Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: Candidate rhetoric in presidential election debates is shaped by campaign context, measured by trial heat polls and press coverage. Debate rhetoric also shapes subsequent public opinion, but is mediated by the nature of the press coverage.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: This paper argues that governments formed from post-election coalitions (majority coalitiotn governments in PR systems) and pre-election coalitions (majority parties in SMD systems) aggregate the interests of voters in systematically different ways. We show that the multiple policy dimensional space that emerges from PR rules motivate parties in the government coalition to logroll projects among themselves without internalizing the costs of those projects in the same way that a majoritarian party would be forced to do. The size of government should therefore tend to be larger in PR systems. We further show that, although centrifugal electoral incentives dominate in PR systems, some incentives towards coalescence across groups and across parties exist through the greater likelihood that large parties have in becoming a member of a minimal winning coalition of parties.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: This study seeks to highlight the commonalities as well as the distinct interests, resources, and strategies of foundations in the area of health policy. It reviews and compares the activities of twelve foundations, including a select number of national foundations, a new breed of state health foundations, and some local foundations that consciously participate in health policy matters. Since the field of health policy is extraordinarily broad, this paper focuses its analysis on foundation activities aimed at expanding or protecting health insurance coverage. The issue is serious, persistent, and provides valuable insight into the connections between philanthropy and public policy.

A key problem facing the policy community, including foundations concerned with gaps in insurance coverage, is that many individuals do not take coverage offered to them in private or public programs. Thus, foundations are faced with two basic challenges: First, they must support strategies to improve take-up rates for existing programs. Second, they must also help develop initiatives to provide insurance coverage for individuals who do not currently qualify for employer-sponsored or public programs.

Most foundations invest in a very broad set of activities to achieve their policy goals. These diverse activities fit into three basic strategies for shaping public policy:

1) Educate the public and members of the policy community
2) Invest in the development and demonstration of new institutions and policy options
3) Support capacity-building and advocacy efforts

Building on twelve individual profiles of foundation activities, the study presents an overview of these foundations’ choice of issues, audiences and partners, jurisdictions, and stages of involvement in the policy process. It identifies some clear patterns in the allocation of resources and examines what those patterns suggest about foundation preferences and capabilities for improving health insurance coverage.

Due to the nature of health care financing and delivery in this country, all of the foundations have devoted resources to improving private insurance coverage as well as protecting and expanding public sources of coverage. All of the foundations, however, accept the premise that governmental action is critical to solving the problems of more than 40 million uninsured Americans and they view public policy as a way to leverage the relatively limited resources they can devote to this issue. In the end, most foundations find themselves funding a combination of activities—public and private, and at different levels of the system. Some grants support policy or program development aimed at long term systemic change, while other grants support the delivery of discrete, short term services. While this study focuses on foundation efforts to change public policy, it is important to recognize that support for direct services may at times be a logical complement and not a competitor to systemic solutions.

The study also draws several lessons from these foundations’ efforts:

Lesson 1
Foundations are not strictly leaders or followers on the issue of health insurance coverage.

Lesson 2
While foundations can adopt different strategies in the public policy arena, those strategies become less differentiated for foundations with greater resources and for foundations focused on state or local initiatives.

Lesson 3
It is necessary but not sufficient for foundations to develop expertise in health policy.

Lesson 4
Foundations must clarify whether they can best meet their goals as investors or as entrepreneurs in the policy process.

Lesson 5
The test of foundations’ capacity to solve critical social problems lies in their collective contributions, not their individual roles in the policy process.

The limited progress toward universal coverage can hardly be attributed to foundation boards and staff wary of political controversy. As a number of foundation leaders point out, a few billion dollars of philanthropy does not go far in a $1.5 trillion health care system. Nonetheless, the potential impact of foundations might be more highly leveraged through stronger, more selective advocacy and also through stronger collaboration among foundations.

