Privatisation: An attempt that failed

Throughout the twentieth century doctors in most western countries strongly resisted government attempts to intervene in private medical markets. The support for privatisation that has developed during the current economic recession is welcomed therefore by the medical profession. In several countries campaigns have been staged for a full or partial return to market forces in the health care field. This article traces the course of one such push in Canada where doctors and other advocates of privatisation demanded a larger role for the private sector in the funding and management of Medicare, the national health insurance system. The policy outcome is contrary to the general privatising tendency in many countries: after a period of intense controversy the federal government passed legislation to preserve and strengthen the public aspects of the scheme. The normally powerful medical profession lost its campaign for an infusion of private funds into the health system and for the retention of the right of doctors to set their own fees. Consumer and other non‐producer groups, which have not traditionally played a central role in health policy, mobilised in defense of Medicare and were able to achieve most of their aims.     

Post-war smoking policy in the UK and the redefinition of public health

Current analyses of UK smoking policy within two frameworks--the 'heroes and villains' view of journalist accounts and a political science emphasis on rival 'producer' and 'issue' networks in policy making. It is often assumed that the US experience provides a universal historical model. This paper sees smoking policy in the UK as a case study in the relationship between 'scientific fact creation' and policy, which has also been emblematic of wider changes in public health ideology. The issue of smoking and lung cancer symbolized the post-war shift from infectious to chronic disease and the rise of a new 'lifestyle'-oriented public health. In the 1980s passive smoking brought a revival of environmentalism; in the 1990s the rediscovered concept of addiction symbolized developments in public health in which curative and preventive initiatives were entwined. Despite the rise of a militant 'healthism' within both anti-smoking and public health since the 1970s, British policy retained a dual focus, an emphasis on risk reduction as well as risk elimination in which policy networks were entwined rather than distinct. Some public health scientists worked in policy milieux, notably the expert committee, which crossed this apparent divide and which linked with industry. Connections between government and industry changed as public health 'treatment' brought the pharmaceutical industry into the picture.     

Capital's Metropolis: Chicago and the Transformation of American Housing Policy

The US economic recovery of the 1990s accelerated amidst privatization, selective devolution and the reinvention of the public sector itself. Simultaneously, mortgage finance and assisted housing policy were recast in terms of market processes, individual responsibility and private home-ownership, even as gentrification enjoyed a dramatic resurgence. The intersection of these seemingly unrelated processes signifies an important transformation of the American inner city. Nowhere are these connections more explicit than in Chicago, where newly devolved and flexible policy infrastructures are built on the ashes of prominent experiments of previous generations. In this paper we use Chicago as a context to explore the linkages between reinvestment, housing finance and the reinvention of assisted housing. We analyse local and federal developments in assisted housing policy and develop a multivariate analysis of mortgage loans in Chicago's neighbourhoods during the 1990s expansion. New constructions of scale in assisted housing, exemplifed by Chicago's Lake Parc Place and the federal HOPE VI programme, constitute a centripetal devolution mediated by the relationship between public policy and local private market forces. National changes in housing finance have altered historical processes of redlining, disinvestment, and gentrification. Mortgage capital, traditionally responsible for the creation or exacerbation of rent gaps, now lubricates the flow of capital into the gentrifying frontier of the inner city. The intensified market discipline of housing policy, based partly on theories incubated in Chicago, suggests a new regime of neighbourhood change in the American inner city.     

The political anatomy of community health policy in Australia, 1972–1982

This article seeks to account for the survival of the 1973–1975 Labor government's new Community Health policy during the conservative coalition government (1975–1983) (which had managed to completely abolish Labor's national Medibank health insurance program). Through extensive interviews with 74 people who were directly involved in the policy process at national, state and local levels, as well as from other sources of information, inquiry is made into the issues and circumstances that were taken into account in the decisions that affected the course of policy from 1972–82. The important political and economic forces included party politics, federal‐state relations, the national economy, the direction of other fiscal and health policies, private and governmental interest groups, administrative nets, and the mass media. The not surprising conclusion is that changes in Community Health policy did not depend on its effectiveness but rather on the balance of political, economic and organizational power of interested groups at particular points in time. Policy‐relevant issues facing the 1983 Labor government are pointed out.     

