The historical logic of national health insurance: Structure and sequence in the development of British, Canadian, and U.S. medical policy

Studies in American Political Development

Volumn 12, Issue 1, 1998, Pages 57-130

  Hacker, Jacob S ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

EID: 0032377251     PISSN: 0898588X     EISSN: None     Source Type: Journal    
DOI: 10.1017/s0898588x98001308     Document Type: Article

References (241)

1. Computed from Organization for Economic Cooperation and Development, The Reform of Health Care Systems: A Review of Seventeen OECD Countries (Paris: Organization for Economic Cooperation and Development, 1994), 38. The comparison with pensions is made by Karl Hinrichs, "The Impact of German Health Insurance Reforms on Redistribution and the Culture of Solidarity," Journal of Health Politics, Policy and Law 20 (1996): 653-87.
2. Computed from Organization for Economic Cooperation and Development, The Reform of Health Care Systems: A Review of Seventeen OECD Countries (Paris: Organization for Economic Cooperation and Development, 1994), 38. The comparison with pensions is made by Karl Hinrichs, "The Impact of German Health Insurance Reforms on Redistribution and the Culture of Solidarity," Journal of Health Politics, Policy and Law 20 (1996): 653-87.
3. Deltov Zöllner, "Germany," in The Evolution of Social Insurance, 1881-1981, ed. Peter A. Köhler, F. Zacher, and Martin Partington (New York: St. Martin's, 1982), 25-26.
4. Rudolf Klein, The Politics of the National Health Service, 2d ed. (London: Longman 1989), 1.
5. Theodore R. Marmor, The Politics of Medicare (New York: Aldine, 1973).
6. Adam Przeworiki and Henry Tuene, The Logic of Comparative Social Inquiry (Malabar, FL. Robert E, Krieger Publishing, 1970), 32-34.
7. Variants of the argument include the "logic of industrialism" perspective, in which the welfare state emerges to fill the gap left by the decline of traditional social institutions and the rise of new forms of social dislocation, and the structural Marxist perspective, in which the welfare state is a response to the systemic imperatives of capital accumulation in capitalist economies. For discussions of these perspectives, and their difficulties, see Harold L. Wilensky, Gregory M. Luebbert, and Susan Reed Hahn, Comparative Social Policy: Theories, Methods, Findings (Berkeley, CA: Institute of International Studies, 1985) ,5-12; Theda Skocpol, Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States (Cambridge, MA: Harvard University Press, 1992), 12-14; and Gøsta Esping-Anderson, The Three Worlds of Welfare Capitalism (Princeton, NJ: Princeton University Press, 1990), 13-14.
8. Variants of the argument include the "logic of industrialism" perspective, in which the welfare state emerges to fill the gap left by the decline of traditional social institutions and the rise of new forms of social dislocation, and the structural Marxist perspective, in which the welfare state is a response to the systemic imperatives of capital accumulation in capitalist economies. For discussions of these perspectives, and their difficulties, see Harold L. Wilensky, Gregory M. Luebbert, and Susan Reed Hahn, Comparative Social Policy: Theories, Methods, Findings (Berkeley, CA: Institute of International Studies, 1985) ,5-12; Theda Skocpol, Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States (Cambridge, MA: Harvard University Press, 1992), 12-14; and Gøsta Esping-Anderson, The Three Worlds of Welfare Capitalism (Princeton, NJ: Princeton University Press, 1990), 13-14.
9. Variants of the argument include the "logic of industrialism" perspective, in which the welfare state emerges to fill the gap left by the decline of traditional social institutions and the rise of new forms of social dislocation, and the structural Marxist perspective, in which the welfare state is a response to the systemic imperatives of capital accumulation in capitalist economies. For discussions of these perspectives, and their difficulties, see Harold L. Wilensky, Gregory M. Luebbert, and Susan Reed Hahn, Comparative Social Policy: Theories, Methods, Findings (Berkeley, CA: Institute of International Studies, 1985) ,5-12; Theda Skocpol, Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States (Cambridge, MA: Harvard University Press, 1992), 12-14; and Gøsta Esping-Anderson, The Three Worlds of Welfare Capitalism (Princeton, NJ: Princeton University Press, 1990), 13-14.
10. The figures for Britain, the United States, and Canada are from, respectively, Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982), 240; Health Insurance Association of America (HIAA), Source Book of Health Insurance Data (Washington, DC: Health Insurance Association of America, 1991), 24; and C, Howard Shillington, The Road to Medicare in Canada (Toronto: Del Graphics Publishing, 1972), 202.
