It is argued by scholars that there has been an institutional change in the United States from a system of iron triangles to a system of loose policy networks (Gais et al. 1984 and Peterson 1993a). Iron triangles, as defined by Gais et al., are autonomous and impermeable. Issue networks on the other hand are composed of specialists, journalists, and administrators. These issue networks tend to lack the structure and homogeneity that subgovernments in the United States posses internally. This results in unpredictably complicated situations that governmental leadership (Gais et al. 1984). These scholars are asking questions such as: What makes a good opportunity for change? How has the institutional structure created an opportunity for health care reform in the United States? and What type of institutional system does the United States currently have?
Scholars such as Gais and Peterson observed that politics along with the structure of American politics and government has been changing, especially since the 1990s. This is
because the iron triangle system has transformed into an open and diverse policy network system (Gais et al. 1984 and Peterson 1993a). Peterson’s theory has always been that institutional change can have a significant effect on and dramatically alter political relationships (Peterson 1993b). This is because institutional change has “practical consequences for how health policy reformers of every stripe approach one another, assess the intersection of substantive policy and political reality, and set the course for restructuring one of the largest economies in the world: the American health care financing and delivery system” (Peterson 1993b, 783). These changes
are what, according to scholars, had led to new opportunities for reform and a new structure in American politics.
Peterson and Gais saw that the institutional change has decentralized the American government and resulted in a change in both size and scope. As a result of this, Congress is now fragmented which allows for private interests to form relationships with small sets of
government actors who can influence policy (Gais et al. 1984, Peterson 1993a). This
decentralization has also allowed for many new government programs that involve the federal government in areas that were once none of its concern, resulting in subgovernments having an opportunity to develop in the United States (Gais et al. 1984). There are many key components to policy change according to Peterson. In the United States, Peterson theorizes that policy change “depends on fairly momentary “policy windows” engendered by a confluence of problem awareness, events, public mood, electoral outcomes, and policy entrepreneurship” (Peterson 1993b, 795). Once these policy windows are open, “major shifts in policy probably depend on the results of…‘political’ decision making, when ideas and people with influence are both energetically in contention” (Peterson 1993b, 795). These key components indicate that when policy windows are open, there is a confluence of the public and private factors, and political decision making produces results where people with influence are in contention, major shifts in policy are possible.
Ultimately, Peterson determines that leadership still matters in American politics and especially in health care reform debate and politics. This is because he provides a theoretical framework that suggests that a president with the most institutional advantages in a reform attempt, who uses them well, will have the most success. He argues that the context of the president is important, but the advantages only matter if they utilize and exploit them correctly
and to their full potential, otherwise, the advantages will not make much of a difference in
reform efforts. Also, despite the number of advantages given, challenges will still remain, it takes an effective leader to navigate the debate properly and effectively (Peterson 2011).
II. Interest Group Dynamics and Challenging vs. Protecting the Status Quo
Other theories suggest that interest groups or representational communities who are protecting the status quo are more likely to succeed in their efforts. These authors seek to understand how the policy process in the United States works, who wins in politics, who loses, and why (Baumgartner et al. 2009). Peterson theorizes that representational communities typically “begin as blocks, with allied stakeholders unencumbered by stake-challengers” (Peterson 1993a, 409). Peterson also believes that “the interests of stake-challengers, however, are generally more diffuse and thus less likely to prompt mobilization. An individual stake- challenger cannot justify unitary action, and organized representation is achieved only if barriers to collective action are overcome” (Peterson 1993a, 409). A change has taken place in the representational communities of the United States. While block communities are the most
common, the representational community became more dyadic from the 1960s to the 1970s. This change resulted when stake-challenger groups polarized health care politics while stakeholders kept old alliances (Peterson 1993a). As a result, according to Peterson, stakeholders are more likely to be competitive with one another, when there are more stakeholders, and the
representational network is heterogeneous (Peterson 1993a).
Baumgartner et al. identified four factors that influence interest groups and policy change in Washington. They are: “first, lobbying is about changing existing public policies. Second, policies are complex, with multiple and contradictory effects on diverse constituencies. Third,
following from previous fact, ‘sides’ mobilized to protect or to change the status quo tend to be quite heterogeneous. And, fourth, attention in Washington is scarce” (Baumgartner et al. 2009, 19). These different factors lead to policy change in the United States, when it does happen, being significant rather than incremental because of the status quo.
Through the research of Baumgartner et al. 2009 it is theorized that interest groups who can assist in reducing uncertainty are usually favored in American politics because policy makers do not want there to be any unpredicted problems or uncertainty when implementing a policy. Also, if groups can cast doubt or uncertainty on other groups’ positions, hey strengthen their own stance while the targeted groups’ positions becomes weaker. Just like the status quo, Baumgartner et al. 2009 theorize that stability is favored which is how they account for the minimal impact of money and interest group spending on interest group success in American politics.
They theorize that because money competes against money and because interest have usually won their preferred position in the previously established status quo, having more money in the present is not necessary for influence or for better policy outcomes for interest groups. Part of this theory is that interest groups who get the policy outcomes that they desire in Washington are those who defend the status quo. This is because those who are protecting the status quo have already achieved what they have wanted in the past. They are more likely to use negative
argumentation, because they are protecting what is already in place, which has less uncertainty than new policies. Those who are protecting the status quo are only going to fully-mobilize if there is a clear and cohesive countermovement against them (Baumgartner et al. 2009). The causes of policy change in the United States, according to this study, are dependent on context
and include having a policy window, social cascades, powerful coalitions, presidential support, and counter mobilizations (Baumgartner et al. 2009).
III. Collective Interests and Citizen Groups
Other scholars theorize that there are different types of interests in the United States. There are four different types of groups: occupational profit sector, occupational mixed sector, occupational non-profit sector, and non-occupational citizen groups. This will be explained further in-depth in the literature review, but briefly stated, profit sector occupational groups include trade associations and professional groups whose members who work mostly in the profit-making sector. Mixed sector occupational groups are small in number and consist of groups such as the National Association of Broadcasters, the American Hospital Association, the Society of American Forecasters and the National Society of Professional Engineers. Non-profit occupational groups consist of associations of universities, non-profit hospitals, state and local government agencies, and professional societies with members that work for the government, social welfare, education, or cultural agencies. Finally, citizen groups that are non-occupational organize around a common cause or an idea and are inclusive to anyone (Gais et al. 1984). Each group has their own dynamics. Citizen groups do not have good insider strategies and because of this, they are twice as likely as occupational groups to use outsider strategies and to appeal to the public through the media and grassroots lobbying (Gais et al. 1984). Also, because of their poor insider strategies, citizen groups are less likely to lobby administrative agencies (Gais et al. 1984).