Go East,Young Cadre: Experiments in Inter‐Provincial Training of Party and State Managers in China

This article situates China's local policy experimentation in the broader context of policy experiments in decentralized political systems, through a case study which represents a local state response to China's transition to a market economy. With growing regional and urban–rural inequalities evident after the initial reform period (1978–1994), local party leaders of inland provinces devised strategies for addressing these inequalities and encouraging public–private sector mobility among party officials. County and township‐level leaders pursued local policy experiments in which they selected and sent officials to find private‐sector work in China's booming coastal cities. Initiated in the 1990s and peaking in the 2000s, these policy experiments and inter‐provincial transfers demonstrate the discretion that local officials possess to conduct programmatic/policy experiments in a unitary political system and show how officials resort to extra‐institutional strategies in order to bridge perceived knowledge gaps. The ultimate demise of these programmes illuminates the challenges to extra‐institutional policy innovations in transitioning states.     

Shifting Environmental Governance in a Neoliberal World: US AID for Conservation

Abstract: By exploring the shifting and uneven power relations among state, market and civil society organizations in US environmental foreign aid policy‐making, this article forges new ground in conversations about conservation and neoliberalism. Since the 1970s, an evolving group of non‐governmental organizations (NGOs) has lobbied the US Congress to support environmental foreign assistance. However, the 1980s and 1990s rise of neoliberalism laid the conditions for the formation of a dynamic alliance among representatives of the US Congress, the US Agency for International Development, environmental NGOs and the private sector around biodiversity conservation. In this alliance, idealized visions of NGOs as civil society and a countering force to corporations have underpinned their influence, despite their contemporary corporate partnerships. Furthermore, by focusing on international biodiversity conservation, the group has attracted a broad spectrum of political and corporate support to shape public policy and in the process create new spaces for capital expansion.     

When Do We “Just Say No”? Policy Termination Decisions in Local Hospital Services

This paper develops a two‐stage decision‐making model of the public policy termination process, which integrates political and economic influences on local decision makers. We empirically explore the model using data on the provision of local public hospitals in California over 1981–95. The results provide support for the model as we find that triggering events as well as characteristics of the local decision‐making context affect the termination decision. For the case of public hospitals, we find that lower state and local revenue growth rates increase the likelihood of termination, while decision makers in communities with a larger local health budget, more unionized public employees, and a larger private hospital sector are less likely to terminate local public hospitals. The implications for public policy and for our understanding of the termination process are discussed.     

Legitimacy and Public Policy: Seeing Beyond Effectiveness,Efficiency, and Performance

Studies of failure typically assess public policies through the lenses of effectiveness, efficiency, and performance. Here I wish to propose a further dimension to the evaluation and assessment of policy failure—legitimacy. The substantive elements of public policies and the procedural steps taken by authoritative decision makers during the policy cycle affect the perception of policy legitimacy held by both stakeholders and the public. In substantive terms, policy content should align with the dominant attitudes of the affected policy community and, ideally, the broader public. Procedurally, factors such as policy incubation, the emotive appeals deployed to gain support for an initiative, and the processes of stakeholder engagement shape the legitimacy of public policies and the governments who promote them. This argument is based on a comparison of education reform in two Canadian provinces during the 1990s. Governments in Alberta and Ontario pursued common agendas of education reform, but while Alberta achieved success, the Ontario government experienced a series of setbacks and lost the support of education stakeholders and the public. The root of Ontario's failures lies in the realm of legitimacy. These findings highlight the fact that the strategies used for enacting policy change may fail to bring about the necessary consensus among societal actors to sustain a new policy direction and calls attention to our need to better understand how governments can achieve meaningful public participation while still achieving legislative success in an efficient fashion.     

