For many students of contemporary Arab politics, the most pressing question is whether Islam will become democratic. One need only point to the case of Algeria to find ready evidence that Islamic movements have already become highly democratic, although frustrated in their electoral objective. Leonard Binder (1989), however, asks a far more pressing question: Will Islam become liberal?

As Tocqueville shows, democracy or the love of equality comes easily to citizens of modernity. The love of liberty, however, is a far more difficult love to cultivate. Yet, without this love of liberty, modern democracy comes to embody arguably the most oppressive tyranny in the history of the human race, the tyranny of the majority. In the aristocratic past, such an extraordinarily powerful and omnipresent tyranny was not possible. Thus, it becomes apparent just how pressing is Binder's question about the prospects for Islamic liberalism.

Although Binder's answer to this question could hardly be characterized as overly optimistic, Binder does harbor some hope for Islamic liberalism. He proposes a synthesis of Fazlur Rahman's Gadamerian version of Islam and the pragmatic liberalism of Richard Rorty. Although it is not difficult to show an affinity between Gadamer and Rorty, it is difficult to show that Islam is tending in the direction of acquiring Rahman's understanding of it. It is even more difficult to show that pragmatism is truly liberal. Although Binder points the way to an “Islamic pragmatism,” I hope to show that he fails to point the way to an “Islamic liberalism.” Binder's pragmatism cannot avoid the tyranny of the majority that Tocqueville warns us can be fought only with the love of liberty.

Health care, like many other arenas of social policy, offers plentiful evidence both to those who picture the policy process as highly dynamic and innovative and to those who prefer to portray it as beset by deadlock and stalemate. Over the last two decades federal policymakers have invented an array of programs designed to make the system more efficient—health maintenance organizations, peer review organizations, health systems agencies, certificate-of-need, a prospective payment system, resource-based relative-value-scale fee schedules, to name the most prominent—but they have been unwilling to extend health coverage to the 17% or so of the nonaged population that lacks it or to change the nation's mixed public-private health insurance system in basic ways.

This pattern is less paradoxical than it may seem at first glance. A diffuse concern about the rising costs of care could well support a string of (largely ineffective) programs that apply gentle brakes without disturbing the system deeply, but benefit-expanding measures and still more federally sponsored programs to achieve a better balance between benefits and costs have met solid political obstacles. The public, fairly content with the system but poorly informed about its workings, wants immediate access to good care at “affordable” rates and rarely cares to hear about tradeoffs among these goals.

The Voting Rights Act (VRA) (79 Stat. 667) is widely regarded as the most effective piece of civil rights legislation enacted in the United States. Adopted initially in 1965 to protect the voting rights of African Americans, it was expanded in 1975 to protect the voting rights of specified language minorities: Hispanice, Native Americans, Native Alaskans, and Asian Americans.

A number of important changes in American politics can be traced directly to the VRA. The first is the dramatic increase in the number of minority voters. The major barriers to minority group members registering to vote and casting ballots have been removed as a result of the Act; consequently, minority disfranchisement is only rarely an issue today.

The expansion of the minority electorate was critical to another important change, the increase in the number of minority elected officials. Minority voter support has usually been essential to the electoral success of minority candidates. Growth in the minority electorate in the United States was followed by an increase in minority officeholders. The magnitude of this increase, however, has been dependent on additional VRA provisions.

It is said that the old political science attempted to be explanatory and the new political science is interpretive. A key question then is what is the meaning of political interpretation. Does it mean that political analysis is simply subjective and that intellectual anarchy reigns? The old political science had its apparent orthodoxy of the canons of the scientific method. The new orthodoxy refers to these and resembles the old in its underlying liberal, pluralist value assumptions.

The old orthodoxy in comparative politics focuses on develop-mentalism; the new orthodoxy emphasizes democratization, market-oriented economics, rational choice theory, and political economy. Developmentalism stressed the importance of the welfare of the individual as well as at the same time the need for secularization and political participation. Developmentalism was also teleological. The goal was to achieve secularization and participation, in the process replicating the advanced industrial states from which the ideas originated. The values implicit in developmentalism were obscured by the old orthodoxy's patina of behavioralism and “scientific objectivity.”

The new orthodoxy has abandoned behavioralism and “scientific objectivity,” but in neither a systematic nor a philosophical way. Instead, the validity of the criticisms seems to be tacitly conceded even while the spokespersons of the new orthodoxy operate within a “new” scholarly and foreign policy culture that shows evidence of having characteristics similar to those of the old.

Women's parliamentary representation in the 27 long-established but “unfinished democracies” (Haavio-Mannila et al. 1985) of the world varies between 2.3% in Japan's lower house to 39.0% in unicameral Finland. Women state legislators in the United States range from 4% in Kentucky to 39% in Washington in the lower house. Women are 11% of the members of the U.S. House of Representatives. The causes of this variation are primarily the electoral arrangements by which legislators are chosen and, secondarily, the political, economic, and social context.