11. The figures for Britain, the United States, and Canada are from, respectively, Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982), 240; Health Insurance Association of America (HIAA), Source Book of Health Insurance Data (Washington, DC: Health Insurance Association of America, 1991), 24; and C, Howard Shillington, The Road to Medicare in Canada (Toronto: Del Graphics Publishing, 1972), 202.
12. The figures for Britain, the United States, and Canada are from, respectively, Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982), 240; Health Insurance Association of America (HIAA), Source Book of Health Insurance Data (Washington, DC: Health Insurance Association of America, 1991), 24; and C, Howard Shillington, The Road to Medicare in Canada (Toronto: Del Graphics Publishing, 1972), 202.
13. J, Rogers Hollingsworth, Jerald Hage, and Robert A, Hanneman, State Intervention, in Medical Care (Ithaca, NY: Cornell University Press, 1990), 30-62.
14. For this reason, the statistical technique used by Hollingworth and his colleagues-hierarchical causal path analysis-is suspect As Hollingiworth and colleague recognize (ibid., 216-28), this technique assumes that the causal link between medical system characteristics and state intervention is unidirectional (that is, complexity causes intervention). If, as I argue, the relationsliip is one of mutual causation, the result will be biased.
15. See Clifford Geertz, The Interpretation of Cultures (New York: Basic Books, 1973); Gabriel Almond and Sidney Verba, The Civic Culture (Boston: Little, Brown, 1963); and Gaston Rimlinger, Welfare Policy and Industrialization in Europe, America, and Russia (New York: Wiley, 1971), For a comparative application to health policy, see Lawrence R. Jacobs, "Institutions and Culture: Health Policy and Public Opinion in U.S. and Britain," World Politics 44 (1992): 179-209.
16. See Clifford Geertz, The Interpretation of Cultures (New York: Basic Books, 1973); Gabriel Almond and Sidney Verba, The Civic Culture (Boston: Little, Brown, 1963); and Gaston Rimlinger, Welfare Policy and Industrialization in Europe, America, and Russia (New York: Wiley, 1971), For a comparative application to health policy, see Lawrence R. Jacobs, "Institutions and Culture: Health Policy and Public Opinion in U.S. and Britain," World Politics 44 (1992): 179-209.
17. See Clifford Geertz, The Interpretation of Cultures (New York: Basic Books, 1973); Gabriel Almond and Sidney Verba, The Civic Culture (Boston: Little, Brown, 1963); and Gaston Rimlinger, Welfare Policy and Industrialization in Europe, America, and Russia (New York: Wiley, 1971), For a comparative application to health policy, see Lawrence R. Jacobs, "Institutions and Culture: Health Policy and Public Opinion in U.S. and Britain," World Politics 44 (1992): 179-209.
18. See Clifford Geertz, The Interpretation of Cultures (New York: Basic Books, 1973); Gabriel Almond and Sidney Verba, The Civic Culture (Boston: Little, Brown, 1963); and Gaston Rimlinger, Welfare Policy and Industrialization in Europe, America, and Russia (New York: Wiley, 1971), For a comparative application to health policy, see Lawrence R. Jacobs, "Institutions and Culture: Health Policy and Public Opinion in U.S. and Britain," World Politics 44 (1992): 179-209.
19. Daniel S. Hirshfield, The Lost Reform: The Campaign for Compulsory Health Insurance in the United States from 1932-1943 (Cambridge, MA: Harvard University Press, 1970).
20. Roy Lubove, The Struggle Social Security, 1900-1935 (1968; Pittsburgh: University of Pittsburgh Press, 1986).
21. Daniel Levine, Poverty and Society: The Growth of the American Welfare State in International Comparison (New Brunswick, NJ: Rutgers University Press, 1988), 179.
22. See, however, Starr, The Social Transformation of American Mediane, 278-79.
23. Hugh Heclo, Modern Social Politics in Britain and Sweden (New Haven, CT; Yale University Press, 1974), 288-304.
24. Seymour Martin Lipset, Continental Divide: The Values and Institutions of the United States and Canada (New York: Routledge, 1990), 2, xvi, 138.
25. See in particular The Federalist, Nos, 10, 51 (James Madison).
26. Maurice Duverger, Political Parties (New York: Wiley, 1954); Douglas R. Rae, The Political Consequences of Electoral Laws (New Haven, CT: Yale University Press, 1971); Gary W. Cox, "Centripetal and Centrifugal Incentives in Electoral Systems," American Journal of Political Science 34 (1990): 905-35.
