| In this dissertation, I argue that business preferences for national health care reform change over the course of the policymaking process and are affected by ideological, political, institutional, and economic factors. My case study is Clinton's Health Security Act. I show that ideological factors are an especially important, yet an often overlooked, source of policy obstructionism. This is particularly true when the economic incentives to support or oppose reform are not strong. This analysis challenges the conventional wisdom that business preferences are guided solely by economic calculations.; The study uses the method of process tracing. I trace business preferences throughout the course of the three stages (issue emergence, executive, and legislative) of the policymaking process for Clinton's Health Security Act. I conducted over thirty open-ended interviews with business leaders, lobbyists, congressional staffers, Senator David Durenberger, members of the Clinton administration, and members of the health care task force. Press releases, statements at hearings, and congressional testimony by the Business Roundtable were also examined in addition to secondary sources such as texts, journals, some economic studies, and major newspapers.; My findings include some significant contributions to the literature about business preference formation. Ideological concerns were responsible for 24% of the observed business preferences. Ideological concerns explained the preferences of two very important business organizations: the Business Roundtable and the National Association of Manufacturers.; Ideological factors are important because they permeate economic calculations of the "bottom line" as well as political calculations to be on the 'winning side'. More ideologically motivated actors tend to add extra costs that they perceive will come from "inefficient and wasteful" government bureaucracies. I show that this more subtle form of ideological pressure influenced several CEO's and the National Federation of Independent Businesses.; Additionally, I argue that the Business Roundtable's inaction and the NAM's opposition during the Clinton health reform episode, despite potential economic gains, is an exercise of power. These findings provide insight for those who want to enact national health insurance. |
