This blogpost is the first in a series exploring a framework created by John Kingdon which deals with policymaking in a public setting. The book was first published in 1984, though we will be using the second edition which was reissued in 2010. It is a veritable mammoth and seeks to deal with all the participants, stakeholders and processes which go into making public policy in the United States.
Although the framework itself is extremely America-centric, it does bring out certain features of the public policy-making apparatus which are common across jurisdictions. In elucidating the elements of the Kingdon framework, we will be trying to tease out these common features and seeing how they apply to health systems.
The first part of the framework focuses on the components of the policymaking apparatus. Specifically, this post will focus on "the players in the game", as Kingdon calls them. These are the people inside the government who have a very direct effect on creating policy. Some of these should be obvious, such as the President and Congress, but we will also be looking into the "deep state": career bureaucrats and political appointees. Some of these components comprise what is known as the administration, and so we start with...
The President of the United States occupies pole position in the hierarchy of policymakers. If the President proposes a bill, it goes right up there in the front of the queue. The President has the prerogative, which (s)he often exercises thoroughly, of setting the agenda not merely for the executive branch, but also for the Congress as a whole. This has been seen in several administrations, such as the Carter Administration's priority of reducing hospital costs, President Reagan's "Morning in America" and Reaganomics, the Clinton Administration's welfare reforms and focus on reducing the budget deficit, the Bush Administration's focus on what became known as the "Bush Tax Cuts", and so on.
This, of course, does not mean that the President manages to get his or her way in all cases. External events often stymie the goals of any President (the COVID-19 pandemic being an epic case in point) and more than anything else, the President is merely one person. The alternatives to the President's proposed policy agenda are usually not crafted by him or her personally nor is the President able to guarantee the final outcome. The example given by Kingdon is that of President Carter's healthcare policies:
The Carter initiative set the agenda for the health-related congressional committees, whose members spent substantial portions of their hearing and markup time over three years on this subject. But the administration proposal, which provided for caps on inflation rates and limits on capital expenditures, was only one of several options considered. People on the Hill also considered defeating all proposals and doing nothing, providing for a voluntary effort by the hospitals with the imposition of government controls if the effort failed, and a longer-range strategy including reimbursement reforms. One Hill staffer said, "This particular piece of legislation is not near and dear to the heart of anyone on Capitol Hill. The ones that favor it, favor it only out of a sense of obligation and duty, out of a sense that they must do something about cost inflation, and out of loyalty to the White House." This sense of obligation and loyalty could carry the president's initiative as far as agenda status, but could not restrict the range of alternatives to his proposal that were seriously considered.
We see similar issues with President Biden's agenda about pumping money into infrastructure. Had the Democrats got their way, the bill being passed through Congress would have been bigger and would have been targeted at what is called "soft infrastructure" as well. America is in dire need of investment into infrastructure beyond roads and power grids. Unfortunately, the President isn't guaranteed to get their way all the time.
Why does the President occupy such a paramount position in the policymaking process? The most important reasons for this are institutional. The President has the power to veto bills which he or she does not want passed. The only way to override a Presidential veto is by getting two-thirds of the Congress to agree to override the veto. But as one of Kingdon's interviewees put it, "You couldn't get two thirds of Congress to pass the ten commandments." The President also has the prerogative to hire and fire people. If you aren't aligned with the President's agenda and work for him, there's a good chance you will be fired from your job and replaced with someone more aligned to the President's way of thinking.
Another institutional reason is that the Executive is a much more unified decision-making body as compared to the Legislature. Once the President makes clear what his or her agenda is, that agenda is likely to carry the day. In contrast, the Congress has 535 different members with 535 different agendas. While some of these agendas might be aligned with their fellows, there is no overarching mechanism to compel Congress to act together. It becomes much easier for Congressmen and Congresswomen to define their agendas as being for certain parts for the President's agenda or against certain parts of it.
A third, non-institutional reason is the President's command over public discourse. As Theodore Roosevelt put it, the Presidency is a bully pulpit. It's much easier to get your point of view out there and convince the public to rally behind it as President. This is, of course, not guaranteed to work, but when leveraged correctly can be a powerful mechanism to pressure the government into getting something done. A Congressional staffer pointed this out to Kingdon in an interview by talking about the vast flood of emails Congressmen and women receive when the President goes on the offensive in a news conference.
