What determines policy change? And what accounts for the durability of the American welfare state? These two questions, respectively, are the focus of the books under review here.

Derek Epp provides a fresh set of answers to the first of these enduring and important questions of what accounts for changes in policy outcomes. He argues that policy making is more stable than previously found, in part due to systematic forces that allow institutions to process information. Epp argues that issue complexity, organizational capacity, and collective decision making are elements that determine a government’s ability to process information and, by extension, the overall stability of policy outcomes.

First, Epp argues that policy areas have complexity along two dimensions: political and native. He maintains that policies with greater complexity will result in policy makers having to navigate more diverse and mixed informational signals, which in turn generates greater policy instability. Second, institutional capacity—determined by available resources for collecting and deciphering information—relates to stable policy, with greater capacity producing more stability. Third, issues that are decided by collective decision making as opposed to a deliberative process will also be more stable. Epp argues that simple issues, when decided through collective processes by resource-rich institutions, can allocate policy makers’ attention in ways that anticipate and solve problems, thereby reducing oscillations in policy outcomes besetting organizations that are often compelled to react to the political passions of the moment.

Epp turns to analyzing how complexity and institutional capacity affect policy change in the second part of the book. The analysis here is creative and compelling. He uses the number of agencies involved in a policy as a way to capture complexity, with more agencies signaling more complexity. Next, he uses agenda diversity to represent institutional capacity. The evidence for these factors in determining the pace and change of budgets is overwhelming. Epp’s analysis shows that greater complexity produces larger budgetary shifts (his main measurement of policy change) and that greater organizational capacity correlates with more policy stability. He continues his study of institutional capacity at the subnational level and again finds evidence through a cross-sectional analysis that state governments with more professionalism, as a measurement of capacity, produce fewer punctuations and more stability.

The final section begins with an examination of how collective decision making, a process that involves the combination of individual unit decisions into one, affects changes to public policy. Epp employs case studies to show how three types of collective decision-making processes—elections, bill introduction, and public opinion—result in steady policy outputs. He notes that, in the case of public opinion, although the public’s mood efficiently aggregates the electorate’s policy preferences, there is still friction in translating them into policy outcomes. This argument is augmented through a comparison of the public and private sectors that shows no discernible difference in system efficiencies, despite rhetoric about the efficiency of markets. He notes that people may confuse or conflate businesses that have hierarchical organizations (similar to governments) with overall markets.

The argument and analysis are clear, compelling, and accessible for undergraduates and graduate students of public policy. As with any quality piece of scholarship, Epp’s analysis raises a number of interesting questions. How much of the observed stability do we assign to institutions with greater information-processing abilities versus to those having more veto points for disabling new initiatives? Does a policy area experiencing drift show the same as one that is stable as a result of institutional efficiencies? If so, how would we distinguish between stability brought about through informational efficiencies and that achieved by policies that move incrementally as a function of outdated designs? Next, as federal spending has moved from on-budget to off-budget mechanisms, how might the factors analyzed here relate to changes in grants, loans, and tax expenditures as measurements of policy stick and slip? However, these are small issues compared to the larger impact of this scholarship in advancing our understanding of policy change by establishing the conditions under which governments, and their ability to process information, produce greater or lesser policy stability.

The durability of the American social welfare state is the focus of Edward Berkowitz’s Making Social Welfare Policy in America. This coda of a decades-long investigation into social welfare policy is a carefully constructed investigation of Social Security Disability Insurance (SSDI), Medicare, and Aid to Families with Dependent Children (AFDC). Berkowitz stresses the unique, idiosyncratic, and often unforeseen factors at work in determining critical changes to these three important social welfare programs over time. He painstakingly traces the political debates around the origins and development of these programs and shows that significant changes often turned on a knife-edge and were fully grounded in the political environment of the time. Although he does not often explicitly use these terms, this book studies how path dependency and policy feedback influenced the evolution of these three programs in the modern political era.

Berkowitz’s first case study is the Social Security Disability Insurance program, passed in 1956. He documents how unions battled the America Medical Association (AMA) and life insurance groups over the parameters of SSDI. Eisenhower’s secretary of health, education, and welfare (HEW) Marion Folsom was a strong proponent for the expansion of Social Security to the area of disability. He was pressured in part by the newly formed AFL-CIO, which pushed for Social Security expansion as disability insurance was making its way up the policy agenda. Berkowitz argues that Lyndon Johnson and liberals in the Senate outmaneuvered Eisenhower and his congressional allies to ultimately pass the legislation in 1956. Conservatives warned that disability was difficult to define and worried that SSDI enrollment would grow substantially in the future.

