The Politics of Policy Change by Daniel Béland and Alex Waddan is a concise and accessible analysis of three major episodes in contemporary welfare policymaking: the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PROWRA), the 2003 Medicare Modernization Act of 2003, and President George W. Bush’s failed campaign to introduce private accounts into the Social Security System. Written for scholars and policymakers, the text provides a useful and much needed overview of recent developments in American welfare, health, and retirement policy.

Much of the text is a synthesis of existing scholarly literature on the US welfare state. Scholars will no doubt find the 32 pages of references invaluable. The text’s major theoretical contribution is an integrated analytical framework that uses the “interaction among actors, ideas and institutions” to explain policy change—or lack thereof—over time (p. 13). Ideas play a key role in this framework. Whereas others have focused on institutions or material and environmental conditions to explain the shape and timing of policy change, Wadden and Béland focus on how ideas shape policies and enable or undermine policy change. This focus returns not only ideas, but also political actors, to the center of policy analysis. Paying attention to ideational factors allows scholars and policymakers hope to understand why “concrete actors . . . introduce or oppose change in the first place.” Only with this understanding can we hope to “explain the direction of policy change” (p. 175).

Béland and Waddan understand that ideas must be understood in relationship to other “potential causal factors,” including policy institutions and issue ownership (p. 7). Although “ideational shifts [do not] always result in concrete policy change, ” paying “close attention to the ideas of political actors helps to explain both continuity and change” (p. 8). To discover these ideas the authors have relied largely on published sources including policy documents, media reports and political speeches. Interviews with more than three dozen policy makers, including think tank members, congressional aides, and policy advocates, shed light on the “less public strategic ideas” that inform policy decisions (p. 19).

The Politics of Policy Change focuses on three distinct policy arenas—welfare, health insurance for the aged, and retirement security. By surveying policy change in these three areas, Béland and Waddan directly challenge a narrative of inevitable welfare state retrenchment. Two of the policies under discussion—Medicare and Social Security—have expanded in the last two decades. Conservative ideas with regard to Medicare reform have succeeded only “under the public radar” (p. 107). Efforts to convince voters that “personal savings accounts are superior to social insurance programs like Social Security” failed spectacularly in the first decade of the 21st century (p. 146). Retrenchment does not describe the dynamics of contemporary American social policy. Rather, as Béland and Waddan point out, the “last thirty years have witnessed a combination of changes reflecting not only retrenchment but also other changes that favor an expansion or a redefinition of state action” (p. 5).

By focusing on three programs, Béland and Waddan also promise to illustrate the importance of ideas across the board. The examples are well chosen. Not only do “welfare,” Medicare, and Social Security play an important role in the “everyday lives of many millions of Americans,” (p. 2) the programs have distinct histories, political reputations, and constituencies. Whereas Medicare and Social Security are well-respected entitlements with politically powerful beneficiaries, welfare has long been unpopular and its recipient pool of poor unwed mothers and children all but powerless.

Moreover, the programs’ trajectory over the last two decades could not be more different. The 1996 PRWORA ended “welfare as we knew it” by transforming Aid to Families with Dependent Children (AFDC) from a federal entitlement to a time-limited and work-tested state block program known as Temporary Assistance to Needy Families (TANF). This kind of “path departing” policy reform is a far cry from the more incremental changes made to the Medicare Program—changes that include the addition of an unpaid-for prescription drug benefit as well as provisions to expand “health savings accounts”—much less the stasis in Social Security. If Béland and Waddan’s “integrated institutional” model can demonstrate that ideas matter in all three of these policy arenas, they will, indeed, have gone a long way toward understanding the “nature and sources of policy change” (pp. 2–3).

The case is stronger for Social Security and welfare than it is for Medicare. Certainly, President Bush’s ill-fated attempt to partially privatize Social Security makes little sense without taking conservative ideology seriously. Indeed, privatization was popular almost only among conservative intellectuals and policy entrepreneurs who had long seen Social Security as the worst—because the most popular—example of New Deal collectivism run amok. In this case, ideas help to explain how a policy got on the public agenda despite significant electoral risks; the unpopularity of those ideas also helps to explain why change did not happen.

Béland and Waddan also make a strong case for the importance of ideas in producing the landmark welfare reform bill in 1996. Specifically, they argue that fundamental welfare reform became possible only when the “debate about welfare recipients focused on their dependency rather than their poverty” (p. 46). But this shift predates the “right turn” of the 1980s. While it is true that popular conservatives like Charles Murray and George Gilder did focus on the relationship between welfare and dependency, this relationship had long been central to liberal welfare politics and policymaking. By the 1950s, liberal welfare experts were committed to preventing dependency by providing recipients with an array of job-related and other “rehabilitative” services. The bipartisan flirtation with a guaranteed annual income in the 1970s only broke temporarily with this longer tradition.

While ideas about welfare and dependency did not change dramatically over this period, the policy responses that flowed out of those ideas did, thanks to both changed economic conditions and electoral calculation. Welfare reform thus demonstrates the need to use an “integrated” framework to understand policy change. Ideas alone do not explain the nature and timing of the 1996 reform. Rather, as Béland and Waddan conclude, it is the “nature of welfare policy legacies, the transformation of welfare as a partisan issue, and the growing weight of conservative ideas” that set the stage for reform (p. 68).

Béland and Waddan’s case is least persuasive with regard to Medicare. The addition of an expensive drug benefit for seniors by a Republican president and a Republican Congress cannot be explained except in terms of simple electoral calculation. President Bush and the GOP wished to rob the Democratic Party of a potent political issue going into an election year. The argument that conservative, pro-market features, hidden within the larger bill embody conservative ideas and help to explain conservative votes for the program is ultimately unconvincing.

The Politics of Policy Change is a lively and readable synthesis of much of the vast social scientific and historical literature on the contemporary American welfare state. It is also an invaluable primer on recent developments in Medicare, welfare, and pension policy. Although the authors claim a little too much for their “integrated ideational and institutional framework;” the text is nevertheless a crucial resource for policymakers and scholars seeking to understand the sources of change and stasis in American social policy.