27. Maurice Duverger, Political Parties (New York: Wiley, 1954); Douglas R. Rae, The Political Consequences of Electoral Laws (New Haven, CT: Yale University Press, 1971); Gary W. Cox, "Centripetal and Centrifugal Incentives in Electoral Systems," American Journal of Political Science 34 (1990): 905-35.
28. Maurice Duverger, Political Parties (New York: Wiley, 1954); Douglas R. Rae, The Political Consequences of Electoral Laws (New Haven, CT: Yale University Press, 1971); Gary W. Cox, "Centripetal and Centrifugal Incentives in Electoral Systems," American Journal of Political Science 34 (1990): 905-35.
29. Paul Pierson, "When Effect Becomes Cause: Policy Feedback and Political Change," World Politics 45 (1993): 606. See also, Paul Pierson, Dismantling the Welfare Safe? Reagan, Thatcher, and the Politics of Retrenchment (New York; Cambridge University Press, 1994); and Esping-Anderson, Three Worlds.
30. Paul Pierson, "When Effect Becomes Cause: Policy Feedback and Political Change," World Politics 45 (1993): 606. See also, Paul Pierson, Dismantling the Welfare Safe? Reagan, Thatcher, and the Politics of Retrenchment (New York; Cambridge University Press, 1994); and Esping-Anderson, Three Worlds.
31. Paul Pierson, "When Effect Becomes Cause: Policy Feedback and Political Change," World Politics 45 (1993): 606. See also, Paul Pierson, Dismantling the Welfare Safe? Reagan, Thatcher, and the Politics of Retrenchment (New York; Cambridge University Press, 1994); and Esping-Anderson, Three Worlds.
32. Bo Rothstein, "Just Institutions Matter: The Moral Logic of the Universal Welfare State," Uppsala University, photocopy, 1994.
33. John R. Searle, The Construction of Social Reality (New York: Free Press, 1995).
34. Michael Shalev, "The Social Democratic Model and Beyond: Two Generations of Comparative Research on the Welfare State," Comparative Social Research 6 (1983): 315-51.
35. Ellen M. Immergut, "The Rules of the Game: The Logic of Health Policy-Making in France, Switzerland, and Sweden," in Structuring Politics: Historical Institutionalism in Comparative Analysis, ed. Sven Steinmo, Kathleen Thelen, and Frank Longstreth (New York: Cambridge University Press, 1992), 57-58. See also Ellen M, Immergut, Health Politics: Interests and Institutions in Western Europe (New York: Cambridge University Press, 1992).
36. Ellen M. Immergut, "The Rules of the Game: The Logic of Health Policy-Making in France, Switzerland, and Sweden," in Structuring Politics: Historical Institutionalism in Comparative Analysis, ed. Sven Steinmo, Kathleen Thelen, and Frank Longstreth (New York: Cambridge University Press, 1992), 57-58. See also Ellen M, Immergut, Health Politics: Interests and Institutions in Western Europe (New York: Cambridge University Press, 1992).
37. If, as I argue, doctors' preferences vary over time and across countries, that would seem to call into question Immergut's claim that her research method allows her to hold the interests of the medical profession "constant and . . . observe the effects of the institutions on the policy process" (Immergut, Health Politics, 252 n. 38). Although doctors in the countries she studied certainly had similar interests, clear intertemporal and cross-national differences emerge in her case studies even when one takes into account the different strategic contexts that the profession faced. Moreover, Immergut does not explore the reciprocal influence of policy decisions on the preferences of doctors-a historical feedback effect that will be a major subject of my analysis.
38. Harry Eckstein, The English Health Service: Its Origins, Structure, and Achievements (Cambridge, MA: Harvard University Press, 1958), 118. An internal poll of the BMA membership at the time showed a majority of doctors in agreement with the government on every important substantive issue and nearly 40 percent of doctors in agreement with the entire scheme (ibid., 147). BMA opposition increased after the Labour Party came to power in 1945, but the organization never reacted with the kind of vehemence that characterized the AMA's response to the far more modest American reform proposals of the 1940s.
