Among the many issues in the national health care debate is the role of the states. Some have asked whether the states can tackle health care on their own and have answered with a resounding “no.” Deborah Stone (1992), for example, argues that health care is too big a challenge for the states to handle: they lack sufficient autonomy from the federal government in certain areas and sufficient power over private interests in others.

But apparently, states are undeterred by such thinking. In the early 1990s, three states—Minnesota, Washington, and Florida—passed comprehensive bills incorporating elements of managed competition. Massachusetts, Oregon, and Vermont had already enacted (but not implemented) major reforms based upon different philosophies. And Hawaii led the way in 1974 with its enactment of an employer mandate.

Today, reform activity is everywhere. In 1993, 1,850 health care reform proposals were introduced in state legislatures; this year virtually every governor is working on some health care initiative. Even Lowell Weicker, Jr., governor of Connecticut, home to the nation's largest insurance companies, has announced his intention to provide universal coverage by 1997. The states are definitely not waiting around to see what the feds will do.

In the fall of 1993 President Boris Yeltsin dissolved the Russian legislature and called for elections to a new assembly in the hope of getting a more pro-reform parliament. That parliament in turn would consolidate his position in the struggle with the republics and regions over the issues of autonomy and the distribution of power between Moscow and the provinces. Instead, the December 1993 elections to the State Duma, the lower house of the Russian legislature, were a clear defeat for both him and the pro-reform forces.

Much attention has been devoted to considering the extent of the defeat and its implications. Particular focus has been placed on ultra-nationalist Vladimir Zhirinovsky's strong showing. Despite the electoral gains registered by Zhirinovsky and his party, the organizational activity of the Duma since the elections strongly argues that it was the communists and not he who won the contest for the lower house. Even so, focusing on the State Duma is as misplaced as focusing on Zhirinovsky if one is to fully appraise the results and likely fallout from the December elections. Having virtually swept the races to seats in the new upper house (the Federation Council), provincial elites are once again in a position to press Yeltsin on the issue of regional autonomy. Hence, Yeltsin is faced with much the same situation as before the decision to assault the Russian parliament building, the White House.

Abundant evidence has been produced to demonstrate substantial empirical relationships between public opinion (in the sense of survey-measured collective policy preferences) and public policy in the United States and elsewhere. Policy outputs—what governments do—tend to correspond fairly closely with what surveys say their citizens want them to do. In my view, however, a number of important research questions remain largely open. Answers to some of them are crucial to deciding what, if anything, opinion-policy congruence has to do with democratic theory.

Open Questions

1. How much impact does public opinion actually have on policy making? In particular, how much of the observed relationship is causal rather than spurious, and how much causal impact proceeds from opinion to policy rather than the reverse? If public opinion simply tends to swing into line behind whatever policies decision makers come up with, or if some third force drives both opinion and policy, the implications for democratic theory are rather different from what they would be if public opinion exerted a powerful influence on government action.

2. Under what circumstances is this impact larger or smaller? What kinds of political systems are most responsive to their citizens? How much difference do free elections make? High levels of economic development, education, and communications? Vigorous party competition? Parliamentary versus presidential systems? Federalism?

In a world where citizens desire to have their preferences reflected in public policy and, for instrumental reasons, policy makers share that desire, the linkage of opinion to policy still faces formidable problems. Chief among these is this: policy making is highly specific, detailed, and informed, while mass electorates choose not to attend closely enough to politics and policy to have preferences that are similarly specific, detailed, and informed. We now believe that many citizens have meaningful preferences over the general contours of government activity. At the level of whether “government should do more to …” deal with any number of problems, we now see individual citizen preferences in a somewhat more favorable light than we once did. More important, we now view change in aggregate preferences over time as expressive of real beliefs and values about public choices.

But this is not enough. Policy makers face no choices as simple as “do more” or “do less.” They deal at a wholly different level. They deal at a level of specificity where public attitudes are only infrequently measured, and for good reason; mass publics in the main do not have (real) attitudes over details they cannot reasonably be expected to attend to. And yet each of those choices, complicated and specific though they are, will reflect some measure of movement at the more general level where citizen preferences are engaged. The daily choices of the C-SPAN world are obscure and arcane to typical citizens. And yet the actors in that world feel bound by citizen preferences.

Americans have been debating national health insurance throughout the twentieth century. The content of this elusive reform has evolved far more than the tone of the debate. When Theodore Roosevelt championed health care reform (during the 1912 presidential campaign) he wanted to build a hardy stock of Anglo Saxons—health insurance would help deliver white America from race suicide (Dyer 1980; Ross 1913, 299–304). More than thirty years later, President Truman made health insurance the major domestic issue of his presidential campaign; his goal was an extension of the New Deal social welfare state (Starr 1982). Today, the reform that was once condemned as too costly is widely prescribed as cost control.

While the reform itself has changed, the debate that surrounds it remains entirely predictable. Theda Skocpol describes the contestants: On one side, self-confident, neo-Progressive experts touting rationalizing schemes. On the other, conservative critics deploying “ideological, emotionally charged arguments” (Skocpol 1994). The shrill rhetoric of opposition has alternately bemused and baffled observers. Compulsory insurance was “a dangerous device … announced by the German emperor” (in 1918), a force representing “social theory … socialism, even communism” (in 1932), “the keystone to the arch of socialism” and “a threat to every area of freedom as we have known it (by the 1960s).

