HMP Governance Lab: Introduction to Health Policy

3.2 American Government 101

Holly Jarman, PhD and Scott L. Greer, PhD

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 49:50

Profs Greer and Jarman examine the branches of American government from the perspective of advocates -if you want to create change in a policy area, where should you focus your efforts?

Holly Jarman:

Hello, and welcome to another HMP Governance Lab Podcast. I'm Holly Jarman. And I'm here with Scott Greer. And today we're going to be talking about American government. But specifically from the angle of how can you try to influence American government? So there are lots of resources that you have access to that explain, what did the three branches of government do? And what does Congress do? What does the presidency do? What does the judiciary do? We thought it would be a helpful complement to that to provide you with some information about if you are wanting to make change in on a health policy topic. And you have some idea of what you want to achieve. How do you go about that? So how do you try to influence Congress? And when should you do that? Versus how and when should you influence the executive or try to influence the judiciary? So, Scott, let's maybe start a bit with Congress. When would you decide? Okay, I want to make change on this policy issue, I'm going to start by thinking about which branch of government is most appropriate to approach and target. So when might you want to try to influence Congress? Well, and we're talking at the federal level, but a lot of this will be replicated at the states, which we'll get to a little bit later. We'll get there. We'll get there at the end. Yes. So Congress does a number of things that are really important. It's the place that you go, if you want to influence the passage of law, they're called legislators. And it's a legislature for a reason. Both houses of Congress jointly have to approve legislation. And therefore, if what you need is a law that isn't entirely an executive order, something feeble at the disposal of the White House, but natural law obliging people to do things, you go to Congress, they also write the budgets. So if you want money or rules about money, you have to go to court talk to Congress. So those are the two really big things that they do, you have. And either of those requires subject to a whole lot of complicated rules on things like reconciliation, both houses of Congress agreeing and then the President signing or if the president vetoes it, Congress can override. So in order to figure this out, then you need to know, does the change I want to see require legislation. And that's quite an important skill to practice. Because a lot of the time, there's ways to achieve it without necessarily changing existing legislation. But there's also a lot of really important things where you have to write a law. Also, bear in mind that budget is kind of an elastic category, because there's a lot of ways to use the budgeting process, to however imperfectly achieve goals that are associated with legislation or normally. So for example, there's a lot of ways that you can use the budget to change the tax code to incentivize behavior, if you don't think you can pass a law. And that's a really popular policy tool right in the US is using the tax code to try and provide various incentives. And so when you're thinking about Congress, you need to understand well, is what I want to achieve. does this require legislation? But then further than that, you have to think about well, how do my priorities match up or not with legislators priorities? And what are their incentives? What issues are they interested in? And their bottom line in terms of every legislator wants to stay a legislator? Right? So you need to think strategically about not only what you want to achieve? And then if that requires legislation, what kind of legislative measure are you looking at? Is this a small niche build that you want to try and build some championship around and get some legislators to sign on to this idea and promote it? And be aware, you might have to do that several times in a row before the idea catches fire or gets enough support within the legislature to push it forward? Or very commonly these days? Are you thinking about having to include your ideas in a must pass piece of legislation, potentially in a piece of legislation that is about the budget. So increasingly, these days, Congress has been relatively gridlocked. And so there has been a number of very important very large bills. And so advocates have pushed very hard to try and get their ideas included in those bills. Because the number of opportunities to actually pass a piece of legislation during the congressional session, I would say has gone down in recent years.

Scott Greer:

There's fewer trains departing their larger capacity, more people around them, but if you miss one of them You're really stuffed. So entire pieces of legislation we talked about in health, like the High Tech Act, which constituted the latest chapter in our ongoing EHR policy debacle. The High Tech Act was a freestanding piece of legislation that was lumped into a much larger piece of legislation in order to get past. And you see this over and over again, where people talk about entire large complicated laws that are actually, if you look at it just one title of an even larger and more complicated law or budget resolution,

Holly Jarman:

absolutely. So this also affects any kind of scrutiny you're doing looking for laws, if you're trying to search for health laws. And you let's just say in the simplest version, you type into your search box, the word health, but a lot of legislation isn't specifically about health, the piece that is about health will be nested, as Scott said, inside, maybe one or more big bills. So finding that stuff is really a skill that you do need to practice.