Favorable societal conditions will not substitute for unfavorable electoral systems for women to reach their optimal representation in parliament and local legislatures. But unfavorable contextual conditions—including cultural biases and discriminatory practices—can be overcome to a great extent by alternate electoral systems. Electoral arrangements are not neutral; they are the means used to exclude or include groups. The arrangements are amenable to change faster than social biases and other barriers to women's election opportunity and fair representation.

Democracy falls short when women of whatever color or ethnic group cannot cast an effective vote to elect representatives of their choice or to enact laws they believe are critically needed. When there are higher proportions of women in parliament, for example, more laws are enacted that benefit children (Lijphart 1991).

Before us is the question of whether or not the 103rd Congress will manage to do what no other U.S. Congress has ever accomplished: the enactment of a comprehensive reform of the way in which health care services are financed in the United States. Does a social science perspective give us a reason to believe that 1994 will be a legislative year that is different from all others? Conventional wisdom might well suggest a simple answer: “no.” Given what we know about the complexity of the issue, the enormous stakes in the system possessed by some of the most powerful private interests, the fragmentation of our governing institutions, the paralysis produced by deficit politics, and the general presumed enthusiasm in our system for caution and incrementalism, a large-scale transformation of health care financing by a legislature best known for parochialism, timidity, and gridlock would seem implausible at best. Can the institution that stimulated scholarly and popular assessments from Congress: The Electoral Connection (Mayhew 1974) to Hill Rat: Blowing the Lid off Congress (Jackley 1992) really overcome the well-known and thoroughly studied barriers to major policy change, especially in the wake of a health care reform proposal from President Bill Clinton that could legitimately prompt the estate of Rube Goldberg to sue for plagiarism (S 1757, HR 3600)?

Rather than “no,” however, the answer really is that we simply do not know. President Clinton's proposed Health Security Act is typically introduced in the media as the most ambitious social policy initiative since the New Deal and social security.

Within the last decade, the amount and quality of research on the relationship between public opinion and policy making has taken a dramatic step forward. This research contributes to the development of democratic theory and to the (re)organization of political science as a profession. Further development of opinion-policy research, however, will require addressing several critical limitations.

What Has Been Done

Statistical analyses and interpretative case studies have reported (both in the United States and Western Europe) a systematic relationship between public opinion and decision making on a range of issues—from national security to social security (for a review see Shapiro and Jacobs 1989 and Shapiro and Young 1989). These results have emerged from several distinct research designs.

The first relies on in-depth investigations of public opinion's impact on formulating specific policies. These case studies rely on closely examining public opinion as gauged through polling results and policy decisions. Many of these studies offer cross-national studies; they discuss issues central to international relations, American politics, and comparative politics (Jacobs 1992a, 1992b, and 1993; Risse-Kappen 1991; Deese 1994 for essays by Shapiro and Page, Graham, and Bennett; Jasper 1990; Eichenberg 1989; Russett 1990; Graham 1989; Kusnitz 1984; Burstein 1985; Sobel 1993; Mattes 1993). For instance, Jacobs (1993) uses interviews and archival evidence to investigate the formulation of American and British health care policy.

The Middle East field is in a crisis within the broader discipline of political science. A review of major departments of political science reveals surprisingly few that have full professors with the politics of the Middle East as their primary research focus. This lacuna exists at such universities as Harvard, Yale, Michigan, Stanford, Berkeley, MIT, Chicago, Ohio State, Emory, Brown, Dartmouth, North Carolina, Rice, Pittsburgh, Brandeis, Wisconsin, and elsewhere. Some of these departments have no Middle East faculty at all, others have denied tenure to deserving junior faculty, while still others have an interest in the region but claim to lack resources to make the necessary appointments.

The situation is clearly better at institutions such as Columbia, NYU, Pennsylvania, Illinois, Johns Hopkins SAIS, Indiana, UCLA, Texas, Princeton, Georgetown, George Washington, Rutgers, and a few others. Nonetheless, there are problems here too. Some faculty are administrators and do not teach a full load. Others may be nearing retirement and are concerned that they will not be replaced by a scholar who also specializes in the Middle East. Although we can disagree about particular institutions or individuals (e.g., Is so-and-so “really” a Middle East scholar?), it is evident that this field is in danger of being marginalized both in professional recognition by the discipline as a whole, and in political science departments that may appreciate having Middle East politics courses on the books, but not the scholarship of the course instructor.

Disregard for the Middle East field can be attributed to an array of political and disciplinary factors with which most of us are familiar. And one could reasonably expand the problem to include all area studies.

Throughout the Cold War, United States national security policy, and the public attitudes that supported it, seemed anchored in the great ideology and power rivalry with the Soviet Union. A basic component of that policy, the ups and downs of American military spending, was largely predictable by changes in the level of Soviet military spending and by public preferences, as expressed in opinion surveys, for increases or decreases in American military spending. Public beliefs about the appropriate level of military spending, moreover, appeared firmly rooted in a larger set of foreign policy beliefs. Attitudes toward the Soviet Union, toward the circumstances justifying the use of military force internationally, and toward cooperating with other countries were all part of a stable and well-defined system of beliefs. In turn, foreign policy attitudes frequently were predictable from a reasonably coherent set of attitudes toward domestic policy.

