Presidents, Prime Ministers and Health Care Reform in Political Time: Using Stephen Skowronek's Institutional Theory to Compare Leadership Behaviour in Britain and the United States

Despite the vast scholarship on presidential leadership, scholars continue to grapple with the issue of the power and authority of the president. Each new president invites a plethora of analysis, discussion and debate, each time reigniting this question. Rarely however, do scholars evaluate more than a single president; rarely do they compare their power, their circumstances, their personalities. It is for this reason that Stephen Skowronek’s theory of presidential leadership is so notable. Indeed, Skowronek’s theory, first articulated in The Politics Presidents Make (1993) and then revised and expanded in Presidential Leadership in Political Time (2008; 2011), fundamentally changed the way scholars and others interpret the American presidency and its development over time. While his theory was also an attempt to answer the perennial question of power and authority, it went much further in its attempt to develop a generalisable theory of leadership that could be applied to all presidents. With Skowronek’s original contribution in mind, this thesis takes his theory and tests its utility in a comparative context. The thesis is driven by three questions: (i) is the theory applicable to Britain – can it effectively explain recent British political leadership? (ii) can an American Political Development (APD) approach be successfully utilised in a comparative context? and (iii) does a mechanism to further specify the expected leadership behaviour of presidents and prime ministers increase the effectiveness of Skowronek’s theory when applied to an empirical context? The thesis addresses these questions using health care reform as a case study to determine the extent to which leaders’ behaviour is institutionally constrained and the impact on their policy-making decisions and outcomes. The main contention of this project is that Skowronek’s theory can be successfully applied to explain the leadership behaviour of British prime ministers, with a comparison based on shared leadership categorisations and macro-level structural similarities. The thesis maintains that Skowronek underestimates the importance of, and neglects to include mechanisms in his model that accurately consider the role of agency, specifically the agency a leader has when confronting constraints. Leadership is inherently more subjective and agency-driven than the theory recognises. The thesis offers a mechanism to join structure and agency more effectively, arguing that it is this that increases the potential of applying Skowronek’s theory successfully. This thesis not only further breaks down the barriers preventing comparisons of (same-country) leaders over time, but also offers a precedent for comparison of leaders across countries. Ultimately, it is hoped that scholars will explicitly recognise that more can be gained from studying leaders in a comparative context at the same time as acquiring a better understanding of power and leadership, whether its historical patterns or its contemporary challenges