Scott Greer:

Now the other thing Congress can do is draw attention to issues and provide oversight. So do not ever underestimate the extent to which congressional committees, and remember, some of them even have subpoena power. But even if it's without a formal subpoena, nobody wants to be caught lying to Congress, it's very bad for your career in most cases. So congressional committees can hold hearings, they can gather information, they can shine a light on topics. And they can do direct oversight of agencies within their purview. So if you think that an agency's not performing well, you might be able to get oversight committees or specialty committees or standing committees to actually investigate. And from the point of view, the administrators being dragged up to defend their decisions is a painful experience, which frequently absorbs days of preparation, and can end up damaging their careers for a long time if they don't handle it well. So if a congressional committee takes an interest in your agency, that congressional committee becomes really important civil servants talk about how difficult it is to prepare for, quote, a congressional unquote. And likewise, if it's an issue where people you think should be paying more attention, where you want to get something onto the agenda of topical, discussing greater depth later, getting a congressional committee to hold hearings on the topic and raise the scale of the problem is a very effective way to do it. And this can go on for years. But it's better to be on the agenda of the subcommittee than it is to not be on any agenda in Congress.

Holly Jarman:

Right. And a lot of the writing and communications work that we'll have you do in this class, is part of the basic building blocks for later, when you're a little bit later in your career, maybe doing some congressional testimony. So don't sleep on these skills, they're really important in that sense. And don't sleep by the on appropriations committees. It helps when you're approaching Congress to think not just about the individual members, but what specialist committees they are on what interests they have in that area, including appropriations committees, which are all about the budget. So understanding who the staff are on those committees a little bit separate from who the members of these committees are, is quite important.

Scott Greer:

So two things to bear in mind on there. One is that authorization is legislation authorization as you create a vehicle that there can be a you authorize the existence of an agency to do a given thing. appropriation is actually giving the agency some money. And unless there's some sort of an automatic finance mechanism built in, like there is with say, Social Security and Medicare, or they depend on user fees or something like increasingly, the FDA, an authorized agency with little or no appropriation is is more abundant, basically, as if it had never been authorized. The other point, Holly mentioned the staffers is that Congress has got 30,000 dod employees. One of the ways in which it's very permeable is simply that there's a lot more specialist people that you can talk to. And they're serving, of course, 435 House members and 100 senators, with their diverse political and policy objectives. So it's much easier to find somebody who will take an interest in your topic and speak with you and potentially borrow some of your ideas. Now, the two chambers work very differently. The senator is much more the Senator is much more egalitarian and decentralized. The health is much more built on go along to get along where you get a reputation and a given subject or for the Committee's Iran and you focus there and otherwise you just vote the way the leadership tells you and the other issues. But nonetheless, that's a lot of committees, a lot of staff you can talk to, they have some local dimension to their work, they might be interested in simply the local angle. A nice example once where Gary Peters and Rand Paul were both senators on the committee that had oversight of a lot of science policy, and so Peters would regularly go out of his way to find examples of good federally funded science in two states, Michigan and Kentucky. Because it made it harder for random Paul to demand defunding things if every meeting involves people talking about the excellent work, the federal government was financing in his home state.

Holly Jarman:

Right. And so staffers need your input, they are responsible for trying to keep their members up to date on what's happening, trying to develop ideas for legislation to support their, their legislator. So they do need your input. So if you are approaching Congress, one of the most important strategies is to provide legislators and their staff with key information, and use that to build up a reputation and a relationship over time, you want to be known as a trusted source for important information on that topic. And so that's why some people get very daunted by advocacy and advocating for things in Congress, because it really, it takes time to establish that relationship, and you have to be a repeat player of this game. Over time, you then might move up to being able to make some more specific requests that the legislator and their staff will actually listen to seriously. And then large groups and their representatives quite often they will draft legislative measures, pieces of law, draft bills, even and provide those to legislators with an interest in that issue. And that's quite common. Everybody in this situation, legislators and staff, both are pressed for time, and anything you can provide to them that is ready to go will probably be welcomed as long as the topic is welcomed.

Scott Greer:

And one final thing is that Congress to a greater extent, in a sense than anybody else responds to simply a letter from a constituent. Don't sleep on that. There's, it's amazing how infrequently people contact their member of Congress. And while it might not change their overall political orientation, I don't think that you're going to get somebody to change sides on something like the constitutionality of abortion by writing them a letter. But there's tons and tons of issues where they decide that maybe they don't want to be quite so vigorous in pursuing it if they're getting pushed back in their mailbags or they decide that maybe they should pay more attention to this issue. If it turns out that people care. And their indicator of people caring is extraordinarily small numbers, you get a few dozen calls on something you say this is an important issue in my district. There's a very well founded finding that members of Congress and their staff systematically overestimate how politically conservative their districts are. And a lot of it seems to be down to the fact that one group in particular, the NRA, and gun owners will absolutely swamp members of Congress with communication at the drop of a hat. So while that's actual structural change in how Congress thinks about things attributable to the vigor of gun rights advocates in contacting Congress, so even if it's totally obscure issue, call them up. Most of them by now you won't get a human being you'll get a voicemail, leave a polite one. And above all, contact your own members of Congress, contact your own senators, Nancy Pelosi represents San Francisco, if you're a voter in San Francisco, by all means, contact Nancy Pelosi otherwise, contact somebody closer to home. Yeah, exactly. And

