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Marketization via Compensation: Health Care and the Politics of the Right in Advanced Industrialized Nations

Abstract

A novel theory of the healthcare policy of right-wing governments is presented in this article. It posits that the politics of health care is inherently different from the politics of a social policy related to the labour market. Health care protects against risks that are in the main uncorrelated with the income distribution. This implies that median voters will favour public provision, while high-income voters will not. This generates a unique challenge to right-wing governments that have to balance the interests of the two. The solution is marketization via compensation, where public spending is expanded but where public support of private market solutions is given special priority.

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12 Evans, ‘Going for the Gold’; Willcox Sharon, ‘Promoting Private Health Insurance in Australia’, Health Affairs, 20 (2001), 152161; Hacker, The Divided Welfare State; King Derek and Mossialos Elias, ‘The Determinants of Private Medical Insurance Prevalence in England, 1997–2000’, HSR: Health Services Research, 40 (2005), 195212.

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15 Hacker, ‘Dismantling the Health Care State?’ p. 693.

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19 Interestingly, in some of Hacker's work on the United States, the role of conservatives is more prominent, and yet in his work dealing with cross-national variation, this explanatory factor is more or less absent.

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21 E.g., Pierson, Dismantling the Welfare State; Huber and Stephens, Development and Crisis of the Welfare State; Korpi and Palme, ‘New Politics and Class Politics in the Context of Austerity and Globalization’; Allan and Scruggs, ‘Political Partisanship and Welfare State Reform in Advanced Industrial Societies’.

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23 Pierson, Dismantling the Welfare State.

24 Cusack, Iversen and Rehm, ‘Risks at Work: The Demand and Supply Sides of Government Redistribution’.

25 Korpi and Palme, ‘New Politics and Class Politics in the Context of Austerity and Globalization’; Allan and Scruggs, ‘Political Partisanship and Welfare State Reform in Advanced Industrial Societies’.

26 Esping-Andersen, Social Foundations of Postindustrial Societies.

27 E.g., Bradley David, Huber Evelyne, Moller Stephanie, Nielsen François and Stephens John D., ‘Distribution and Redistribution in Postindustrial Democracies’, World Politics, 55 (2003), 193228.

28 Williams David R., ‘Socioeconomic Differentials in Health: A Review and Redirection’, Social Psychology Quarterly, 53 (1990), 8199; House James S., ‘Understanding Social Factors and Inequalities in Health: 20th Century Progress and 21st Century Prospects’, Journal of Health and Social Behavior, 43 (2002), 125142.

29 Le Grand Julian, ‘The Distribution of Public Expenditure: The Case of Health Care’, Economica, 45 (1978), 125142.

30 Jæger Mads M., ‘Equal Access, but Unequal Outcomes: Cultural Capital and Educational Choice in a Meritocratic Society’, Social Forces, 87 (2009), 19431972.

31 Evans, ‘Going for the Gold’.

32 Pierson, Dismantling the Welfare State?

33 Evans, ‘Going for the Gold’; Willcox, ‘Promoting Private Health Insurance in Australia’; Hacker, The Divided Welfare State; King and Mossialos, ‘The Determinants of Private Medical Insurance Prevalence in England, 1997–2000’.

34 Korpi and Palme, ‘The Paradox of Redistribution’; Rothstein, Just Institutions Matter.

35 On institutional layering, see Hacker, ‘Privatizing Risks without Privatizing the Welfare State’.

36 Pierson, Dismantling the Welfare State? p. 74.

37 Lyle Scruggs, Welfare State Entitlements Data Set: A Comparative Institutional Analysis of Eighteen Welfare States, Version 1.1. Available at http://sp.uconn.edu/~scruggs/wp.htm.

38 Korpi and Palme, ‘New Politics and Class Politics in the Context of Austerity and Globalization’; Allan and Scruggs, ‘Political Partisanship and Welfare State Reform in Advanced Industrial Societies’.