The end of the Cold War brought remarkable changes in both policy and attitudes. The major anchoring point for the rivalry—the Soviet Union itself—has ceased to exist, and Russia no longer poses the same level or kind of military threat. Rationales for U.S. military spending, for the use of military force abroad, and for international cooperation have likewise changed. But in some respects they have not changed so greatly. These historic events present us with an extraordinary opportunity to study the structure of Americans' foreign policy beliefs and the dynamics of attitude change. They also provide a chance to speculate about how changed and stable attitudes may affect national security policy.

Ample evidence confirms that public opinion influences the policy-making process. Research suggests that public preferences are not simply translated into government policy; rather, policymakers' response to public opinion is conditioned or mediated by political and institutional processes (Jacobs, 1993a, 1993b, 1992a, 1992b; Jacobs and Shapiro, 1994a, 1994b; for discussion of this research see PS, March 1994, 9–38).

The passage and designing of health reform will depend in important respects on public attitudes toward health care and health reform. The interpretation of public opinion by the media and other political observers, however, is not a neutral process dictated by scientific methods; it is the product of institutional and political struggles for position and power.

Conventional wisdom regarding the public's health reform attitudes holds that Americans are narrowly self-interested, unambiguously antitax, and unwavering opponents of government regulation. Are these three sets of assumed attitudes supported by the available empirical evidence?

Here we take an historical approach to studying public opinion—one that identifies the patterns and trends of Americans' responses to identically worded questions asked in national opinion surveys.

Budget politics has always been an obstacle to adopting national health insurance. The questions of budget politics—the risk or size of deficits and the size of government—have a conservative effect. In any country, very few people would endorse deficits for their own sake. In America, support for larger government on principle, displacing the market, has rarely had close to majority support and has surely been diminishing. Defining social policy expansion as a budget issue is a standard tactic for persons opposed to the policy.

The events of the 1980s have in many ways made budget politics more of an obstacle to sensible health care reform—which I define as reform that insures all Americans, yet keeps this country from opening an even wider lead on the international field in the race to spend on health care.

During the 1960s a portion of elites such as economists, the press, and politicians would at least defend deficits in principle under some circumstances. Misinterpretation of the events of the 1970s, exaggerated arguments by economists who think that hyperbole is required in the political arena, the possibility that the 1980s deficits favored Republican constituencies, the fact that a Republican president was in office for those deficits, and the unprecedented scale of the deficit in full-employment terms during peacetime, combined in the 1980s to commit Democratic politicians, economists, and opinion leaders to at least the rhetoric of deficit-reduction. President Clinton has continued the process.

In a 1985 American political science roundtable analyzing the state of the field of comparative politics, the participants concluded that Middle East studies lagged behind most other area studies in the generation of theory (PS 1985). They determined that scholars of Latin America, Asia, and Africa had traversed a greater distance along the road to theory than had analysts of the Middle East. Today, almost a decade later, despite some promising developments, the situation remains basically unchanged.

From the Rigor of Metatheory to Theoretical Rigor Mortis

In the 1960s and 1970s, scholars of comparative politics emphasized issues of philosophy of science and the logic of theory construction. They spent an inordinate amount of time debating metatheory, i.e., they theorized about theory. Although this exercise yielded important intellectual advances, it ultimately degenerated into a sterile exercise in logic for its own sake, and its formulations remained divorced from the empirical world. Partially in reaction to this preoccupation with metatheory, many comparativists in the 1980s abandoned theoretical concerns and focused instead upon empirical investigation and data collection. The result has been the generation of uneven, disconnected, and unrelated stagnant data deposits.

How does public opinion in American democracy relate to policy making, particularly in Washington, D.C.? This question has a special pertinence right now, and not just for political scientists. As I write, it is a little over a month after President Bill Clinton delivered a major televised address on the health care crisis, and only a few days after he and Hillary Rodham Clinton went up to Capitol Hill to introduce a 1,342 page “Health Security bill” into Congress. Clearly, Clinton is staking his presidency—not to mention the immediate prospects of the Democratic Party—on an attempt to respond to a certain reading of public opinion. By wading into a policy arena already staked out by many resourceful vested interests, Clinton is undertaking to mobilize and influence broad public support for what is arguably the most ambitious federal social policy initiative since the Social Security Act of 1935.

Consideration of various aspects of the relationship of public opinion to the current round of health insurance policy making in Washington, D.C., can, in my view, underline the value of a historically grounded and institutionally mediated analysis of the roots and effects of public opinion. The approach I shall illustrate builds upon Lawrence Jacobs's (1993) recent book, The Health of Nations: Public Opinion and the Making of American and British Health Policy. One major undertaking of that work is to make sense of the role of U.S. public opinion in the enactment of Medicare in 1965.