Evaluating the role of bricolage in US Health Care policy reform

Abstract

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’.