Private Citizens as Policy Entrepreneurs: Evidence from Autism Mandates and Parental Political Mobilization

Growing bodies of research in the social sciences point to politicians, bureaucratic officials, interest groups, and other actors who serve as policy entrepreneurs. In this paper, we argue that private citizens can also serve a primary role as policy entrepreneurs. To analyze this phenomenon, we investigate the behavior of private citizens and their role in changing state policies surrounding insurance mandates for autism coverage. Using a thematic analysis of focus groups and interviews conducted with individuals active in the push for autism policy change, we demonstrate that private citizens meet all of the requirements identified for policy entrepreneurs in the existing literature. We then investigate when, why, and how these private citizens step forward into the policy process as entrepreneurs. We show that entrepreneurship occurs when private citizens have needed resources, a sense of duty to fix a policy status quo they see as unjust, and a stake in policy change. We conclude by discussing the importance of our findings to the study of public policy and their generalizability beyond autism policy.     

Punctuated Equilibrium in Limbo: The Tobacco Lobby and U.S. State Policymaking from 1990 to 2003

Since the mid-1980s, U.S. tobacco policy has been an intense and acrimonious issue between antitobacco advocates and the tobacco industry. In the United States, the tobacco industry has responded to heightened state antitobacco litigation, adverse public opinion, and public health advocacy by aggressively mobilizing against tobacco taxes and regulations. This article examines whether these tobacco policy trends can be generalized to punctuated equilibrium theory ideas that policy monopolies are stable over long periods and usually change because of sharp and short-term exogenous shocks to the policy system. From 1990 to 2003, there was a sharp mobilization by health advocates in all states and a significant rise in new legislation to control tobacco use. The tobacco industry, nevertheless, was able to generally keep state tobacco taxes low and counter significant regulatory threats to tobacco sales. From this, I conclude that the policy monopoly favoring the tobacco industry did not significantly change, despite the symbolic appearance of punctuation in the policy system.     

Optimizing Productivity Through Privatization and Entrepreneurial Management

Efficiency and economy have become the forces driving both, public and private organizations in the 1990s. Competition and legal mandates constrict managers' abilities to use their traditional options in delivering goods and services to their citizens and customers. Privatization and entrepreneurial management are being utilized increasingly to improve productivity. This is creating a genuine transformation in the way we manage our organizations, it also changes the nature of the relationship between our organizations and their citizens, clients, and customers.
In this article we explore this unfolding transformation and analyze its significance. An entrepreneurial management productivity optimization model is also developed. Productivity is explored in terms of efficiency and effectiveness. The mechanisms for improving productivity, privatization, and entrepreneurial management are then examined. After noting the changing rotes that public policy and competition now play, the more prominent managerial models are explored, including reinventing and reengineering.
The article then presents examples of federal, state, and local entrepreneurial strategies and innovations. It concludes by alerting us to endangered public policy priorities and sets forth significant public management caveats to which we increasingly should become sensitive. The entrepreneurial management productivity optimization model has been developed to assist in clarifying and analyzing the issues involved in this article. It should also help those working in this arena to formulate optimal choices when building entrepreneurial management models for their own organizations or for those of their citizens, clients, or customers.     

The New South Wales doctors' dispute 1984–85: An interpretation

The NSW doctors’ dispute 1984–85 has had a lasting effect on the Australian health care system. Militant surgeons were effective in securing some modifications to regulations and administrative arrangements governing the role and remuneration of certain groups of doctors in NSW public hospitals and some changes to the federal government's Medicare scheme.

This paper examines the causes, actors, issues and outcome of the dispute. The key to understanding the dispute is a knowledge of both the specific issues debated by militant doctors and the federal and NSW Labor governments and the broader historical forces that have shaped the politics of national health insurance throughout the twentieth century. In contrast to media reports, the outcome of the dispute is interpreted as a compromise rather than a victory for the doctors. It is further argued that a theoretical generalisation formulated by two American political scientists, Marmor and Thomas, about disputes between doctors and governments over payment methods is only partially useful in explaining the outcome.