39. Harry Eckstein, The English Health Service: Its Origins, Structure, and Achievements (Cambridge, MA: Harvard University Press, 1958), 118. An internal poll of the BMA membership at the time showed a majority of doctors in agreement with the government on every important substantive issue and nearly 40 percent of doctors in agreement with the entire scheme (ibid., 147). BMA opposition increased after the Labour Party came to power in 1945, but the organization never reacted with the kind of vehemence that characterized the AMA's response to the far more modest American reform proposals of the 1940s.
40. Malcolm G, Taylor, Health Insurance and Canadian Public Policy: The Seven Decision That Created the Canadian Health Insurance System and Their Outcomes (Toronto; McGill-Queen's University Press, 1987), 23.
41. Ibid., 108.
42. Robin F. Badgley and Samuel Wolfe, Doctors' Strike: Medical Care and Conflict in Sashatchewan (New York: Atherton, 1967).
43. See, for example, Walter Korpi, The Democratic Class Struggle (London: Routledge 1983); and John Stephens, The Transition from Capitalism to Socialism (London: Macmillan, 1979).
44. See, for example, Walter Korpi, The Democratic Class Struggle (London: Routledge 1983); and John Stephens, The Transition from Capitalism to Socialism (London: Macmillan, 1979).
45. Michael Foot, quoted in Klein, The Politis of the National Health Service, 1.
46. Indeed, a remarkable degree of consensus existed among Conservative and Labour politicians about the necessary features of a national plan, so much so that Klein's authoritative account characterizes the development of the NHS as a process of "social learning" rather one of partisan struggle (ibid., 26).
47. Strikes, for example, were actually more frequent in the United States than in the United Kingdom. Victoria Hattam, Labor Visions and State Power (Princeton, NJ: Princeton University Press, 1993), Table 1. On comparative unionization, see Skocpol, Protecting Soldiers and Mothers, 219, Indeed, the critical difference between British and U.S, unions during this period was not their organizational strength, but their orientation and strategies. In the United States, the national American Federation of Labor led by Samuel Gompers actually opposed compulsory health insurance as a threat to private union contracts.
48. Strikes, for example, were actually more frequent in the United States than in the United Kingdom. Victoria Hattam, Labor Visions and State Power (Princeton, NJ: Princeton University Press, 1993), Table 1. On comparative unionization, see Skocpol, Protecting Soldiers and Mothers, 219, Indeed, the critical difference between British and U.S, unions during this period was not their organizational strength, but their orientation and strategies. In the United States, the national American Federation of Labor led by Samuel Gompers actually opposed compulsory health insurance as a threat to private union contracts.
49. Noah M, Meltz, "Labor Movements in Canada and the United States," in Challenges and Choices Facing American Labor, ed. Thomas A. Kochan (Cambridge, MA; The MIT Press, 1985), 315-16.
50. See, for example, Peter B. Evans, Dietrich Rueschemeyer, and Theda Skocpol, eds., Bringing the State Back In (New York: Cambridge University Press, 1985) ; Peter A. Hall, Governing the Economy; The Politics of State Intervention in Britain and France (Cambridge: Polity Press, 1986); and Sven Steinmo, Kathleen Thelen, and Frank Longstreth, eds., Structuring Politics: Historical Institutionalism in Comparative Analysis (New York: Cambridge University Press, 1992).
51. See, for example, Peter B. Evans, Dietrich Rueschemeyer, and Theda Skocpol, eds., Bringing the State Back In (New York: Cambridge University Press, 1985) ; Peter A. Hall, Governing the Economy; The Politics of State Intervention in Britain and France (Cambridge: Polity Press, 1986); and Sven Steinmo, Kathleen Thelen, and Frank Longstreth, eds., Structuring Politics: Historical Institutionalism in Comparative Analysis (New York: Cambridge University Press, 1992).
52. See, for example, Peter B. Evans, Dietrich Rueschemeyer, and Theda Skocpol, eds., Bringing the State Back In (New York: Cambridge University Press, 1985) ; Peter A. Hall, Governing the Economy; The Politics of State Intervention in Britain and France (Cambridge: Polity Press, 1986); and Sven Steinmo, Kathleen Thelen, and Frank Longstreth, eds., Structuring Politics: Historical Institutionalism in Comparative Analysis (New York: Cambridge University Press, 1992).
53. Theda Skocpol, "Bringing the State Back In: Strategies of Analysis in Current Research," in Bringing the State Back In, 9.
54. Margaret Weir and Theda Skocpol, "State Structures and the Possibilities for 'Keynesian' Responses to the Great Depression in Sweden, Britain, and the United States," in Bringing the State Back In, 118.
