THE POLITICAL EFFECTS O F CONSUMER PARTICIPATION A POLITICAL SCIENTIST’S VIEW

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EDWARD R. PADGETT, PbD. Professor of Political Science and Director, Graduate Program in Public Administration, Department of Political Science, University o f Cincinnati

Although this paper is directed towards the specific problems of the consumer in comprehensive health planning, this aspect of the so-called consumer problem is part of a larger issue, that of the consumer in our current social order. At present, the United States is going through an upsurge of alleged “consumerism” which is, among other things, a reaction of the largely unorganized individuals who comprise the mass of Americans who feel that the current distribution of public goods and services is inadequate to meet their needs. A political scientist must in any evaluation of such a problem address himself to such issues as power, the nature of the political system, and most particularly to those strategies which suggest as a basic reality a “payoff” for those who wish to participate in transactions best described as political bargaining. Our political system has become one of group bargaining in a pluralistic setting.( 1) The political scene is characterized by the interaction of well-organized groups which claim through diverse strategies a share of the advantage of our economic and political system. Political participation has been developed primarily upon the part of those who are able to make their wishes known and respected within the framework of the political order. Pluralism has had a high level of “payoff’ for those who have found the benefits of organizational strength productive in their own terms. Our system has been based upon the postulates of an open society which in terms of vague propositions such as the “public interest” attempts to provide reasonable satisfaction to as many groups as possible. It is, of course, a twentieth century restatement of Calhoun’s concurrent majority. The basis of the bargaining system is that of compromise and protection of the vested rights of major group interests. At present it is quite apparent that there are certain groups in the pluralistic system which have felt that their interests have been neglected. Our purpose is naturally that of the hoped-for reconciliation of such diverse interests with the aims of the social order. However, many such groups have found recourse to violence and t o

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unconventional action as the only means of bringing attention to their needs. The problem of comprehensive health planning cannot be isolated from the other aspirations of groups which do not fully participate in American pluralistic decision making. Despite the affluence of our nation, there are obvious discrepancies in the distribution of public goods and services. Every person is well aware that our people will tend to support large expenditures of federal funds for defense, space exploration, and national security objectives. At the local level our cities expend huge sums upon highway systems, sports stadia, parking lots, and other objectives which serve only a part of the body politic while neglecting the needs of the urban poor and the disadvantaged. Urban renewal and rehabilitation often create more problems than they really resolve. In recent years, there has been an upsurge of consumer interest which has become the basis of the consumer revolution. Our governmental system at all levels has been developed in the interest of major groups upon a “clientele” basis. Such major groups as labor, commerce and agriculture have been able to claim a stake in governmental activity. The process of governmental regulation unfortunately has become one in which regulatory agencies have become the prisoners of those whom they are supposed to regulate. Our political system is much more responsive to “special interests” than it has been to many particular interests? Long ago Lasswell made us aware of the important proposition that politics is a question of who gets what, how, and under which circumstances.( 3) More modern transactional theories have in effect restated this assumption. Power in the social order has become a problem of the existence of community power structured4) This has, of course, also been posited as the “establishment” Galbraith has made clear the discrepancies in the national utilization of our abilities to fulfill private needs in comparison to our lack of ability to satisfy public requirements45) Political science has projected in recent decades a concept of an open society in which government has attempted by a variety of devices regulation, programmatic efforts, and overblown rhetoric - to solve pressing national social problems. Power in government, and the exercise thereof, is based upon several rather different concepts, i.e. the rational model, the incremental model, and the mixed-scanning model. All of these are efforts to present paradigms of the decisional alternatives and modes of behavior which face administrators. These models of administrative behavior suggest the ways in which major decisions are made. Pressure groups and political parties play a significant role, but the act of deciding is accomplished within the 68