The next chapter explores how SSDI indeed grew substantially in both the number of recipients and overall cost to the federal government. Soon after its initial passage, members of Congress worked hard to make sure that their constituents who applied to the program were approved for benefits. The program design bestowed relatively generous cash benefits that were more similar to Social Security than other social welfare programs. The administrative structure of SSDI was built on Social Security and therefore contributed to the program’s expansion with features such as a liberal appeal process. In the late 1970s, media reports of the expansive disability rolls generated negative attention for the program and resulted in congressional hearings. These hearings generated a number of changes such as a family cap and an alteration to the benefit formula. There were reform efforts that pushed the program toward rehabilitation that experienced mixed success. Berkowitz notes the remarkable stability of SSDI even through conservative reform efforts in the 1980s. Efforts to scale back SSDI became more difficult as disability rights became viewed more as a civil rights issue.

The passage of Medicare in 1964 occurred at the end of a fraught battle with physicians, health insurance companies, and hospital administrators pushing against the public demand for national health insurance for the elderly. Nelson Cruikshank (AFL-CIO), legislator Wilbur Mills, and Wilbur Cohen (HEW) were crucial figures in cultivating and negotiating the specifics of Medicare. This group was responsible for creating the Kennedy administration’s proposal. The Johnson administration had to work with these crucial players along with Robert Ball from the Social Security Administration (SSA). Johnson’s Great Society push included negotiations about adding the Medicare program to Social Security. Johnson’s landslide 1964 victory set the table for successfully passing Medicare in 1965 over the objections of the AMA and some conservative legislators. The policy compromises on Medicare included creating a separate trust fund and collection program, delivering benefits through private insurance, and paying a fair cost to doctors and hospitals participating in the program.

Berkowitz chronicles how the policy changes to Medicare went from acquiescing to the medical community to regulating it. Medicare grew quickly, measured both by the number of enrollees and the cost of benefits. The popularity of Medicare facilitated Nixon’s signing of a 1972 law that expanded Medicare to include recipients of SSDI and people with renal disease. These changes established that Medicare could be expanded to nonelderly citizens. The next round of reforms took place in a different and difficult economic environment of higher inflation and lower growth. The Reagan administration picked up where President Carter had failed with hospital cost-retrenchment efforts. Reagan, through multiple bills, was able to change hospital reimbursement rates and add more cost regulations to the program. Yet again, change was difficult, small, and infrequent to this cornerstone of the American welfare state.

Berkowitz argues that welfare experienced the most dramatic changes of the three programs, but still retained many of its fundamental features. He finds that “welfare to work” did not begin with the 1996 reforms; instead, both Democrats and Republicans pushed shifting the focus of the program from cash assistance to promoting work throughout the 1960s and 1970s. Welfare’s lack of popularity resulted in constant alterations being made to the program from its inception. The early days of lighter welfare rolls were dominated by older recipients, and it was a more popular program than Social Security. Over time the program became associated with single mothers (often women of color) and lost popularity. Welfare was placed under the same bureaucracy as Social Security and expanded in tandem with it in 1950. However, in the 1950s the roles of AFDC grew as widowed recipients were replaced by single mothers in cities. The National Governors Association became a critical player in welfare reform starting in the 1980s. Clinton’s unorganized governing style and policy agenda gave Newt Gingrich and congressional Republicans the upper hand in negotiating the issues in the final 1996 welfare reform bill.

A recurring theme of Berkowitz’s book, familiar to political scientists, is the resiliency of social welfare programs when faced with political reform efforts. He shows that a combination of persistence from critically positioned political actors and luck is needed to change the trajectory of policy. Berkowitz notes that when changes did occur, they were often opaque to the recipient and targeted at the institutions charged with implementing the public program. This work shows how submerged even major public benefits are to the public. Berkowitz also highlights the strong role that the rhetoric of “deservingness” played in the development of these policies. Berkowitz argues that SSDI passed narrowly due to agreements that tightened the definition of disability. The principle of only giving benefits to people who deserve it also animated the passage of Medicare funding through a trust fund and the bipartisan agreement that welfare reform had to promote work and be time limited.

These two books from different levels of analysis demonstrate the structure and serendipity involved in policy changes. Both are highly recommended.