Holly Jarman:

a little caveat here is do practice old school communication, call them on the phone, send a paper letter. Even now, Congress is not really in the information age as much as we would like paper letters,

Scott Greer:

since anthrax have often sort of gone to be disinfected, so they can vanish for a long time. If you send them to Washington, you want to send them to the constituency offices where the level of ambient security is lower, and that you don't arrive detoxified, three months later. But there's a resource we have up on the web called call the halls, which is an advice on how to talk to them. And a lot of it's very simple think like an intern who's checking the voicemail for a senator. So you want to start your message, you know, Hi, I'm Joe Smith, and I'm a voter in the state of wherever you come from. And I'll leave my address at the end of the message. And I'm calling to advocate Senator pounds to vote in favor of something something something. And my address is, you know, 123 Main Street.

Holly Jarman:

Yep, I used to get those messages all the time. And it's very, they're nice and simple for whoever is fielding the messages to record what you're interested in, and your contact details. And then, you know, can members of Congress want to be responsive to these types of calls?

Scott Greer:

And online forums are okay, what really doesn't work is blast emails. Those are really not interesting. Yeah, don't

Holly Jarman:

do that.

Scott Greer:

I'd also don't tag them on social media like they really Yeah, even if they should care. Your average member of Congress has an absolute or Senator let alone has an absolutely terrible social media game in every respect, and they're not capable of and often not interested in transmitting their social media profile in to an understanding of where they stand politically, so just don't don't tweet to your Senator, it's not going to achieve anything.

Holly Jarman:

So that's Congress. What about the executive? And by that we mean, the President and all the agencies, the offices around the President?

Scott Greer:

Well, so first of all, if you really want to get something done, it pays to bring up the president, because as this class is going to stress, the President just gets to do whatever the president wants, and something's going on. It's probably the President did it. More accurately, you're very, very rarely going to have much contact with the president and the president, while the most powerful person in the entire American political system. And basically the country is very, very time pressured and very likely to deal with only the biggest issues in units and maybe 20 or 30 minutes. And it's noticeable that in most presidents, most presidents, the Asterix is not Trump. The president actually has something like a 20 minute cycle for entire policy issues, blank desk, briefing papers come in five minutes later, 10 minutes later, staff come in five minutes present the issue decision, desk cleared, repeat. There's a lot of presidents have a schedule, something like that. So the President personally is hugely powerful, but you're unlikely to meet the president. What does matter is understanding the influence that the President has on the issues that you're paying attention to where the President stands on it, how the President thinks about these matters, and understand that in large part, you have to talk to the people around the president, aka, the White House, where we start with the people closest to the president, all the pro appointees of the President, that's the executive office.

Holly Jarman:

Right. And so potentially, then you'll find an into some aspect of the White House, which is the term White House makes it sound like there's a one building. And then all the people associated with the president are in that building. And frankly, know that they're dotted around lots of different agencies. And understanding the difference between the Executive Office of the President, which has important agencies in it, like the Office of Management and Budget, and then other executive agencies, you may have heard of, like HHS, which deals with health care, and FDA, which deals with a lot of products affecting health, like tobacco, for example, understanding the differences between those different agencies and what they do is quite important. And the White House, it might include lots of important task forces and committees that are dealing with specific issues of the day. So for example, in in COVID-19 response, there were was a quite infamous Task Force dealing with day to day decision making on COVID-19. So you might need to think strategically about which if any of the eight parts of the Executive Office of the President might be accessible to you, and otherwise, for your issue area, which agencies actually are involved in determining the day to day of policymaking? So the important thing here is that we've talked about Congress and Congress makes primary legislation, so the laws of the land, but Congress does not put into practice all the tiny little details for how those laws get implemented. That's done in executive agencies. So if you want to influence not necessarily how the primary law is formulated, but then the actual nitty gritty of how those laws are implemented, you need to go and spend a lot of time monitoring the activities of these different agencies, what are they doing in your policy area, you maybe need to attend in person or virtually some public meetings about those proposed implementation of the primary laws. And then you probably would end up trying to build up relationships over time with specific agencies that work frequently in your policy area, you might choose to do things like respond to public comment opportunities. So these agencies are required to be quite transparent about the decisions they're making. That doesn't mean that officials in these agencies don't have a lot of one on one or more private meetings with different interest groups they do. But in addition, they are required to publish well in advance the details of the rules that they are proposing. And that allows different interest groups in society. So groups representing medical professionals, businesses, groups representing patients, maybe you they can all respond to these public comment opportunities. And in fact, any member of the public can respond to these public comment opportunities. And during this class, we will actually have you respond to a real opportunity for comment.