55. Martha Derthick, Policymaking for Social Security (Washington, DC: Brookings, 1979), 316-38. The Social Security Administration (SSA) actually began as the Social Security Board-a three-member board that administered old-age insurance and other Social Security Act programs until 1946, when the SSA inherited its duties. To avoid confusion, however, I use SSA throughout this article.
56. As Immergut notes in the European context, bureaucracies in very different countries "have prepared quite similar proposals for national health insurance, and the differences in what was ultimately enacted cannot be traced to differences in the implementing bureaucracies." Immergut, Health Politics, 24.
57. On early theories, see David R. Cameron, "The Expansion of the Public Economy: A Comparative Analysis," American Political Science Review 72 (1978): 1248. (Cameron, in fact, found the opposite effect.) For current theories, see Paul E. Peterson, City Limits (Chicago: University of Chicago Press, 1981); and Peterson, The Price of Federalism (Washington, DC: Brookings, 1995).
58. On early theories, see David R. Cameron, "The Expansion of the Public Economy: A Comparative Analysis," American Political Science Review 72 (1978): 1248. (Cameron, in fact, found the opposite effect.) For current theories, see Paul E. Peterson, City Limits (Chicago: University of Chicago Press, 1981); and Peterson, The Price of Federalism (Washington, DC: Brookings, 1995).
59. On early theories, see David R. Cameron, "The Expansion of the Public Economy: A Comparative Analysis," American Political Science Review 72 (1978): 1248. (Cameron, in fact, found the opposite effect.) For current theories, see Paul E. Peterson, City Limits (Chicago: University of Chicago Press, 1981); and Peterson, The Price of Federalism (Washington, DC: Brookings, 1995).
60. In contemporary research on state health policies, the constrained range and scope of state-level initiatives are frequently linked to the Employee Retirement Income Security Act (ERISA), a 1974 federal law that prevents states from taxing or regulating insurers who "self-insure" (that is, pay for employee medical claims themselves). But, as Carolyn Tuohy argues, "there was little evidence of state activism in the health care financing arena before the passage of ERISA in 1974" ("Variation in Health Care Policy in the American States: The Dog That Didn't Bark," [University of Toronto, photocopy, p. 2]). The obvious exception to this generalization is of course Hawaii, which started its program just as ERISA took effect and now enjoys a special ERISA waiver.
61. For a summary of this revisionist scholarship, see Gwendolyn Gray, Federalism and Health Policy: The Development of Health Systems in Canada and Australia (Toronto: University of Toronto Press, 1991), 12-14.
62. For a parallel argument that expands on these points, see Paul Pierson, "Fragmented Welfare States: Federal Institutions and the Development of Social Policy," Governances 8 (1995): 463-67.
63. Frank J. Sorauf, Party Politics in America (Boston: Little, Brown, 1968), 32.
64. Antonia Maioni, "Parting at the Crossroads: The Development of Health Insurance in Canada and the United States," Comparative Politics 29 (1997): 413-14. I am also indebted to Kent Weaver for emphasizing this point.
65. Pierson, "Fragmented Welfare States," 466.
66. Immergut, for instance, speaks of a country's "institutional configuration," which she defines as "the political system taken as a whole, with all its institutional provisions and a particular distribution of partisan representatives," Immergut, Health Politics, 28, The danger here is including aspects of the political environment that are not, properly speaking, institutional. The "distribution of partisan representatives," for example, is obviously shaped by electoral rules and procedures, but it is also influenced by a host of noninstitutional factors-public opinion, foreign crises, economic performance, political scandals, and so on.
67. R. Kent Weaver and Bert A. Rockman, "Assessing the Effect of Institutions," in Do lnstitutions Matter? Government Capabilities in the United States and Abroad, ed, R. Kent Weaver and Bert A. Rockman (Washington, DC; Brookings, 1993), 19-21.
68. Lipset, Continental Divide, 205.
69. On the status quo bias created by multiple veto points, see Iminergut, Health Politics; and George Tsebelis, "Decision Making in Political Systems: Veto Players in Presidentialism, Parliamentarism, Multicameralism and Multipartyism," British Journal of Political Science 25 (1995): 289-325.
70. On the status quo bias created by multiple veto points, see Iminergut, Health Politics; and George Tsebelis, "Decision Making in Political Systems: Veto Players in Presidentialism, Parliamentarism, Multicameralism and Multipartyism," British Journal of Political Science 25 (1995): 289-325.