Two prominent and well‐documented historical themes from the politics of national health insurance in Australia — namely, the resistance of sections of the medical profession to any contraction of the private market for medicine and the fragmentation of the organised medical profession during periods of disputation with governments at the state and federal level — are discussed. These themes, and some generalisations about the capacity of the medical profession to influence public policy outcomes, are illuminated by the study.     

PUBLIC‐PRIVATE SUPPORT OF THE ARTS AND GERMAN CULTURAL POLICY

This paper provides a historical context for thinking about Germany’s recent embrace of sponsorship and private donations as a means of supporting education and the arts. The paper notes that the chief architect of a new national cultural policy, Michael Naumann, has justified a turn to public‐private collaborative arts funding with the argument that a market‐driven model of private responsibility for the arts stimulates greater citizen involvement in civic life and thus greater democracy. Yet Naumann has not reconciled this argument with Germany’s own history, in particular the fact that Germany’s Golden Age of private support of the arts coincided with the authoritarian German Empire (1871–1918). My analysis of this historical constellation, presented as a case study of one of Germany’s most important museum directors, Wilhelm Bode (1845–1929), argues that private support of the arts formed part of a larger strategy designed to wrest control of arts institutions away from traditional elites. My essay seeks to show that the rise of more responsive public forums was intended to make the fruits of German imperialism and economic domination available to more Germans, particularly middle class Germans. On this basis, the essay suggests two things. First, German imperialist society was less hierarchical and more broadly participatory than is often assumed, complicating its ability to figure as a negative foil today. Second, the harnessing of market forces to German culture was expected to deepen popular appreciation for chauvinistic conceptions of German nationalism that today seem to conflict with what German democracy might ideally be. With these points in mind, I contend not that sponsorship and private donations are incapable of promoting greater public involvement in the arts. Rather, the private sector might yield more democratic outcomes when publicly funded democratic institutions retain a strong voice in the direction of culture.     

Australian Public Opinion on the Israel–Palestine Conflict: Implications in the Context of Arab Revolutions

This article examines the relationship between public opinion and foreign policy making in Australia by turning to the findings of a national survey of Australian public opinion on the Israel–Palestine conflict. The survey findings suggest that the Australian government's policy on the Israel–Palestine conflict is inconsistent with public opinion, and such disparity is explained here in terms of the lack of public attachment to the conflict, the limited media and the absence of any notable public advocacy for policy change. This explanation is informed by in-depth interviews conducted with current and former members of parliament and senior public servants. The article also explores the implications of the survey's findings in relation to the significant political changes taking place across the Middle East region. It suggests that these events may be creating an impetus for policy change that endorses Palestinian self-determination, for which there is significant support among the Australian public.     

Biodiversity and sectoral responsibility in the development of Swedish Forestry Policy, 1988-1993

In 1993 the Swedish parliament deregulated national forestry policy and established an environmental goal in parallel with the previous, long-standing goal of high wood production. This paper shows how the change occurred in the context of major changes in Swedish environmental policy during the late 1980s and early 1990s. Within a short time, new environmental legislation and the introduction of legal protection for small forest and agricultural habitats of high ecological value reoriented national forestry policy, away from an overriding focus on wood production to an increased awareness of nature conservation and biodiversity preservation. Reflecting a major compromise with the state, forest owners have gained greater freedom to manage their land, but must also improve environmental conditions while achieving high wood production, a policy known as 'freedom under responsibility'. The paper explains how both the parliament and industry supported increased nature conservation and biodiversity to maintain forest health and support the forestry industry, by favouring responsible resource use and not simply protection from human influence.     