Scott Greer:

So let me do an example. Let's say you're interested in drugs, regulation, medicine or tobacco. These are by legislation The province of the FDA, Food and Drug Administration. Now the FDA is powerful and autonomous agency which directly has its own budget authorization and its own budget and directly talks to Congress. However, on an organization chart, the FDA is part of the Department of Health and Human Services. So in theory, not necessarily in practice, the FDA commissioner is subordinate to the cabinet appointed Secretary of Health and Human Services, who then in turn, works for the President, and should be responsive to the White House agencies that the President uses to coordinate the entire federal government, which includes the executive office, which is what most people mean by the White House, and also the Office of Management and Budget, which is the more formal institutionalized system that the White House uses to, for example, write its proposed budget to Congress, and also to oversee all the regulations passing through the federal government in a little office called ally era, the Office of Information and Regulatory Affairs, which is a choke point developed by Ronald Reagan specifically to make sure that the White House had the final say on every agency's attempt to make regulations which are sort of subordinate level of law that we'll discuss later. So in that example, the FDA, if it wants to regulate, has to get it through its own internal process probably checks it out with HHS to see if there's something seriously politically or policy wise askew negotiates its budget with the OMB and the HHS Secretary, because the HSS HHS Secretary has the good relations with Congress as well as the FDA commissioner, and then the regulation associated with it would have to go through the White House and Oh, Ira before it finally was approved and became law or became established as a formal federal regulation.

Holly Jarman:

And in the background of all this are a lot of committee meetings, interagency meetings, committees to discuss particular things. So really, the characteristics of bureaucracy come through here. So a lot of those meetings and conversations within government aren't necessarily visible to outsiders. So you have to think about, first of all, what are your initial points of contact, which might well be the most visible things, these public comment opportunities, public hearings, etc. And then over time, work up a reputation or relationship with individual key individuals in these agencies in order to try to more routinely influence what the agency is doing,

Scott Greer:

or hire people who already have those and enjoy playing the game. Because if you really want to be thinking about, you know, tobacco policy or your neighborhood, you don't also have the time and expertise to build the relationships in Washington, DC. So you need to understand the division of labor. And I think we can't stress enough these comments matter takeaway era choke point on every regulation in the entire federal government of the United States? Where are they getting information where they're getting a sense of what's politically salient? Yes, sometimes somebody has a contact in the White House indirectly brings them up. Yes, sometimes members of Congress will directly raise it. That's, that's good, strong lobbying. But equally, the information being fed into the system is in large part through those comments on proposed regulations, which Oh, Ira, it's the easiest thing for them to review, when somebody says this regulation is silly or burdensome.

Holly Jarman:

Right. And I think the other thing to be aware of is political appointees versus non political appointees. So we'll talk about this more in a later session when we talk about the bureaucracy. But some folks in the administration are political appointees, they have a direct line of sight, if you like to the President and political parties in that sense, and others don't have that political baggage, if you like. They are supposed to be neutral employees, they're more permanent, they stay on longer in their positions. But quite often, you'll get a situation where a political appointee is actually above several non political employees in the hierarchy. And so it's important to figure out when political appointees might be a choke point or a point of resistance to things that you're proposing.

