From Social Security to Health Security? Opinion and Rhetoric in U.S. Social Policy Making

Abstract

How does public opinion in American democracy relate to policy making, particularly in Washington, D.C.? This question has a special pertinence right now, and not just for political scientists. As I write, it is a little over a month after President Bill Clinton delivered a major televised address on the health care crisis, and only a few days after he and Hillary Rodham Clinton went up to Capitol Hill to introduce a 1,342 page “Health Security bill” into Congress. Clearly, Clinton is staking his presidency—not to mention the immediate prospects of the Democratic Party—on an attempt to respond to a certain reading of public opinion. By wading into a policy arena already staked out by many resourceful vested interests, Clinton is undertaking to mobilize and influence broad public support for what is arguably the most ambitious federal social policy initiative since the Social Security Act of 1935.Consideration of various aspects of the relationship of public opinion to the current round of health insurance policy making in Washington, D.C., can, in my view, underline the value of a historically grounded and institutionally mediated analysis of the roots and effects of public opinion. The approach I shall illustrate builds upon Lawrence Jacobs's (1993) recent book, The Health of Nations: Public Opinion and the Making of American and British Health Policy. One major undertaking of that work is to make sense of the role of U.S. public opinion in the enactment of Medicare in 1965.