Biodiversity and Sectoral Responsibility in the Development of Swedish Forestry Policy, 1988–1993

In 1993 the Swedish parliament deregulated national forestry policy and established an environmental goal in parallel with the previous, long-standing goal of high wood production. This paper shows how the change occurred in the context of major changes in Swedish environmental policy during the late 1980s and early 1990s. Within a short time, new environmental legislation and the introduction of legal protection for small forest and agricultural habitats of high ecological value reoriented national forestry policy, away from an overriding focus on wood production to an increased awareness of nature conservation and biodiversity preservation. Reflecting a major compromise with the state, forest owners have gained greater freedom to manage their land, but must also improve environmental conditions while achieving high wood production, a policy known as ‘freedom under responsibility’. The paper explains how both the parliament and industry supported increased nature conservation and biodiversity to maintain forest health and support the forestry industry, by favouring responsible resource use and not simply protection from human influence.     

Private Conflict and Policy Passage: Interest-Group Conflict and State Medical Malpractice Reform

James Madison argued in Federalist 10 that "rival political factions" work against the public good. In contrast to Madison's pessimistic account, I suggest that factional conflict can lead to more representative public policy, and thus further the will of the people. I theorize that elected officials often seek a safe political position—one that corresponds to the preferences of the public at large—during periods of high conflict. I assess this theory in one, salient policy area, medical malpractice. I measure conflict with contributions for state candidates given by (i) the health and insurance industries, which generally support malpractice laws, and (ii) lawyers, who frequently oppose the laws. I find that group conflict matters to policy outcomes. I also find evidence that, under conditions of elevated conflict, adopted policies are more likely to move toward the general ideological preferences of the public at large. These results suggest that group conflict affects both the quantity and character of policy in the American states.     

Evolution of Innovation Policy in Emilia-Romagna and Valencia: Similar Reality,Similar Results?

This paper examines the evolution of regional innovation policy in Emilia-Romagna and Valencia, two regions with similar economic features that implemented close innovation policies in the 1970s and 1980s. We investigate whether their similarities have led to parallel targets, policy tools and governance developments. We show that innovation policy in both regions suffered from the effects of privatization, budget constraints and changes to manufacturing during the 1990s and we highlight the consequences. Although Emilia-Romagna experienced deeper changes to its innovation policy, privatizations and/or the replacement of public funds promoted commercial approaches and induced market failures in both regions. The worst effects of these policies were the implementation of less-risky innovation projects, the shift towards extra-regional projects and markets, and the favouring of large firms.     

Policy Cues and Ideology in Attitudes toward Charter Schools

Charter schools have generated support from politicians in both major American political parties while stimulating intense debate among interest groups. We investigate whether and how public attitudes reflect interest group polarization or politician consensus. Using an original survey, we find that charter school opinions diverge along ideological lines among high‐information respondents. With embedded experiments, we manipulate respondents' information using policy cues tied to opposing sides of the charter debate: We assess whether the role of private companies and nonunion teachers changes support for charter schools. We find that the public responds favorably to some informational cues; conservatives without prior information are especially persuaded by information about nonunion teachers. This explains how polarized opinion can develop even in the absence of strong partisan sorting among top political leaders and clarifies the partisan and ideological context of ongoing education policy debates.     

Political Decoupling: Private Implementation of Public Policy

Where policy goals can be achieved through regulation of private firms, private provision of public services allows governments to separate public policies from their political costs by shifting those costs to the private sector. Over the past three decades, financial decoupling has emerged as a regulatory strategy for promoting conservation, especially in the energy sector. Decoupling refers to the separation of a firm’s revenues from the volume of its product consumed, which allows companies to pursue resource efficiency free from financial risk. Similarly, when private firms provide public services, they separate public policies from their political costs. This political decoupling allows governments to pursue controversial policies while avoiding their attendant political risks. Applied to environmental policy, this theory implies that potentially unpopular conservation policies are more likely to be adopted and succeed when implemented through private firms. As an initial test of the theory, we analyze California water utilities and their responses to that state’s drought from 2015–2017. Analysis shows that, compared with those served by local government utilities, private utilities adopted more aggressive conservation measures, were more likely to meet state conservation standards, and conserved more water.