In November 1993, 100 years after becoming the first nation to enfranchise women, New Zealand again made electoral reform history as its citizens voted by a 54–46 margin to replace their venerable, U.S.-style first-past-the-post (FPP) method of electing legislators with a new mixed-member proportional (MMP) system. Political scientists in the United States and elsewhere may find New Zealand's decision instructive in six ways:

• as a harbinger of a wider movement toward electoral reform in established democracies and of a global trend toward mixed-member legislatures;

• as a demonstration of how constitutional reform can overcome entrenched interests;

• as a symptom of political backlash against the imposition of orthodox economic policies of the sort advocated by the IMF and other international agencies;

• as a partial repudiation of the Westminster model that U.S. reformers have often taken as their ideal;

• as the source of a new method of ensuring fair and effective representation for a minority ethnic group; and

• as an example of how political scientists can play influential roles as institutional designers and public educators.

Scholars who study the connections between public opinion and the policy process, and politicians who engage in making those connections, face the same two problems. First, determining what opinion the public actually holds is much more of an interpretive than a methodological exercise. Second, designing policies to respond to that (presumed) opinion is at best an inexact art and at worst a demonstration that making the wrong moves can produce more harm than good. This essay illustrates these points by examining race politics in America over the past three decades.

In order to move quickly to those illustrations, let me stipulate, with minimal evidence, several starting points. First, middle-class African Americans are better off now than middle-class members of their race have ever been; well-off African Americans are getting richer at a faster rate than well-off white Americans (though from a lower absolute starting point); and middle-class African Americans are gaining ground at the same time that poor African Americans are losing it.

Those points require much evidence to be completely persuasive, but they are all illustrated by a simple comparison of income quantiles by race over time (see Table 1).

Just as sportsmanship is essential for competitive sports, statesmanship is necessary for competitive democracy. This obvious assertion, which I followed with a distinction between primary and secondary democracy, was greeted with some misunderstanding when it was presented at a 1993 American Political Science Association workshop on democratization headed by Gabriel Almond. Because this distinction appears to be controversial, let me defend it here as a way to overcome some of the quandaries found in the literature on democracy; to link democracy to development; and to suggest more fruitful approaches to encouraging democracy than elections.

Professor Almond's response to my primary/secondary democracy distinction was to point out that those participating in his workshop had used a definition of democracy presented by Dahl (1971) in his book on polyarchy, emphasizing two dimensions: widespread participation and contestation (including competition and conflict). This seems to me a one-sided definition (focusing almost exclusively on what I call “primary democracy”), leaving out the aspects emerging from secondary democracy: a mutual respect among competing groups and between leaders and followers and consensus on governmental goals and procedures.

Without secondary democracy, primary democracy tends to be meaningless, much like an Olympics without the necessary conditions for sporting events and rules for participating, competing, and officiating. Another way of making the distinction here presented would be the “two ideals of democracy” suggested by Mansbridge (1991, 7): “one based on conflict, the other on commonality.”

In the September 1993 pages of this journal, I asked whether senators can illuminate the political and legal beliefs of Supreme Court nominees by questioning them at confirmation hearings (Comiskey 1993). Many observers of the confirmation process believe that a nominee's testimony can produce insights into the nominee's views that go beyond what is available from the nominee's public record. While such testimony has often proved barren in the past, these observers often express the view that better questioning of nominees can bring forth greater insights in the future (Carter 1988; Melone 1991; Rees 1983; Ross 1987). By contrast, I concluded that the political context in which Supreme Court nominations occur, the motives of participants in the confirmation process, and the incentives facing these participants will likely continue to inhibit illuminating testimony by nominees.

Since my previous paper was written before last summer's hearings on the nomination of Ruth Bader Ginsburg, this article examines those hearings. In some respects, her testimony resembled that of most recent nominees. In at least one respect—her candor on abortion—her testimony was a major departure from that of all recent nominees with the partial exception of Robert Bork.

The growing strength of the pro-life movement in the 1980s and the escalating violence of parts of the movement in the 1990s have led many commentators to question the value of the Supreme Court's decision in Roe v. Wade. Had the Supreme Court not lifted first trimester restrictions on abortion in its 1973 decision in Roe, so the argument runs, the states would have gradually enacted laws to change their restrictive abortion laws anyway, thus avoiding the agonizing national controversy that ensued.

One of the most prominent supporters of this position was Ruth Bader Ginsburg. During her confirmation hearings to the Supreme Court last summer, her views about the Roe decision re-entered the public arena. In the course of the hearings she asserted that like the guarantees of individual autonomy found in several Amendments, the right to an abortion should also be grounded in the equal protection provisions of the Constitution, thereby linking women's equality with the ability to control their reproductive function.

The answer to the question we pose in the title is by no means obvious. That it might be affirmative is suggested by the facts that Ross Perot:

• ran ahead of the major-party presidential candidates in several presidential preference polls at the height of his popularity in June 1992; and

• on election day in November received a higher proportion of the popular vote (19.0%) than any third-party candidate since Theodore Roosevelt in 1912 (27.4%), who came in second to Woodrow Wilson that year.

More significant than Perot's relatively large percentage, however, is that he appealed to many Republicans because of his conservative economic policies, especially with respect to reducing the budget deficit, and to many Democrats because of his liberal social views on issues like abortion.

It is precisely this kind of wide-ranging appeal that favors candidates under approval voting (AV), whereby voters can vote for as many candidates as they like or consider acceptable in a multicandi-date election. (In a three-candidate race like the 1992 presidential election, this means voting either for one's top or one's top two choices.) Yet despite extensive research on AV (Brams and Fishburn 1983), comparisons of it that have been made with other voting systems (Nurmi 1987; Merrill 1988), and empirical studies of its actual use (reviewed in Brams and Fishburn 1992), it is no easy task to establish how candidates would fare under AV in a specific election.