The final way in which the President can direct policy agendas is through his or her involvement in its setting. Policies which the President does not care about and does not personally get involved with tend to not get as much attention from the executive branch as those where the President makes it their mission to work on. News conferences and public opinion is one thing, but repeated phone calls, letters, and direct reporting tend to matter a lot more.
There is a huge caveat to this, though. The President's bully pulpit works in their favour when the President is popular. A less popular president would be unable to use their office the same way as a popular one. It has been seen that members of the Congress often try to set their own agendas against that of an unpopular President and align their agendas with a popular one. This tells us that while a President might be very powerful, they aren't all-powerful.
The Presidential Staff
The Presidential Staff is of vital importance to the functioning of the Executive. However, unlike the President himself (or herself), the staff is less involved in setting the agenda and more in setting up the alternatives. It has been noticed that the President and the Cabinet members are generally the ones who set the tone of the agenda, and the staffers are those who have to set up the alternatives.
Once the agenda and alternatives are set, the Presidential Staff engages in talking to the relevant stakeholders and establishing a detailed negotiating position. They flesh out the bones of administrative proposals and engage in discussions with everyone else who needs to be consulted. In other words, while they don't really set the agenda itself, they are the ones who actually do the work.
This group comprises of cabinet secretaries, undersecretaries, heads of bureaus, administrations, and other such agencies. Traditionally speaking, these people are thought to have a lot of clout in the day-to-day running of their agencies the setting of their agendas. However, modern, conspiratorial thinking tends to portray them as being subsumed by the desires of the agency they are supposed to be running. In other words, they are thought to be prisoners to the "deep state" itself.
Interviews conducted by Kingdon seem to suggest otherwise. The interviewees tended to mention political appointees as some of the most powerful actors in the policymaking system. They are mentioned more often than the President or their staff when talking about powerful actors in the policymaking apparatus. Their business is not to generate new issues or ideas. Their work is to "elevate" ideas which are already there. The ideas they need to work on already exist and are floating around in the executive branch. All they need to do is to take an interest in them. A neglected idea can often gain a lot of traction in case a political appointee takes an interest in it.
This is not to say that they have the power to trump the President's wishes. The President will always win in a difference of opinions between the President and a political appointee. The political appointee may try to convince the President of his or her point of view, but the President will always have the last word. A public disagreement between the President's agenda and the wishes of a political appointee have the potential of completely derailing a political appointee's career. The reverse can also be true: the President might find it embarrassing to be seen to be in conflict with a political appointee. This is the reason why such spats are typically not publicised.
Finally, these political appointees tend to have shorter tenures than the President's two terms. This leads to them trying to get things done as soon as possible. In the words of one interviewee about a particular Cabinet Officer, "He wants to be the firstest with the mostest, and it doesn't matter if it's the bestest."
By contrast, while there is a lot of speculation and conspiracy about civil servants due to their relative permanence and expertise, Kingdon's interviews did not find them to be a major force in policymaking. As a civil servant said of his appointed superior, "You go in and tell him X and he wants to hear Y. You go back again and you tell him X and he says he wants to hear Y. The third time, you finally conclude that you'd better say Y."
This might be surprising, because it has often been argued that it is not possible for a political appointee to control their subordinates. The counter-argument to that is that Kingdon was trying to understand the power civil servants hold in the process of setting an agenda. The development of alternatives and the actual implementation of policies is where civil servants have a lot of influence. Political Appointees generally tend to define the agenda for their sphere of influence, but they leave the drafting of the exact policy and its alternatives to civil servants. In the words of a congressional staffer, "Bureaucrats are not so important with respect to the generation of ideas, but they're critical with respect to their professional advice and consultation in pursuing approaches which we have generated. For example, with manpower, if we want the definition of underserved areas to include Pittsburgh or other urban areas, technically how can we do that? The bureaucrats are in a position to tell us how."