The process of policy innovation requires the collaboration of different types of leaders—inventors of policy ideas, investors, promoters, and managers. But it also typically requires “policy entrepreneurs” who take the lead in that collaboration—entrepreneurs recombine intellectual, political, and organizational resources into new products and courses of action for government. The most distinguishing trait of policy entrepreneurs is their singular focus on a specific idea for new governmental procedures, organizations, or programs, and the significant professional and often financial stakes they place in those ideas. Policy entrepreneurs can and often do come from outside of government, even though their success depends on recruiting government insiders who have key positions and the political capital to move their proposals forward.

Foundations are clearly capable of becoming entrepreneurs in the policy process. Alternatively, foundations may choose the role of investor, providing financial support, technical assistance, access to decision makers, and prestige to one or more groups promoting their own ideas for improving public policy and public health.

There is a fundamental difference in these two roles and important implications for the allocation of foundation resources. In general, the national foundations in this study have consciously avoided endorsing particular solutions to the problems of the uninsured. In contrast, nearly all of the state and local foundations have selected—indeed, sometimes created—particular policies or administrative arrangements that they want government to adopt. Due to their more limited resources, local foundations appear to focus their health policy efforts on one principal initiative at a time.

There are many possible reasons why foundations would shy away from the role of policy entrepreneur and prefer that of investor. The choice involves practical issues of the amount of resources available to address an issue and the proximity of the foundation to key actors in the policy community. The choice also depends on whether the foundation’s board and staff are willing to commit themselves to a specific initiative for a lengthy period of time.

Nonetheless, at whatever scale and in whatever manner foundations pursue an expansion of health insurance, they must confront the question of whether they might increase their effectiveness by not only helping develop products for policy makers but engage in more selective, forceful advocacy of their preferred products. The evidence from this study suggests that focused advocacy efforts might well be put to greater use in foundation efforts to protect and expand health insurance across the nation.

If there is a lesson that smaller, more local foundations can teach larger foundations, it is the importance of establishing and sustaining a specific policy design and marshalling resources to support it through close public-private partnerships. One approach is to pool resources into a single, foundation-sponsored initiative. Another approach is to establish informal collaboration in support of a government or community-based initiative.

Collaboration is primarily a means to an end, not an end in itself. There are two key issues regarding collaboration among funders and their operational partners in any initiative. First, are resources sufficient to meet the agreed-upon goals of the participants? Second, is the combination of activities comprehensive, incorporating each of the three strategies needed to maximize the likelihood of reshaping public policy?

Even in a best-case scenario of collaboration, foundations can rapidly approach boundaries to further progress on the issue of health insurance coverage. Without a single, well-endowed source of responsibility or success in persuading governmental officials to adopt the program, even the most skilled policy entrepreneurs within the world of philanthropy cannot sustain expansions of coverage—even modest ones—because of their extraordinary financial costs. At all levels of the political system, the financial and political costs require collaboration among foundations. Significant commitment and communication will be required, however, to work out the most effective configuration of roles and resources for protecting and expanding health insurance coverage across the nation.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract:  The motivation for this project stems from the realization that political institutions and the
policies they produce not only govern citizen action, but cultivate and condition citizen desires.
Unfortunately, the means by which they do so, and the direction in which such desires are formed, often
do not work to sustain democracy. If institutions and policymakers play this role in constructing and
fulfilling undemocratic desires, then making change on the level of political institutions is a way to alter
the context in which desires are formed and pursued, a way to make and sustain social change.
However, the project of designing political institutions and public policies to structure normative
action has a dark side, raising a specter of “legislating desires” that should make democratic theorists
uneasy. To probe this uneasiness, I turn to three of Plato’s dialogues where the political shaping of
souls takes center stage. It may seem surprising to turn to Plato for this project, since Plato’s best-
known attempt to institutionalize a just polity is notorious for its antidemocratic character. But I join
many theorists in arguing that Plato’s work is more complex and multiple-voiced than that. A variety of
forms of soulcraft appear in Plato’s dialogues, and I argue that he is trying to tell us something about
their limits as well as about their potentials. What follows is an examination of the problems and
possibilities that inhere in various modes of soul-shaping in the Gorgias, the Republic, and the Laws.

Publication Type: Proceeding