government itself. Assuming the joint creation of policy by legislative and executive branches of government, it is, on balance, the actual decisions which implement policy which determines the course of the society. One of man’s most firmly held traditions is that of rationality. This implies a systematic effort to determine goals and sub-goals, to weigh alternatives of choice, and to select the most appropriate decisional alternative. Simon has suggested that administrative man “satisfices” rather than “maximizing.”(6) The rational model is central to most theories of administration, planning, and social equilibrium. It is part of the assumption that the intelligence of man enables the species to engage in effective problem-solving. In addition, democratic man in an open society is assumed to have the capabilities of solving the major issues and problems of his day. Modern technology, the advances of natural science, and the general complexities of modern life would tend to question such propositions. Lindblom has taken a different view of man’s problem-solving ability in his concept of incrementalism or “muddling through” as it is more generally known.(7) This position recognizes man’s preferences for present consequences and sees his alternatives of choice as those of adding to or subtracting from what he is already doing at a given moment. He defines this as the method of successive limited comparisons as opposed to the rational comprehensive method, assuming that decision-making and policy-making are synonymous. Means-end analysis is viewed as often inappropriate or limited481 Etzioni, in an interesting attempt to reconcile the fundamental weaknesses of the two approaches discussed above, sees the mixed scanning one as both a realistic description of strategy used by actors in a large variety of fields and the strategy for effective actors to follow. Such strategy would include the use of two cameras: a broad angled one covering all parts of the sky but not in great detail, and one which would zero in on areas of the first camera requiring a more in-depth examinationd9) It must be stressed that each of these three approaches is compatible with a democratic system. However, each in its own way raises fundamental questions with regard to the ability of policy produced by decision makers to respond to the needs of society and of its components. Moynihan has recently suggested that such problems can be seen as follows: All manner of problems come to the fore as issues of social policy, but for general purposes they can be divided between those that involve the aggregation of sufficient support in the political system to bring about some change in public policy, 69

and a quite different set of problems wherein public policy is already reasonably settled, so that public administrators know well enough what it is they are supposed to do, but don’t know how to do it. The first might be called political problems: the second knowledge problems.(lO) In our concern with the consumer and consumer education related to comprehensive health planning, it is clear that we face several quite involved problems. Comprehensive planning assumes a high degree of rationality, i.e., and ends-means continuum which attempts rather specific problem solving. On the other hand most decision makers display a preference for muddling through. What we do is simply a matter of an incremental change in relation to our present course of action based upon prior decisions. The pluralistic concept of hierarchical bargaining has, as noted before, excluded certain groups from a transactional position. The consumer is an obvious example of this. Decision makers include in their frames of reference relevant data with regard to major group interests. The consumer is an ever-present, but relatively new, institutionalized participant in public policy analysis. The consumer lacks a specific power base. The options faced by the consumer appear to fall into several major categories. First, the consumer and the consumer movement can play the game according to the established rules and begin to acquire the right of access to the pluralistic bargaining mechanism. In doing so, there is a major risk of cooptation by the established mechanisms of the system. Second, the consumer groups can chart new and different courses of action. This would place their efforts within Moynihan’s first category, that of aggregating support in the political system to bring about change in public policy. These appear to be the major programmatic alternatives of choice which face the consumer. Despite many suggestions that all citizens are consumers in one way or other, the general public is known for its apathy or inertia with regard to pressing social problems until the crisis stage is reached. The immediate past has been characterized by the growth of several distinct types of consumer organization, informational and reformist, such as those which have as their objectives the rigorous testing of products sold to the public, and those which engage in confrontational activity with the objective of significant social change. The consumer is to be given aid in making choices, or if you wish, allocations of his resources. Another trend has led through statutory and other means to a form of hoped-for-participation in decision-making at various levels of governmental activity. The forces of advertising, governmental

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programmatic activity, and certain forms of advocacy have all been weighed with regard to specific behavioral responses upon the part of the consumers of public goods and services. The rise of the independent regulatory commission in 1887 with the creation of the Interstate Commerce Commission and culminating in the days of Franklin Roosevelt’s New Deal has been based upon the American assumption that disclosure of basic facts would protect the consumer and/or the public from abuses in those areas of business engaged in interstate commerce. Commerce was redefined in the Jones Laughlin Case, by a broader definition of interstate commerce which dealt with causal factors as well as mere effects.( 11) Certain segments of our population were further protected by the creation of clientele departments. The most recent example is Health, Education, and Welfare (HEW), which is an organizational monstrosity combining several well established old-line agencies and which has been faced by perennial problems of reorganization4 12) At the state and local levels a crazy-quilt of boards and commissions has been created. These bodies are often staffed by members who have no known competence in these areas and who far too often merely reflect the realities of prevailing political power. As is often the case in other instances, the modern consumer owes much of the vigor of consumer movements to specific individuals such as Ralph Nader. Nader’s long struggle against General Motors and other corporate giants is well known and need not be recounted here. It is, however, important to note that Nader’s tenacity and careful marshalling of data has enabled him and his co-workers to revolutionize our attitudes towards the independent regulatory commissions and other agencies. Nader has recently expressed some serious reservations concerning the effectiveness of the organized consumer movement.( 1 3) The resilience of the accepted ways of doing business within our system is amazing. Any mature American can recall during his adult lifetime the long struggles which have led to such advances as the Wagner Act, the Securities Act of 1933, and Medicare to name only a few. Major interest groups by large expenditures of funds and by effective lobbying at all levels have been able to block or to delay interminably such advances. It would appear that only crisis situations which seriously threaten the normal approaches to bargaining d o tend to bring about change. The context of group politics brings almost unbearable pressures upon lawmakers and administrators who make decisions which bring about major social change. Established groups can utilize congressional support, the activity of lobbyists, and other means of overwhelming under-staffed agencies.(l4) There is little reason for surprise when the 71

