Evaluating the role of bricolage in US Health Care policy reform

Abstract

<jats:p>Understanding of the role of ideas in non-paradigmatic policy change has been advanced by the introduction of the concept of bricolage, which suggests that reformers are likely to piece together ideas from disparate sources. However, the current literature is limited in several ways. As such, this article proposes three main contributions to the field. First, the use of bricolage as a pragmatic strategy is perfectly compatible with actors being motivated by relatively fixed policy goals or seeking to imitate policies from elsewhere. Second, the creative use of ideas can be limited by the imposition of narrow frames or problem definitions by the victors of agenda-setting battles. Third, the use of bricolage comes with more potential for conflict and unintended consequences than has been recognised. This argument is illustrated through an analysis of healthcare reform in the United States in 2009/10, focusing particularly on the fate of the ‘public option’.</jats:p>

Why we need bricoleurs to foster robust governance solutions in turbulent times

“…Despite its creative and pragmatic nature and focus on emerging solutions, the bricolage process is not without constraints. These include the physical limitations of the objects put to use; the particular history of how each element has been applied beforehand; the conservative inclination of bricoleurs to continually (re)order rather than transgress their universe and to reuse existing resources rather than finding new ones; the institutional capacity afforded to some actors at the expense of others to impose certain definitions of problems and agendas; and how such power disparities play into upholding the dominance of certain interpretive practices (Duymedjian & Rüling, 2010; Hannah, 2020; Levi‐Strauss, 1966; Perkmann & Spicer, 2014; Wilder & Howlett, 2014). Returning to the above mentioned relative success of Danish policymakers' management of the financial crisis, the bricolage devised was certainly also saturated with power.…”

“…The pragmatism of the bricoleur engaged in robust governance also displays itself in a willingness to push through decisions that may not be preferred by all actors but are promising and carry sufficient coalitional support to be implementable. In other words, bricolage in no way precludes power; to the contrary, building coalitions and strategically presenting the bricolage in the most persuasive terms available (potentially even making the process look more rational than it was, see Boxenbaum & Rouleau, 2011) is often key to maintaining the agility of governance institutions and producing robust solutions to turbulent problems (Carstensen, 2011; Hannah, 2020; Koppenjan & de Jong, 2018).…”

Explaining societal change through bricolage: Transformations in regimes of water governance

“…We thus weave into our analysis insights from science and technology studies showing how technologies are developed, adapted and widely diffused through bricolage (Ciborra, 1996; Garud and Karnoe, 2003; Naouri et al, 2020). Additionally, given our emphasis on state–society co-production, we draw from policy studies and political sociology literature concerned with how state actors also engage in bricolage and to what effect (Allain & Madariaga, 2019; Carstensen 2011; Hannah, 2020).…”

“…Power works invisibly through such processes to shape subjects and make certain arrangements seem like the right way of doing things (Svarstad et al, 2018; Whaley, 2018). Political scientists also distinguish between political ideas that are deliberately manipulated in the foreground of political debates (strategic bricolage) from those underlying assumptions and core beliefs that invisibly shape less conscious processes of bricolage, in the background (Campbell and Pedersen, 2014; Hannah, 2020).…”

Ideas and crisis in policy and administration: Existing links and research frontiers

“…This finding is broadly in line with Schmidt and Thatcher's (2013) argument regarding neoliberalism's capacity for shape‐shifting in response to challenges, as well as observations made by scholars of the welfare state, who have observed the use of markets and privatization by both left and right parties in the wake of a general perception of crisis in mature welfare systems (Gingrich, 2011; Hannah, 2018). Evidence casting doubt on whether coherent and stable paradigms exist in some policy areas has led to descriptions of various more gradual mechanisms of ideational change, such as through layering (Kay, 2007), conversion (Chwieroth & Walter, this issue), and bricolage (Carstensen, 2011; Hannah, 2020)—each involving the recombination of ideas, instruments, and policy goals.…”