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AAHPN  August 2009

AAHPN August 2009

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Subject:

Re: Spotlight

From:

Adam Oliver <[log in to unmask]>

Reply-To:

[log in to unmask]

Date:

Mon, 17 Aug 2009 19:27:20 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (93 lines)

Seems to me, David, that path dependency is more like "no damn thing after another".
Or, alternatively, "Let's use 1,000 words to state the obvious when 10 will do".
 
Actually, I do think there are one or two good texts on path dependency (although, of course, I've not read them all..) The others I've read are verbal gymnastics (which often forget to clearly define what they mean by an 'institution').
 
Path dependency can of course explain everything. Except all the things it can't (which are all the things that 'fit' the theory, but may not in fact be explained by it, and also those things that might not fit the theory - Canadian Medicare? Social insurance in the early 20th century? Public health legislation in the late 19th century?).
 
But then, I guess all these "rare moments of perfect storm, where previously accreted institutions and their paths are left behind, as a prior equilibrium becomes punctuated, and volitional will...." [oxygen please!? I'm losing my volitional will to live....]
 

________________________________

From: Anglo-American Health Policy Network on behalf of David Wilsford
Sent: Mon 8/17/2009 7:03 PM
To: [log in to unmask]
Subject: Re: Spotlight


Dear Adam and friends

In spite of my even greater pessimism than Joe White's on the prospects for non-incremental health policy reform under Obama in the US, Adam, your view of path dependency theory (see below) is a caricature - "just one damn thing after another," therefore it explains everything and thus explains nothing - and it's the caricature that is analytically and theoretically useless.

Here's why:

Path dependency, explains well the continuity of policy across time, and in particular, the pervasive presence of incremental policy movement, as opposed to non-incremental big policy change - which many countries, but especially the US seem to find hard to accomplish, even when policy elites agree that things are just downright yukky. So, path dependency also explains well the persistence of manifest suboptimality in a given system.

But even a path-dependent universe is full of quasi-autonomous decision agents, with their multitudes of actions and reactions unfolding and cascading over time.

This is where, against the backdrop of a seemingly static dependent path, volitional will ("choice") comes to the fore in certain well-defined ways: 

At the micro level, volitional will characterizes the choice exercised by decision agents when assessing an imperfect landscape and the sometimes cryptic reactions and actions of other decision agents around, these latter often contributing little better than a cacophony of Surround Sound(tm) noise. At the macro level, volitional will characterizes the choice that unfolds, especially but not exclusively in larger aggregates, at moments of large conjuncture. It thereby plays the primary role in determining the content and direction of new big movement through the exceptional window of opportunity, in the absence, by definition, of accreted structures, that is, the previous institutions of neo-institutionalism and the prior path of path dependency.

These decisions of volitional will - choice - are not made in a cognitive vacuum, but, as in rational choice, represent decision agents' best assessment of utility  maximization, given an environment of deeply and acutely scrambled variables and highly imperfect information - not to mention many contingencies.

It is through these interaction effects - the dynamic interaction of the structures of a dependent path (that change with glacial slowness) with the decisions and choices of hosts of interacting decision agents (which  change, in a flash, all the time) - that we can analytically square the circle, so that it does not "explain everything, therefore explain nothing":

Path dependency interacts with volitional will at the level of the decision agent and leads to incremental movement within prevailing structures and along the established path in long phases of static equilibrium.   

But also, in - sensitive dependence on initial conditions: There are we at the moment of creation, the initial conditions upon which the future henceforth is sensitively dependent.  (Obamacare:  Which way will it go, in the end, if it goes anywhere at all?)

The logic of change in the policy universe is therefore the logic of a complex adaptive system that alternates between the relatively static and the suddenly dynamic. In the first, the ongoing policy equilibrium, a relatively stable policy life proceeds more or less directly and with reasonable stability - and with many measures of nonlinearity - along an established policy path.  This established path defines the realistic solution sets on the landscape. In the second, a previous policy equilibrium is punctuated and replaced with a new one, where whole new solution sets become possible ("let's nationalize the banks!). Agency, or volitional will, plays a micro-level role in the first and a macro-level role in the second.

All this, Adam, is why your caricature of path dependency below is misplaced.
Yours
David  




On 8/17/09 5:53 PM, "Oliver,AJ" <[log in to unmask]> wrote:

> Looks like that's it then. At least now, perhaps people won't blame Mrs C so 
> much for not managing to pass major reform in the 1990s. I guess there are 
> some who will say that this can all be explained by path dependency theory. 
> The trouble is, path dependency theory is so badly and broadly defined, that 
> it can explain everything, and is thus, it seems to me, pretty useless.
>  
>  
> SPOTLIGHT: SAYONARA, PUBLIC PLAN?
> The Obama administration over the weekend indicated that it would be willing 
> to accept health reform legislation that does not include a public plan 
> option. In an interview on CNN, HHS Secretary Kathleen Sebelius on Sunday said 
> that the public option was "not the essential element" for reform. She also 
> said that not-for-profit health cooperatives were being developed by the 
> Senate Finance Committee as an alternative to a public option. During a 
> town-hall meeting on Saturday in Grand Junction, Colo., President Obama said 
> that a public option "is not the entirety of health care reform," but rather 
> "just one sliver of it, one aspect of it." Sen. Kent Conrad (D-N.D.) said on 
> "Fox News Sunday" that "the fact of the matter is there are not the votes in 
> the U.S. Senate for the public option, there never have been. So to continue 
> to chase that rabbit is, I think, a wasted effort." An unnamed Democrat close 
> to the administration will continue to attempt to persuade lawmakers of the 
> value of a public plan. 
> 
> Please access the attached hyperlink for an important electronic 
> communications disclaimer: 
> http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm
> 

-- 
David Wilsford Ph D
Professor of Political Science, George Mason University (Fairfax Virginia USA) and
Visiting Fellow, London School of Economics (UK)

[log in to unmask]
French cell  +33.6.11.16.50.93
U.S. cell  +1.224.522.0111




Please access the attached hyperlink for an important electronic communications disclaimer: http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm

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