consumer is made to feel that his interests are relatively unprotected. Our organizational responses to current policy issues have produced myriad problems in national policy machinery.( 15) It is sufficient to note that decision making has been multilateralized and in the felicitous phrase of Robert Lovett, organization has produced a merrygo-round of concurrences. One may genuinely question whether administrative organization is really in existence to solve problems or merely to avoid them. Each of us knows that a rule of behavior for administrators is: when in doubt appoint a committee. If the committee or commission reports and the report tends to suggest drastic changes in the established ways of bargaining, simply ignore the report.( 16) In addition transactional pluralistic activities tend to have a lowest common denominator effect, despite rhetoric about breakthroughs and new plateaus. In the last resort dialogue about the structuring of national and other priorities can be counted upon to produce stalemate o r at least delay. Budgetary realities and some budgetary misconceptions can also produce reasons for inactivity and nonpro blem-solving. It is worth nothing that Program-Planning-Budgeting-Systems (PPBS), a significant advance based upon systems analysis and upon a highly rational structuring of priorities and alternatives of choice based upon the concepts program categories and program elements, has been much more successful in its applications to “hard services” than to “soft services.” The protection of the consumer is, of course, within the “soft services” category. In addition, the application of PPBS to the state and local levels of government has encountered many difficulties, despite limited successes.( 17) PPBS is a means whereby analysis can produce decisional alternatives in terms of cost-benefit evaluation which will really serve to respond to national priorities. At this point it is appropriate to turn to the specifics of the actual problems to which this paper is addressed. “Comprehensive health Planning” is a technical term which implies that decisional mechanisms in health administration can assume the characteristics of an allembracing program which would achieve desired levels of national well-being. If really comprehensive, those decisions would have a high degree of rationality, maximum search for and evaluation of viable alternatives, and a careful stipulation of the ends-means continuum as a decisional determinant. If truly comprehensive, the parameters would extend far beyond the normal limits of the health field. When the consumer is to be brought into the health planning process, it would be fair to suggest that any facet of existence which affects health is within such boundaries. What is really being attempted is an effort within a political problem, as delineated by Moynihan, to bring about a change in public policy. It 72

is beyond question that the delivery of health care is a major problem of our era. Comprehensive planning suggests significant alteration in the current methods of the distribution of public goods and services. Tc educate consumer participants in comprehensive health planning is to make a direct assumption that such education will be followed by effective participation in planning-decisional activity. It is a basic premise in the analysis of political participation that individuals and groups tend to take part in the political process in direct proportion to their expectations of rewards from the system. The initial efforts of the Office of Economic Opportunity to bring the poor into the framework of the poverty programs and efforts to provide legal services to the poor have engendered tremendous opposition in legislative bodies and within the power structure at all levels. An enlightened, effective participatory effort by consumers in any field is a direct threat to the established ways of conducting public business. It would appear that the consumer faces several basic alternatives: 1) to work within the system, 2) to determine which methods of action and of participation are most effective, and 3) to define the levels of change which are to be injected into a resistent system. In the first of these alternatives, the consumer faces the paramount danger of cooptation which, simply stated, is nothing more than the modification of original objectives by the demands of the operational network of the system itself. Major groups which already possess power-influence in political parties and in the group structure of administrative organizations, for example, will resist the granting of access to new groups except under outright crisis situations. Access to power in highly structured relationships is exceedingly difficult. In the second alternative, the consumer and the people face an internal division of opinion between more traditional techniques and those of a more militant viewpoint.(l8) It is worth noting that men such as Alinsky and Gans are, in effect, challenging the fundamental assumptions of the social order.( 19) The third alternative brings us to the involved problems of inducing social change.(20) Social change has tended to be introduced through formal mechanisms rather than through highly innovative courses of action. The consumer movement is, in effect, introducing change through non-formal and highly abnormal means. What is the desired state of affairs of the level of services which comprehensive health planning wishes to bring about? Which aspects of environmental reality are preeminent? How are resources to be allocated?(21) In a period of budgetary orthodoxy how can priorities and allocations of resources be made in a manner to achieve “satisficing?” Are most efforts towards change to be within the area of