39 Duane Swank, Comparative Parties Dataset. See http://www.marquette.edu/polisci/faculty_swank.shtml.

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44 Hacker, ‘Dismantling the Health Care State?’

45 Pierson, Dismantling the Welfare State?

46 Universal benefits are given to everyone regardless of income; ‘residual’ benefits are given only to the most needy.

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51 Sundhedsloven §87; Lovbekendtgørelse no. 95, 7 February 2008.

52 The Audit of State Accounts, Beretning til Statsrevisionerne om pris, kvalitet og adgang til behandling på private sygehuse (Copenhagen: The Audit of State Accounts, 2009).

53 Ligningsloven §30; Lovbekendtgørelse, no. 176, 11 March 2009.

54 Forsikring & Pension, Arbejdsgiverbetalte forsikringer i perioden 20032008 (Copenhagen: Forsikring & Pension, 2008); Bræmer Michael, ‘Velstillede vælter sig i sundhedsforsikringer’, Ugebrevet A4 (2008), 1 December 2008.

55 Bræmer, ‘Velstillede vælter sig i sundhedsforsikringer’; Kjellberg Jakob, Nyhus Andreasen Michael and Søgaard Jes, Private Sundhedsforsikringer (Copenhagen: Dansk Sundhedsinstitut, 2010).

56 Esping-Andersen, The Three Worlds of Welfare Capitalism; Huber and Stephens, Development And Crisis of the Welfare State.

57 Scotton Richard B., ‘Medibank: From Conception to Delivery and Beyond’, Medical Journal of Australia, 173 (2000), 911; Colombo Francesca and Tapay Nicole, Private Health Insurance in Australia: A Case Study (Paris: OECD, 2003).

58 Willcox, ‘Promoting Private Health Insurance in Australia’; Colombo and Tapay, Private Health Insurance in Australia.

59 Scotton, ‘Medibank’.

60 On the various policies, see Willcox, ‘Promoting Private Health Insurance in Australia’; Blendon Robert J., Schoen Cathy, DesRoches Catherine, Osborn Robin and Zapert Kinga, ‘Common Concerns amid Diverse Systems: Health Care Experiences in Five Countries’, Health Affairs, 22 (2003), 106121; Colombo and Tapay, Private Health Insurance in Australia; Australian Institute of Health and Welfare, Health Expenditure Australia 2007–2008 (Canberra: Australian Institute of Health and Welfare, 2009).

61 Australian Institute of Health and Welfare, Health Expenditure Australia 2007–2008, pp. 21–22; see also Moorin Rachael Elizabeth and Holman Cashel D'Arcy J., ‘Does Federal Health Care Policy Influence Switching between the Public and Private Sectors in Individuals’, Health Policy, 79 (2006), 284295.

62 Willcox, ‘Promoting Private Health Insurance in Australia’; Hindle Don and McAuley Ian, ‘The Effects of Increased Private Health Insurance: A Review of the Evidence’, Australian Health Review, 28 (2004), 119138.

63 Pierson, Dismantling the Welfare State; Pierson, ‘The New Politics of the Welfare State’; Huber and Stephens, Development and Crisis of the Welfare State.

64 Korpi and Palme, ‘New Politics and Class Politics in the Context of Austerity and Globalization’; Allan and Scruggs, ‘Political Partisanship and Welfare State Reform in Advanced Industrial Societies’.

65 Pierson, Dismantling the Welfare State.

66 Lindbom Anders, ‘Obfuscating Retrenchment: Swedish Welfare Policy in the 1990s’, Journal of Public Policy, 27 (2007), 129150.

* Department of Political Science, Aarhus University (email: ). The author wishes to thank Jørgen Goul Andersen, Viola Burau, Marius Busemeyer, Christoffer Green-Pedersen and Deborah Stone for comments on earlier drafts of this article.

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British Journal of Political Science
  • ISSN: 0007-1234
  • EISSN: 1469-2112
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