Theories of policy and institutional reform are of major interest to numerous disciplines in the social sciences. The main question motivating this study is under what circumstances is dramatic reform possible. It is argued that theories of reform formulated within two central heuristic frameworks—historical institutionalism and punctuated equilibrium—fail to satisfactorily explain reform dynamics in small policy domains, which are characterized by having program constituencies with little political clout. In small policy domains, dramatic reform is facilitated by the political weakness of the opposition. Policy makers are able to pursue reform successfully in small domains without resorting to obfuscation strategies or reliance on slow-moving institutional mechanisms. This argument is illustrated in a study of mental health care privatization in two American states: Massachusetts and Texas.
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