Scott Greer:

And there's a lot of political appointees, there's 1000s. There's a subset of them who are Senate confirmed. So for example, the FDA commissioner is Senate confirmed. And this is double sided. On one hand, it means that the Senate can use its enormous powers of slowing things down and messing things up. But on the other hand, it means that the FDA commissioner more or less, by definition, has gone and established a lot of relationships on the hill with the Senate. And one of the weaknesses of CDC is that the CDC head is not actually Senate confirmed position. It's just a normal White House political appointment. And that means that you don't arrive at CDC necessarily having discussed what you plan to do there with a lot of powerful senators. The other point and this matters a lot when it came to matter from the Reagan administration in particular onwards, but there's The standard organizational hierarchy which is already diffuse enough, you know, nobody thinks the FDA commissioner is the employee of the HHS Secretary. But then there's also the ability to assault people who are often very junior sort of former heritage interns, you know, in their 20s, in order to watch the people who are actually doing the job. So the Trump administration got to the point where we had entire cabinet level agencies like HUD, Housing and Urban Development that were basically empty, where they hadn't appointed people to most of the jobs. So most of the jobs were being done by civil servants, then what you do is you go find a 26 year old who's going to make their career by being Donald Trump's guy, in this office of HUD, and this person is the strongest political lead that the civil servant in the acting position has, and can use their influence to shape what the agency is doing. So it is increasingly important after the precedents of to some extent, the W. Bush administration, but very far, far more much the Trump administration to pay attention to the likelihood that there's actually somebody with no real legal status, who is informally driving what's going on in a given agency. If you get a Republican president in the near future, I would expect that to be something to really watch, who's the 27 year old who's actually driving this theoretically civil service led office? Yep.

Holly Jarman:

And for any president, any new president, you've got to understand that, although you'll be trying to establish relationships as soon as possible, for a long time, because politics is so divisive at the moment. And we don't see that changing in the future, that there might not be some functional people in place in some of these departments. And so that's important to note. What about the judiciary? We often talk about lobbying Congress, we talk about how to influence the executive. What about judges.

Scott Greer:

So if you don't like something, basic credo of American life, take them to court. The key thing that you do, if you want to use the judiciary is find something that you do not like and sue to stop it. You don't want a building built so that the people posing it violated the National Environmental Policy Act, you don't want a regulation enforced sue to say that it's regulatory overreach, or that the agency proposing it messed up its process. You don't like abortion rights, getting a little trickier here, pass a law infringing on abortion rights under the current law, and then dare somebody to sue you in order to force the case up to the Supreme Court that can change abortion rights.

Holly Jarman:

And that's important. So you're basically they're playing judicial chicken. And this gets called strategic filing. So it's thinking several steps ahead about what this how this will play out, and how it will play out against different layers of government. So states have been deliberately passing some of these laws in basically daring, legal action to occur.

Scott Greer:

And it worked a charm. So for example, the two really prominent sort of 2021 20 to 22 abortion cases, one was Texas established a novel kind of bounty hunter mechanism, where they would pay $10,000 to people who were able to prevent an abortion essentially, and Mississippi had a flat out 15 week abortion ban. Now, I don't think it's any great surprise that Texas and Mississippi passed laws that were extremely restrictive of abortion, that's not really gonna shock anybody. But notice that part of the reason is that they're both in the Fifth Circuit. And the Fifth Circuit, we'll discuss this later is the Federal Circuit Court most likely to be interested in really novel, innovative, shall we say, conservative law. So it's strategic, that it's Mississippi that was the tip of the spear in terms of leading up to the dobs decision, because they knew that they had a politically and traditionally good place to do it.

Holly Jarman:

And there's a name for this kind of activity, and it's called forum shopping. And basically, that means looking around and understanding what the characteristics of different courts within the US political system, and understanding the kinds of cases they like to take on. And you can see already how I'm talking. This is not a value neutral proposition, we sometimes pretend that the judiciary is neutral, and it is not. And so, understanding that landscape and then strategically choosing to try and push an issue towards a particular court is a very popular thing to do within the US political system.

Scott Greer:

So this might all be sounding even more intimidating than getting in with an with an agency or with Congress, right? Because at least I can tell you write letters to Congress get to know members of Congress, you can get at them. Agencies, there's websites where you can go find out what the agencies are thinking and offer commentary on it. This game is of a qualitatively different levels, starting with the fact that it's full of lawyers. It's expensive. It involves a whole lot of information about how different judges are thinking and where filings work in different ways. It is a very complicated multi dimensional political problem that people dedicate their lives to play. So if you're thinking of using judicial politics, plenty of people do it. But notice the extent to which the system is built around established players, that over and over again, for example, if you're doing reproductive rights, you're going to find Planned Parenthood and ARL and the ACLU, arguing with conservatives from, for example, the national right to life committee.

