195227.
Converse, Philip E. 1964. "The Nature of Belief Systems in Mass Publics." In Ideology
and Discontent, ed. David E. Apter. New York: Free Press.
David, Paul A. 1985. "Clio and the Economics of Qwerty." Economic History 75 (2):3327.
34
DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith. 2011. "Income,
Poverty, and Health Insurance Coverage in the United States: 2010." Washington,
D.C.: U.S. Census Bureau. Current Population Reports, P60-239.
Ellerman, A. Denny. 2003. "Ex Post Evaluation of Tradable Permits: The U.S. So2 CapAndtrade Program." Center for Energy and Environmental Policy Research. 03003 WP.
Esping-Andersen, Gøsta. 1990. The Three Worlds of Welfare Capitalism. Princeton, N.J.:
Princeton University Press.
———. 1999. Social Foundations of Postindustrial Economies. New York: Oxford
University Press.
Geddes, Barbara. 1994. Politician's Dilemma: Building State Capacity in Latin America.
Berkeley, California: University of California Press.
Greif, Avner, and David D. Laitin. 2004. "A Theory of Endogenous Institutional
Change." American Political Science Review 98 (4):633-52.
Hacker, Jacob S. 1998. "The Historical Logic of National Health Insurance: Structure
and Sequence in the Development of British, Canadian, and U.S. Medical Policy."
Studies in American Political Development 12 (1):57-130.
———. 2002. The Divided Welfare State: The Battle over Public and Private Social
Benefits in the United States. New York: Cambridge University Press.
———. 2004. "Privatizing Risk without Privatizing the Welfare State: The Hidden
Politics of Social Policy Retrenchment in the United States." American Political
Science Review 98 (2):243-60.
———. 2010. "The Road to Somewhere: Why Health Reform Happened." Perspectives
on Politics 8 (3):861-76.
Hacker, Jacob S., and Paul Pierson. 2010. "Winner-Take-All Politics: Public Policy,
Political Organization, and the Precipitous Rise of Top Incomes in the United
States." Politics and Society 38 (2):152-204.
Hamburger, Tom , and Kim Geiger. 2009. "Healthcare Insurers Get Upper Hand." Los
Angeles Times, August 24.
Jacobs, Alan M. 2011. Governing for the Long Term: Democracy and the Politics of
Investment. New York: Cambridge University Press.
Jacobs, Lawrence R., and Theda Skocpol. 2010. Health Care Reform and American
Politics: What Everyone Needs to Know. New York: Oxford University Press.
35
Kingdon, John W. 1984. Agendas, Alternatives, and Public Policies. New York:
Harper/Collins.
Klein, Jill G. 1991. "Negativity Effects in Impression Formation: A Test in the Political
Arena." Personality and Social Psychology Bulletin 17 (4):412-8.
Knight, Jack. 1992. Institutions and Social Conflict. Cambridge [England] ; New York,
N.Y.: Cambridge University Press.
Kuklinski, James H., and Paul D. Quirk. 2001. "Conceptual Foundations of Citizen
Competence." Political Behavior 23 (3):285-311.
Lau, Richard R. 1985. "Two Explanations for Negativity Effects in Political Behavior."
American Journal of Political Science 29 (1):119-38.
Liebman, Robert C., and Robert Wuthnow, eds. 1983. The New Christian Right.
Hawthorne, N.Y.: Aldine Pub. Co.
Mahoney, James, and Kathleen Thelen. 2009a. "A Theory of Gradual Institutional
Change." In Explaining Institutional Change: Ambiguity, Agency, and Power, ed.
James Mahoney and Kathleen Thelen. New York: Cambridge University Press.
———, eds. 2009b. Explaining Institutional Change: Ambiguity, Agency, and Power.
Edited by James Mahoney and Kathleen Thelen. New York: Cambridge
University Press.
Mettler, Suzanne. 2005. Soliders to Citizens: The G.I. Bill and the Making of the Greatest
Generation. New York: Oxford University Press.
Nelson, Thomas, Rosalee Clawson, and Zoe Oxley. 1997. "Media Framing of a Civil
Liberties Conflict and Its Effect on Tolerance." American Political Science
Review 91:567-83.
Nordhaus, William D. 1975. "The Political Business Cycle." The Review of Economic
Studies 42 (2):169-90.
North, Douglass C. 1990. Institutions, Institutional Change, and Economic Performance.
New York: Cambridge University Press.
Oberlander, Jonathan. 2010. "Long Time Coming: Why Health Reform Finally Passed."
Health Affairs 29 (6):112-6.
Patashnik, Eric M. 2008. Reforms at Risk: What Happens after Major Policy Changes
Are Enacted. Princeton: Princeton University Press.
Patashnik, Eric M., and Julian Zelizer. 2009. "When Policy Does Not Remake Politics:
The Limits of Policy Feedback." Paper presented at Annual Meeting of the
American Political Science Association, September 3-6, at Toronto, ON.
