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

Abstract

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.