Title: National agenda setting and health care reform
Description: The national agenda--the subset of issues which national public opinion and policymakers regard as the country's political priorities at the moment--changes over time and reflects a complex interaction between the public and political leaders, each influencing and responding to the other. For an issue to resonate on the national agenda, at least in matters of domestic affairs, public concern about objective conditions may serve as a condition of constraint and potential receptivity. To explore the dynamics of national agenda setting, I focus on the issue of national health care reform during the 1980s and 1990s--an issue that rose to the national agenda suddenly and dominated national politics for three years after a long period of quiescence during the previous decade. A number of studies have examined the politics of health care reform, but none systematically address the process by which health care reform emerged as a national priority in the first place. I explain how public concern about objective real-world conditions provided an important foundation for the issue's rise to the national agenda but itself was insufficient during the decade preceding the issue's rise.

Public concern about health care problems, which were understood mainly as personal, not political problems, existed well before the issue's sudden rise in 1991. Rather than educating the public through Downsian "alarmed discovery" of new information about health care problems, political leaders channeled the public's existing concern about objective conditions and persuaded the public to attach new, distinctly political relevance to information it already possessed. Leadership built upon existing objective public concern about objective conditions, rather than building up public concern in any significant way. Leadership transformed the political character of health care by spurring the public to consider their personal experiences with health care, particularly their negative experiences, as politically relevant without changing its opinion about underlying conditions.