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innovative concepts such as the OEO program of lawyers for the poor?(22) The ideas of Nader for law firms which deal exclusively with consumer issues and his new plan for a consumer affairs organization free of the normal hierarchical structures of government are most significant.(23) The current momentum which has led to deep concern with environmental problems, especially as stated in terms of rather vague goals in the President’s State Of The Union address, must be sustained. Such activities as congressional hearings and investigations with regard to the use of the “pill” and with regard to air and water pollution must be continued. A t the state and local levels, the consumer movement, often by trial and error, must determine its own organizational forms. Political scientists and others simply cannot merely tell the consumer movement what it wishes to d o and how to d o it. The inner dynamic is of vital importance. Much current research both psychological and otherwise suggests very strongly that groups determine their own goals and sub-goals. The group also structures and determines the strategies which can produce the basic payoff needed. A t the same time, it appears to be highly feasible for the consumer movement to attempt to solve its own organizational dilemma. The consumer movement must resolve to which of the Moynihan problems it wishes to address itself - political o r knowledge problems. Then, it must determine its short- and long-run strategies. Working within the system has been the traditional method of satisfaction of group goals in the bargaining process. However, many minority groups have learned to beware of the game within the pluralistic system. There is a great temptation to avoid the almost impossible task o f succeeding within the bargaining system. Unconventional methods have a high level of payoff. Alinsky has had success in utilizing shock tactics and has produced change where other methods failed. Social science has giving us the theory of unanticipated consequences which permits the identification of controllable variables. This approach implicates the individual and the group and their behavior in producing their own problems.(24) The consumer group must give due attention to this theory. The movement, by failing to account for controllable variables, may lessen its own effectiveness. T h e consumer movement must broaden its horizons, it must utilize all the available techniques, and it must prepare itself for the in-built resistance of the social order. Consumerism is something of a fad at present. Those in power are very adept in preventing access of those to whom they wish to deny power. The regulatory movement in this country has been vitiated by cooptation. T h e consumer movement is fragmented at present. Public apathy is ever present. 74

The consumer effort must move from micro to macro levels. A fragmented organization at the state and local levels will fail without substantial activity at the federal level. A cabinet department of consumer affairs is not the answer.(25) Study groups can evaluate a problem into the grave. The responses of the political party system are unreal in a sense when applied to these kinds of problems. American history has well demonstrated that reform and reformers all too often bog down and collapse in the levels of their own acceptance. The consumer movement is positing new courses in the economic, social and political system of this country. Political problems are much more difficult to resolve than knowledge problems. The consumer is, in effect, staking out a claim to a high level of participation in decisional activities from which he has been barred in the past. We are all consumers and our efforts will determine what we do. Those of us who are social scientists can help and offer suggestions, but the consumer movement must possess an inner dynamic of its own to produce relevant social change. Consumer education can perhaps serve as a linkage mechanism in the production of effective social action. It may even begin the solution of a major political problem. In a new and challenging study of the American political process, Professor George Beam has suggested a conceptual apparatus for an alternative to usual politics which has two basic characteristics: First, new politics must deal with substantive questions, and second, new politics admits a wide range of needed concepts to deal with the various aspects of government and with a wide range of legitimate questions concerning political processes, structure and actors.(26) Beam has also suggested that democracy is not just a matter of procedure; it is also a matter of content.(27) In the area of comprehensive health planning the organized consumer is, a n balance, attempting to create a new concept of participation in decision-making which challenges the concepts of the old politics. The success or failure of this movement will determine the course of social change in an area vital to the well-being of democracy in this nation.

REFERENCES AND FOOTNOTES 1. Dahl, Robert A. and Lindblom, Charles E. Politics, Economics and Welfare: Planning

and Politico-Economic Systems Resolved Into Basic Social Processes. New York: Harper, 1953. See also the classic work on the group process: Turman, David. B. The Governmental Process. New York: Alfred A. Knopf, 1955.

