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Presidential Leadership in Political Time Introduction Durham E-Theses Presidents, Prime Ministers and Health Care Reform in Political Time: Using Stephen Skowronek's Institutional Theory to Compare Leadership Behaviour in Britain and the United States FLYNN-PIERCY, HOLLY How to cite: FLYNN-PIERCY, HOLLY (2018) Presidents, Prime Ministers and Health Care Reform in Political Time: Using Stephen Skowronek's Institutional Theory to Compare Leadership Behaviour in Britain and the United States, Durham theses, Durham University. Available at Durham E-Theses Online: http://etheses.dur.ac.uk/12495/ Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in Durham E-Theses • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full Durham E-Theses policy for further details. Academic Support Oce, Durham University, University Oce, Old Elvet, Durham DH1 3HP e-mail: [email protected] Tel: +44 0191 334 6107 http://etheses.dur.ac.uk 2 PRESIDENTS, PRIME MINISTERS AND HEALTH CARE REFORM IN POLITICAL TIME Using Stephen Skowronek’s Institutional Theory to Compare Leadership Behaviour in Britain and the United States Holly Flynn-Piercy A thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy 2017 SCHOOL OF GOVERNMENT AND INTERNATIONAL AFFAIRS DURHAM UNIVERSITY Abstract Despite the vast scholarship on presidential leadership, scholars continue to grapple with the issue of the power and authority of the president. Each new president invites a plethora of analysis, discussion and debate, each time reigniting this question. Rarely however, do scholars evaluate more than a single president; rarely do they compare their power, their circumstances, their personalities. It is for this reason that Stephen Skowronek’s theory of presidential leadership is so notable. Indeed, Skowronek’s theory, first articulated in The Politics Presidents Make (1993) and then revised and expanded in Presidential Leadership in Political Time (2008; 2011), fundamentally changed the way scholars and others interpret the American presidency and its development over time. While his theory was also an attempt to answer the perennial question of power and authority, it went much further in its attempt to develop a generalisable theory of leadership that could be applied to all presidents. With Skowronek’s original contribution in mind, this thesis takes his theory and tests its utility in a comparative context. The thesis is driven by three questions: (i) is the theory applicable to Britain – can it effectively explain recent British political leadership? (ii) can an American Political Development (APD) approach be successfully utilised in a comparative context? and (iii) does a mechanism to further specify the expected leadership behaviour of presidents and prime ministers increase the effectiveness of Skowronek’s theory when applied to an empirical context? The thesis addresses these questions using health care reform as a case study to determine the extent to which leaders’ behaviour is institutionally constrained and the impact on their policy-making decisions and outcomes. The main contention of this project is that Skowronek’s theory can be successfully applied to explain the leadership behaviour of British prime ministers, with a comparison based on shared leadership categorisations and macro-level structural similarities. The thesis maintains that Skowronek underestimates the importance of, and neglects to include mechanisms in his model that accurately consider the role of agency, specifically the agency a leader has when confronting constraints. Leadership is inherently more subjective and agency-driven than the theory recognises. The thesis offers a mechanism to join structure and agency more effectively, arguing that it is this that increases the potential of applying Skowronek’s theory successfully. This thesis not only further breaks down the barriers preventing comparisons of (same-country) leaders over time, but also offers a precedent for comparison of leaders across countries. Ultimately, it is hoped that scholars will explicitly recognise that more can be gained from studying leaders in a comparative context at the same time as acquiring a better understanding of power and leadership, whether its historical patterns or its contemporary challenges. 1 Declaration No material for this thesis has been previously submitted for a degree at this or any other University. The work is solely that of the author, Holly Flynn-Piercy, under the supervision of Professor John Dumbrell and Dr Steve Welch. Material from the published or unpublished work of others which is used in the thesis is credited to the author in question in the text. Statement of copyright The copyright for this thesis rests with the author. No quotation from it should be published without the prior written consent and information derived from it should be acknowledged. 2 Acknowledgements Life is a journey, not a destination; or so said my uncle when I visited him in Salt Lake City a few years ago. Looking back that is very much how I feel about my PhD. The experience has, at different times, been enriching, infuriating, challenging and rewarding, but above all it has been a shared journey. The things I have learnt over the course of my PhD – about my topic, myself, my family and friends are, in essence, much more important than the finished thesis. Each person that has supported me through this process has contributed something unique and deserves my unreserved thanks and gratitude. The journey would not have been possible, nor would I have reached the destination without them. My parents have always been my biggest source of love and support. Everything I have achieved is in part because of them. They have helped me to reach my potential; their belief in me has never diminished and it is for this that I am most thankful. So as the culmination of my academic journey, I hope my PhD in some small way helps them to know how deeply grateful I am for all the opportunities they have given me, for all the support, financial and emotional, for all the telephone calls and visits, for all the listening and advice, for all the investment and care, and so much more. Over the course of my three years in Durham, I especially looked forward to my Mum’s visits to Newcastle and our evenings at the theatre, laughing together makes everything better. Equally, my trip to the Sunderland-Arsenal game with my Dad was another particular highlight, made all the more enjoyable because of a 0-2 win. These things provided a welcome break and made the demands of my PhD seem more manageable. They are another reason I am thankful to my parents, because they helped me to relax and reminded me of the important things and the important people in my life at a time when it was all too easy to get lost in the books. Alongside my parents, my fiancé, Gunnar, has been my rock, sharing the ups and downs, the joys and the difficulties, giving me confidence when I couldn’t see the end. Most of all though, I want to thank him for just being there, each day, to listen, to reassure, to help and to hug me, without him my PhD would be so much less; my life would be so much less. Of course the pressures of thesis writing could not be overcome without welcome distractions, and for this I must thank my sisters, Sophie and Daisy, and my grandparents. They have offered unconditional support throughout, even if they didn’t always realise it. My frequent trips to Outwood, watching rugby, playing cards, shopping and eating lots and lots of pasta, have always 3 put a smile on my face, even after the most challenging of days. I will be forever grateful to my Grandad for his constant care and support, and I am truly sorry that my Grandma is no longer here to see the end of my journey. To my supervisor, Dr Stephen Welch, whose support and guidance, especially over the past six months gave me renewed confidence in my thesis and belief that I would overcome the difficulties I faced in the final months. He constantly challenged me to think differently, questioned my opinions and inspired me to aim higher. I thank him for seeing me through to the end of the process and for his patience and understanding throughout. To my supervisor, Professor John Dumbrell, for his insights, his questions and comments that kept me focused and committed to my project. Away from Durham I received considerable support from Dr Jon Herbert at Keele University and Dr Alex Waddan at University of Leicester. Beginning with conversations at the American Politics Group Conference in Oxford, Jon gave his time generously, and was always willing to share his knowledge and expertise, no matter how complicated or time-consuming my question. He was constantly supportive and I could not have gained understanding and conviction in my theory without his guidance. Alex provided helpful comments on initial drafts of my case study chapters, which helped me to develop and strengthen them. I would like to thank them both for all they did to help me improve my project, it is considerably better because of their contribution. To my closest friends, Ravza and Merve, for welcoming me into their homes and their lives, and for showing me the true meaning of friendship. I cannot think back on my experience of Durham without remembering them and all the cups of tea, Turkish food and heart-warming conversations we shared.
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