HEALTH REFORM IMPASSE - THE POLITICS OF AMERICAN AMBIVALENCE TOWARD GOVERNMENT

This paper presents two interrelated arguments: it rethinks convention al understanding of the policy-making process and analyzes an importan t substantive issue regarding public opinion. The substantive issue in volves the public's deep ambivalence toward government reforms: Americ ans are simultaneously supportive of significant reform and uneasy abo ut expanding government involvement. The critical question is what, if any, impact this public ambivalence will have on policy deliberations . Answering this question requires an analysis of the role of public o pinion in policy-making. Investigation of historic as well as contempo rary health reform suggests that the impact of public opinion varies, depending on the character of both public opinion and the policy issue . The public's preferences are not especially influential when they ar e characterized by uncertainty or when an issue is not salient, but st rong and sustained sentiment can affect agenda setting, interest group leverage over government officials, and policymakers' formulation of detailed administrative arrangements.