Holly Jarman:

And similarly, if you're doing tobacco control, let's say you go and work for the American Cancer Society, you may very well be trying to do things like anticipate tobacco industry, legal action against the government, but you might also push for your own legal action. Some of these big tobacco control groups actually did sue the FDA a couple of years ago, in order to try and get a law fully implemented, that the FDA was reluctant to implement. So you know that this kind of stuff is for the big players, and you may well find yourself in a team that's connected to these big players. But on a more granular level, there are some things that you can do to try and at least understand what and educate yourself around what courts and judges are doing and saying, you might choose to think about joining an amicus brief, for example. So an amicus brief, it's a friend of the court document, it is submitted in the context of a court case in order to try to inform decision making. And so it is a not a document for, again, for amateurs, or for people to do on their own. But as part of a team, you might choose to sign on to an amicus brief that supports a particular position on a particular issue that is about to be deliberated by the court. And that's a more entry level thing that you might do, should you become a policy expert in a particular area.

Scott Greer:

And before we get into the the morrow tray ways to try and influence the law, also, bear in mind local law, and we're shades over into local law enforcement. So one of the good things that has come out of 2020s, George George Floyd protests and subsequent is a greater public understanding of the role of local law enforcement and local district attorneys and so forth, because traditionally, the only direction for district attorneys and prosecutors in such to go as to say they're going to be tougher on crime and less innovative. And there's a lot of local elected offices, which might be technically law enforcement and prosecution and might actually be judicial, but which are very susceptible to innovative political pressure in a way that you're not going to find the extremely expensive and elite bounds of places like the federal courts. Yep. So in

Holly Jarman:

other words, these judges are elected, they're local to you, maybe you have some influence, and might be able to organize around their electoral campaign, think carefully about which candidates are being selected for these positions, and start at the lower level, because the career path for these folks is up and up. And it's pretty well defined. And so judges who have relatively minor roles at a local level will eventually become much more important within the judiciary. And so the influencing those electoral campaigns is important. Now, on the same note, most recently in conservatives, in recent years have tried very hard to influence law students and Law Education in order to reframe some important questions of law with the same premise, right, the idea here that last today's law students may become tomorrow's judges, and so influencing how they think, is very important.

Scott Greer:

And there's specific organizations to do that, which conservatives rightly say, is them counterbalancing, a liberal bias within elite legal profession.

Holly Jarman:

So the judiciary might seem the least penetrable if you like, of the three branches of government. But nevertheless, I think there are things that you might strategically do to try and influence decision making in that regard. But what if your issue, we've talked a little bit about local politics, but what if your issue is not decided by the federal government or any of the big federal institutions that we've talked about? When should you go to your state government? When should you consider your local government?

Scott Greer:

So the federal government's got three and a half million ish employees, but it is still not the main service provider in almost any area that you speak of just about the only thing the federal government tends to do overwhelmingly on its own is the defense system, and that's only if you count the National Guard as federal. So over and over again, states decide things, highway rule states influenced by the federal government, Medicaid states within the bounds of the federal government. So over and over again, you're going to find that the state matters and the thing about states is their big con complicated political systems and their own rights, and some of them are hundreds of years old. And they've built up a lot of eccentricity. So one of the dicta is if you've seen one state, you've seen one state. Don't assume that the way it works in Michigan is the way that it works in Ohio. And when you move from state to state, you'll often find this just endless things you need to learn. I'd lived in other states, I had no idea what a millage was, I had a very limited idea what the powers of a township were figuring out what a charter Township is, is kind of a research project in itself. And I'm only beginning to scratch the surface of the eccentricities of Michigan. Wayne County data on public health doesn't include Detroit, because Detroit uniquely has its own public health department, etc, etc.

Holly Jarman:

Yeah, not to intimidate you all. But the US does have like 87,000

Scott Greer:

governments, we love government,

Holly Jarman:

and none of them are the same, which is quite complicated. So yeah, America loves government. They're learning these eccentricities is quite important. And especially, you know, don't be surprised if when you start looking at a new jurisdiction, the legislature has one chamber, or the governor. Yeah, the governor has some odd powers, like a line item veto, they can literally strike pieces of a law out. And so those kinds of mechanisms, it's important to focus on fortunately to help us there are some collective organizations like the National Council on state legislatures whose job it is to try and represent this diversity of government. And so I would go to those and use those kinds of resources and nature as though all of these bodies which represent now state and local government in different ways, and understanding that starting with their materials, and getting a sense of well, how does this government supposed to work is a good place to start, I think,