Civil servants also work on proposals which they agree with for extended periods, waiting for a sympathetic superior to pitch it to. This showcases their relative powerlessness in the practice of actually setting the agenda, for which they are critically dependent on their political superiors. However, their strength comes from their longevity. Since they tend to have worked on specific problems for a longer time than their politically appointed superiors, they are the ones often turned to for advice on how to go forward. Kingdon's interviews highlight the fact that this does not mean their advice is always followed. Kingdon does not go into detail about the frequency of political appointees "turning native", as it were, but it is noted that it goes both ways. Political appointees often start looking at things the way the bureaucracy wants, and they often don't. After all, civil servants aren't the only sources of expertise for political appointees. They often have their own networks which they turn t0 for wider ranging advice.
Congress is seen as the location of the people's representatives, and thus definitely does have an extremely important part to play in the policymaking process. Kingdon's interviews showed that interviewees held the Congress as being more important than any single part of the Executive, though less than powerful than the Executive in aggregate. However, since there are 535 different members of Congress, it might be difficult to say that Congress has a unified agenda.
That isn't to say that individual members of Congress do not have any power to set the agenda. Senators, especially those in prominent positions, can often leverage public position and their own standing to set the agenda in ways which is usually only possible for the President. The example given by Kingdon is that of Senator Long, who, as chairman of the Senate Finance Committee had scheduled mark-up sessions for national health insurance which prominently featured catastrophic medical bills. This caused it to rise up in the policy agenda of the day. In the words of an administrative source:
He says that it was when he scheduled his markups that the administration was really galvanized into action. And I think there probably is something to that. You know, in one of the markup sessions he told the story about this, and he said, "It's a little like the game you played when you were kids when you count to ten and then say, 'Ready or not, here I come. ", He says that's what he did to the administration; he counted to ten and he said, "Ready or not, I'm going to mark up a bill."
Senator Long's interest did not mean that anything would pass, but it was able to move the policy agenda forward in many important ways. And his example is not an isolated one. Senator Bennett pushing a proposal of Professional Standards Review Organizations onto the agenda, Senator Magnuson's interest in health manpower maldistribution causing the Health Service Corps to come into being, and Senator Ted Kennedy's forays into a number of policy areas are merely a few other examples of a fairly widespread occurrence.
Senators and Representatives are discussed very often by Kingdon's interviewees because of their ability to define both the agenda as well as the alternatives. While most people in the administration have the power to set either agendas or alternatives, few have the power to influence both in the way members of Congress do. The President cannot pass a law if there is no support from Congress. Policy proposals tend to undergo major changes in order to pass Congress.
Why is this so? First and foremost, the Congress derives its power from its legal authority. Major changes in domestic policy require new legislation, which requires Congressional approval. Another reason is that Congress tends to be a breeding ground for future Presidential candidates. No one wishes to go afoul of a Senator who may run for President in the future. The third is that Congressional information tends to be a blend of all types. In Kingdon's own words:
Congressional information is not the type of expertise that comes from undertaking a detailed study or being on an operational firing line. Rather, its major characteristic is a blend of the substantive and the political, the academic and the pressure group information, the bureaucracy and the constituency. Members and staffers are exposed to an impressive variety of information-studies, administration arguments, leaks, interest group pressures, complaints from the districts, concerns of constituents-and the combination of these various communications is different from the perspectives of others in the system.
This information is also generally very freeform and informal. Unlike the Executive, where everything happens in defined channels, information in Congress tends to go about in very informal channels and one gets access to it through the strength of one's relationships. And finally, members of Congress often have more longevity than the President does, and this extends to their staffers as well.
Kingdon also identifies three goals which motivate Senators:
- Satisfying their constituents to get re-elected. This is a major consideration, and getting things done is seen as better for this than doing nothing. This often extends to make themselves known to a greater number of potential voters in order to prepare for a future Presidential run. However, since this is a fairly sensitive thing, Congressmen and women tend to be fairly conservative in their choices, ducking hard choices and backing safe proposals
- Enhancing their intra-Washington reputation. It is in the interest of a Senator to carve out their own niche and be seen as a heavyweight in their area, so as to become a go-to person for that topic and to perhaps lead committees for the same
- Achieving their own conception of a good set of public policies. In other words, Senators tend to try to follow their consciences and ideologies
Kingdon has a subsection on Congressional staffers as well. However, it is sufficient to say that they have a role similar to that of political appointees and civil servants in the Executive. They manage the details, they often come up with ideas, alternatives, and specific provisions of legislation. However, everything they do has to be approved by their political masters.
In the next post, we will look at the role of non-governmental organisations, such as interest groups and the media.