2. Dahl and Lindblom, op. c i t See especially the chapters on polyarchy and hierarchy.

3. Lasswell, Harold. Politics: Who Gets What, When. H o w . New York: McGraw-Hill, 1936. Two recent studies of note are Locard, Duane. The Perverted Priorities o f

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American Politics, New York: Macmillan, 1971, and Dye, Thomas R. and Ziegler, L. Harmon. The Irony of Democracy: An Uncommon Introduction to American Politics. (Belmont, Calif.: Wadsworth Publishing, 1970).

4. The classic work is Hunter, Floyd. Community Power Structure: A Study of Decision Makers. Chapel Hill: University of North Carolina Press, 1953. Also an Anchor Book Edition, 1963.

K. The Afluent Society. Boston: Houghton-Mifflin, 1958. A penetrating new analysis is Mitchell, William C. Public Choice in America. Chicago: Markham Publishing Company, 197 1.

5. Galbraith, John

6. Simon, Herbert. Administrative Behavior: A Study of Decision-Making Processes in Administrative Organization. New York: Mucmillan. 1947.

7. Lindblom, Charles E.“The Science of Muddling Through.” Pub. Admin. Rev., 19:7988, Spring, 1959. 8. fbid., especially pp. 86-88.

9. Etzioni, Amital. “Mixed-Scanning: A ‘Third’ Approach to Decision-Making.” Pub. Admin. Rev., 27:385-392. Dcc., 1967. 10. Moynihan, Daniel P. “To Solve Problem, First Define It.” The New York Times, Jan.

12. 1970. pp. 49, 62. 11. National Labor Relations Board v Jones-Laughlin Steel Corp. 301 US. 1. 12. Bailey, Stephen K. The Ofice of Education and The Education Act of 1965. InterUniversity Case Program No. 100. New York: Bobbs-Merrill Co.. 1966. 13. The New York Times, Jan. 16, 1970, p. 19. See also Cox, Edward F., Fellmeth, Robert C.. and Schultz, John E. The Nader Report on The Federal Trade Commission. New York Grow Press, Inc., 1969. 14. “Ousted F.D.A. Chief Charges ‘Pressure’ From Drug Industry.” The New York Times, Dcc. 31. 1969, pp. 1, 13. IS. I have addressed myself to these problems elsewhere. Sce Padgett, Edward R. “A Nation Looks At Its Policy Machinery.” Internal. Rev. of Admin. Sci.. 31:233-238, 1965. 16. Report of The National Advisory Commission on Civil Disorders. New York: Bantam Books, 1968. This is simply a prime example of several major commission reports which have been ignored by the executive branch and by the general public. 17. Harper. Edwin L., Kramer, Fred A.. and Rouse, Andrew M. ”Implementation and Use of PPB in Sixteen Federal Agencies.” Pub. Admin. Rev., 29:623-632, Nov.-Dec., 1969. In a recent article I have dealt with several aspects of the use of PPBS. See Padgett, Edward R. “Program-Planning-Budgeting: Some Reflections Upon The American Experience With PPBS.” Internat. Rev. of Admin. Sci.. 37:4, 1971. 18. Saul Alinsky in a conversation with Marion K. Sanders. Sec “The Professional Radical, 1970.” Harper’s, 24035-42, Jan., 1970.

19. Gans, Herbert J. “We Won’t End The Urban Crisis Until We End ‘Majority Rule.’ The New York Times Magazine, Aug. 3, 1969, p. 17.

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20. Bennis, Warren G., Benne, Kenneth D.. and Chin, Robert. The Planning ofchange. New York: Holt, Rinehart and Winston. Inc., 1968. 21. U.S. Senate, Planning-Programming-Budgeting. Hearinga Before The Subcommittee o n National Security and International Operations of the Committee on Government

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Operations, 91st. Cong., 1st. seas.. Part 5. Washington, D.C.: Government Printing OtTce, 1969, especially pp. 308-309. 22. The Post & Times Star, Cincinnati, Ohio, Jan. IS, 1970, p. 4. 23. The New York Times, Jan. 16, 1970, p. 19. 24. Gouldner, Alvin W. “Theoretical Requirements of the Applied Social Sciences.” Amer. Socio Rev., 22:92-102, Feb., 1957.

25. Nader has suggested an ofice independent of the White House. See The Washington Post, Jan. 22, 1970. p. F14. 26. &am, George D. Usual Politics: A Critique and Some Suggestions For A n AIternutive. New York Holt, Rinehart and Winston, Inc., 1970, pp. 150-151. 27. Ibid., pp. 166-167.

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