Scott Greer:

and one of the things to notice is that the level of what we call professionalism among state legislators varies wildly and it often interact strangely with term limits. So for example, Michigan has highly professional state legislators, it's a reasonably well paid, well supported full time job, except are very tough and fatuous. It was designed to wreck Michigan State Government, and it worked well. Term limits laws mean that it's essentially an eight year job, at which point you're necessarily unemployed, your voters might love you, but you're out because of the term limits. Now, the result is that you get some really strange political recruitment patterns on one hand, who wants a full time, all encompassing eight year job, which then ends with no necessary prospect of promotion? Well, people either at the very beginning of their careers or people at the very end of their careers, so you get a weird pattern of ideologues and retirees. Secondly, it also means that people do the strangest things in terms of political career paths where you're in the state legislature one day, and then you run for Oakland, county treasurer, the next. In the more populated areas of Michigan. This means that this kind of a circulating political class where people are mayor one day in state senator the next. But in some of the thinner, more sparsely populated rural areas, it means that there's a whole lot of amateurism, which is good from the point of view of the architects of Michigan's term limits law, because it means that the people who get elected from those areas are more dependent on lobbyists for their information.

Holly Jarman:

But we don't want to put you off thinking about state and local government, because it might be some of the most important advocacy that you do. The advantage with focusing on a state or focusing on places within a state is that if you eventually want to build support for federal action, let's say at the moment, higher levels of government are entirely gridlocked on your issue. And no matter how hard you try, you're not necessarily going to make any progress, doing advocacy work at the federal level. But let's say eventually, you would like to see action at the federal level. And that would be the most desirable policy response, you might well start by planning a strategy in which you try to build support locally and build support at state level for the kind of policies that you want to see. States are sometimes called the laboratories of democracy and Scotland, I might be a bit sarcastic about that label sometimes, but in some cases, policy ideas get can get worked out at local or state level that then become attractive over time, as more states get interested in that policy at the federal level, and so support can build. So some examples would be an interesting one is marijuana policy right now, in terms of a lot of states making choices to decriminalize or legalize marijuana? And the question is, at what point might a policy area like that cause a change of heart or a change in politics more likely, at the federal level, and you'll see some some federal action. And that kind of thing tends to happen also with in the past has happened with healthcare reform bills.

Scott Greer:

So states are increasingly part of a very, very nationalized political system. There's A general tendency with American legislators that their party ID matters more and more than the opinion of their district. So if it's kind of a 5050, read blue district, legislators are less and less likely to actually pay attention to opinion on an issue in their district, they're much more likely to just vote their party, which means districts swing wildly if they change at the elections. Nonetheless, state legislators are still far more accessible than practically anybody else. And there's some states like New Hampshire, where it seems like every third person is a member of the state legislature. So you have a lot of access to states and a lot of ability to find out what's going and meet people personally, even if frequently what's actually going on in state government is completely obscured by the collapse of the local media ecology.

Holly Jarman:

I mean, there's a reason why big interest groups who have engaged in advocacy activities, they hire professional advocates to do things at a regional level or state level, even a local level. And they there will be one person whose job it is to be the Michigan advocate, right. And they they're connected to a net whole entire network of advocates in different places around the country, that maybe they'll have one or two states to look over. But maybe they'll even just have like part of a state a couple of different cities. And it is their job to try and understand the local political situation and push locally in the effort to try and get enough momentum built up that then the state maybe flips and changes its position, etcetera. So the the big interest groups don't necessarily just focus on the federal level, they're doing all this work on the ground all the time, trying to get depending on the interest rate, trying to get draft legislation or model legislation passed in different places in order to try and demonstrate the value to policymakers at other levels of the political system.

Scott Greer:

And people build careers out of states, which means they're interested in ideas. So for example, Seema Verma, who was Trump's CMS head, she came from Indiana, where she worked for Mike Pence. And she had been in Indiana, looking for big ideas that she could spearhead that would fit with the political orientations of her boss, Governor Pence, and the Indiana State Legislature. But that would also demonstrate to the nation that she was a real player who was going to get some stuff done some innovative new thinking in, in this case, payments, reform, Medicaid, that sort of thing. And it worked. She got to go to CMS and try her ideas out.

Holly Jarman:

Right? That's the thing about a federal system is is this kind of competitive marketplace in that sense, you know, so advocates are competing to try and get noticed, governors are competing to try and get noticed with policy ideas. And other elected representatives are trying to do that to you see, mayors and house representatives, local legislative representatives, go on to take a step up and maybe take a role in federal politics at a later date, because they've cultivated reputations for interesting ideas that caught the public's attention. And that potentially, hopefully solved problems.