36
Pierson, Paul. 1993. "When Effect Becomes Cause: Policy Feedback and Political
Change." World Politics 45 (4):595-628.
———. 1994. Dismantling the Welfare State? Reagan, Thatcher, and the Politics of
Retrenchment. New York: Cambridge University Press.
———. 2000. "Increasing Returns, Path Dependence, and the Study of Politics."
American Political Science Review 94 (2):251-67.
———. 2004. Politics in Time: History, Institutions, and Social Analysis. Princeton,
N.J.: Princeton University Press.
Pierson, Paul, and Trowbridge. 2002. "Asset Specificity and Institutional Development."
In Paper presented at the Annual Meeting of the American Political Science
Association. Boston, MA.
Quadagno, Jill. 2011. "Interest-Group Influence on the Patient Protection and
Affordability Act of 2010: Winners and Losers in the Health Care Reform
Debate." Journal of Health Politics, Policy and Law 36 (3):449-53.
Schickler, Eric. 2001. Disjointed Pluralism: Institutional Innovation and the
Development of the U.S. Congress. Princeton: Princeton University Press.
Schludi, Martin. 2005. The Reform of Bismarckian Pension Systems : A Comparison of
Pension Politics in Austria, France, Germany, Italy and Sweden. Amsterdam:
Amsterdam University Press.
Skocpol, Theda. 1992. Protecting Soldiers and Mothers: The Political Origins of Social
Policy in the United States. Cambridge, MA: Belknap Press of Harvard University
Press.
———. 1996. Boomerang: Clinton’s Health Security Effort and the Turn against
Government in U.S. Politics. New York: W.W. Norton.
Soroka, Stuart N. 2006. "Good News and Bad News: Asymmetric Responses to
Economic Information." Journal of Politics 68 (2):372–85.
Soroka, Stuart N., and Christopher Wlezien. 2010. Degrees of Democracy: Politics,
Public Opinion, and Policy. New York: Cambridge University Press.
Steinmo, Sven, and Jon Watts. 1995. "It's the Institutions, Stupid! Why Comprehensive
National Health Insurance Always Fails in America." Journal of Health Politics,
Policy and Law 20 (2):329-72.
Stone, Deborah. 1989. "Causal Stories and the Formation of Policy Agendas." Political
Science Quarterly 104 (2):281-300.
37
Streeck, Wolfgang, and Kathleen Ann Thelen, eds. 2005. Beyond Continuity:
Institutional Change in Advanced Political Economies. New York: Oxford
University Press.
Thelen, Kathleen. 2003. "How Institutions Evolve: Insights from Comparative Historical
Analysis." In Comparative Historical Analysis in the Social Sciences, ed. James
Mahoney and Dietrich Rueschemeyer. New York: Cambridge University Press.
———. 2004. How Institutions Evolve: The Political Economy of Skills in Germany,
Britain, the United States, and Japan. New York: Cambridge University Press.
Thorpe, Kenneth. 1999. "Managed Care as Victim or Villain?" Journal of Health
Politics, Policy and Law 24 (5):949-56.
Tversky, Amos, and Daniel Kahneman. 1991. "Loss Aversion in Riskless Choice: A
Reference-Dependent Model." Quarterly Journal of Economics 106 (4):1039-61.
Vogel, David. 1989. Fluctuating Fortunes : The Political Power of Business in America.
New York: Basic Books.
———. 1993. "Representing Diffuse Interests in Environmental Policymaking." In Do
Institutions Matter? Government Capabilities in the United States and Abroad,
ed. R. Kent Weaver and Bert A. Rockman. Washington, D.C.: The Brookings
Institution.
———. 2003. "The Hare and the Tortoise Revisited: The New Politics of Consumer and
Environmental Regulation in Europe." British Journal of Political Science 33
(4):557-80.
Vonk, Roos. 1993. "The Negativity Effect in Trait Ratings and in Open-Ended
Descriptions of Persons." Personality and Social Psychology Bulletin 19 (3):26978.
Weaver, R. Kent. 1986. "The Politics of Blame Avoidance." Journal of Public Policy 6
(4):371-98.
West, Darrell M., Diane Heith, and Chris Goodwin. 1996. "Harry and Louise Go to
Washington: Political Advertising and Health Care Reform." Journal of Health
Politics, Policy and Law 2 (1):35-68.
Weyland, Kurt. 1998. "Swallowing the Bitter Pill: Sources of Popular Support for
Neoliberal Reform in Latin America." Comparative Political Studies 31 (5):53968.
Wilson, James Q. 1980. "The Politics of Regulation." In The Politics of Regulation, ed.
James Q. Wilson. New York: Basic Books.
38
Zaller, John. 1992. The Nature and Origins of Mass Opinion. New York: Cambridge
University Press.
39