Scott Greer:

So in terms of advocacy, a vast number of issues you're going to find are either state issues or local government issues, and local governments have variable independence of the state governments behind them. So pay a lot of attention to state and local. This is hard. The national media is focused on national politics and the local media has been pretty much destroyed by Craigslist and social media. So it's really amazingly difficult to find basic answers to questions such as why are Michigan's roads systematically bad. So it takes persistence. But on the other hand, if you're willing to persist, your actual ability to meet the legislators, for example, is comparatively impressive. So states can be a good target for advocacy. And local governments can be a good target for advocacy, even if there's problems like the absence of good media oversight in most cases.

Holly Jarman:

And I would bring all this together by saying, the core task that lies ahead of you when you start working on an issue is to figure out who has authority to actually create change. You don't want to get that wrong. It's very important to understand what if I am pushing for this particular change in society? What policy tools will achieve that? Is it a piece of legislation? Is it some kind of rule that implements legislation? Is it some kind of court case that's needed? Is it some kind of rule at state level or law at state level or a local ordinance? So figure out the tools that are required to make the change you want to see, figure out who holds the keys to those tools who has the levers of power that can create or modify those tools? Once you know that you're going to get a sense of, Well, this is where I should focus my efforts first,

Scott Greer:

and we'll touch on Understand the agenda setting in multiple streams. But the mere fact that the President or the Speaker of the House or the Senate Majority Leader, could be enormous ly important doesn't mean you should write to them. You need to write to somebody who is actually able to say, Yes, this makes sense in my career is going to benefit. And my agenda will benefit if I listen to this person and work with this advocate. So you have to be operating an extremely high level of politics, to this think that sending a memorandum to the Speaker of the House is the most effective way to operate. And so when you're writing a policy tool, am a little more realistically, if you're mad about something, and you want to find a member of Congress, phone, your own member of Congress,

Holly Jarman:

yeah, start at the start with the people who are most accessible to you. Think about how to cultivate people that could be champions for your issue, it may be that the very first thing you do is not send a very strongly worded policy memo to a particular person, but approach them with information, approach them and try and develop a relationship. And at a later date, move on to well, this is a policy idea that is important to me. And so it's I can't stress enough that lobbying and advocacy are our long term endeavors. And most of you will be doing this with a team of folks in coalition with people in your community, in in a team with people who are in your organization, you will be able to access more resources than you have in this class in the sense of being able to understand these landscapes and create messages. But at the same time, the more you can do to understand this system at the point you're at now on what the accessible points for advocacy are to you, the better.

Scott Greer:

And so for example, let's say you want to pursue a change that's entirely within the bounds of something a state can do in Medicaid, you could write to the governor, it's not stupid. But why don't you try writing to whoever's head of the Medicaid agency, because they're the ones who are going to respond best to a political a well informed policy and political memorandum discussing the topic. And likewise, let's say you want to get something onto the agenda, you want to get something noticed? Well, your own member of Congress might not care. But there's a subcommittee on Aging at the federal level. That might be the agency whose staffers whose ranking members you might want to talk to to see about getting a hearing. So if, for example, you want more attention paid to this issue of aging, then a committee on Aging's chair is almost certainly going to have staff who will have a good look at your policy memo and might want to speak to you more. And likewise, if you want to make a Medicaid change in a state, yeah, sure the governor could order it. But it's probably wiser to start with the actual people whose job it is to think about Medicaid.

Holly Jarman:

And think not just about the memo and the message or think about the memo as a tool. But what gives your message credibility? Is it that you are known to this person is it that you bothered to take the time to establish a relationship where you send information or you have a trusted, you have a conversation, you become a bit more trusted? Is it because of the organization that you represent? Whether that's like a formal interest group within the health sector, or whether it is representing a community and being able to demonstrate Yes, a lot of people really care about this issue. There are different ways to go about that, depending on your positionality and your relationship and what you're trying to achieve. But both the message and then the trust behind the message are important.

Scott Greer:

And sometimes you say I can't be local. So let's say you're a conservative living in Ann Arbor, the odds are pretty good that you have Democrats top to bottom. Everybody you could write to who represents the place that you live is a Democrat, and they're probably not very interested in most of your policy ideas. Well, that's when you start to think about building connections where you start thinking about, for example, who are Republicans who have some other reasons, such as a subject matter expertise, in listening to your ideas, right. So you might not have a Republican legislator, but there's other Republican legislators who can be identified who will want to hear your ideas about Medicaid at the state level, or aging or what have you.

Holly Jarman:

So that's a lot to throw at you at once. But we hope that by looking at American government and the political system from this perspective of what do I want to achieve, what change do I want to see? And then just thinking strategically and rationally about some steps that you can take to identify the right places to focus your efforts? We think that's a reasonable place to start in terms of trying out advocacy, and we hope that this was a useful discussion for all of you