71. Svera Steinmo, "American Exceptionalism Reconsidered: Culture or Institution?," in The Dynamics of American Politics, ed, Lawrence C. Dodd and Calvin Jillson (Boulder, CO: Westview, 1994), 126-27.
72. The classic account of how congressional individualism fuels distributive particularism is David R. Mayhew, Congress: The Electoral Connection (New Haven, CT: Yale University Press, 1974).
73. W. Brian Arthur, "Competing Technologies, Increasing Returns, and Lock-In by Historical Events, Economic Journal 99 (1989): 116-31; Paul David, "Clio and the Economics of QWERTY," Economic History 75 (1985): 332-37; Douglass C. North, Institutions, Institutional Change, and Economic Performance (New York: Cambridge University Press, 1990).
74. W. Brian Arthur, "Competing Technologies, Increasing Returns, and Lock-In by Historical Events, Economic Journal 99 (1989): 116-31; Paul David, "Clio and the Economics of QWERTY," Economic History 75 (1985): 332-37; Douglass C. North, Institutions, Institutional Change, and Economic Performance (New York: Cambridge University Press, 1990).
75. W. Brian Arthur, "Competing Technologies, Increasing Returns, and Lock-In by Historical Events, Economic Journal 99 (1989): 116-31; Paul David, "Clio and the Economics of QWERTY," Economic History 75 (1985): 332-37; Douglass C. North, Institutions, Institutional Change, and Economic Performance (New York: Cambridge University Press, 1990).
76. David, "Clio and the Economics of QWERTY," 332.
77. Arthur, "Self-Reinforcing Mechanisms in Economics," in The Economy at an Evolving Complex System, ed. Kenneth J. Arrow and David Pines (Reading, MA: Addison-Wesley, 1988), 10.
78. Pierson, "When Effects Becomes Cause,"
79. Ibid., 606.
80. For more on counterfactual analysis, its rationale, and its proper use, see James D. Fearon,"Counterfactuals and Hypothesis Testing in Political Science," World Politics 43 (1991): 169-95.
81. Ruth Berins Collier and David Collier, Shaping the Political Arena: Critical Junctures, the Labor Movement, and Regime Dynamics in Latin America (Princeton, NJ: Princeton University Press, 1991), 29.
82. Classic works dealing with such seminal moments in national development include Seymour Martin Lipset and Stein Rokkam, "Cleavage Structures, Parly Systems, and Voter Alignments: An Introduction," in Political Parties and Political Development, ed, Joseph LaPalombara and Myron Weiner (Princeton, NJ: Princeton University Press, 1960); Barrington Moore, Jr., Social Origins of Dictatorship and Democracy: Lord and Peasant in the Making of the Modern World (Boston: Beacon, 1966); and Alexander Gerschenkron, Economic Backwardness in Historical Perspective: A Book of Essays (Cambridge, MA: Harvard University Press, 1962).
83. Classic works dealing with such seminal moments in national development include Seymour Martin Lipset and Stein Rokkam, "Cleavage Structures, Parly Systems, and Voter Alignments: An Introduction," in Political Parties and Political Development, ed, Joseph LaPalombara and Myron Weiner (Princeton, NJ: Princeton University Press, 1960); Barrington Moore, Jr., Social Origins of Dictatorship and Democracy: Lord and Peasant in the Making of the Modern World (Boston: Beacon, 1966); and Alexander Gerschenkron, Economic Backwardness in Historical Perspective: A Book of Essays (Cambridge, MA: Harvard University Press, 1962).
84. Classic works dealing with such seminal moments in national development include Seymour Martin Lipset and Stein Rokkam, "Cleavage Structures, Parly Systems, and Voter Alignments: An Introduction," in Political Parties and Political Development, ed, Joseph LaPalombara and Myron Weiner (Princeton, NJ: Princeton University Press, 1960); Barrington Moore, Jr., Social Origins of Dictatorship and Democracy: Lord and Peasant in the Making of the Modern World (Boston: Beacon, 1966); and Alexander Gerschenkron, Economic Backwardness in Historical Perspective: A Book of Essays (Cambridge, MA: Harvard University Press, 1962).
85. See, for example, Collier and Collier, Shaping the Political Arena, 27.
86. On punctuated equilibria in institutional development, see Stephen D. Krasner, "Approaches to the State: Alternative Conceptions and Historical Dynamics, " Comparative Politics 16 (1984): 223-46.
87. Kathleen Thelen and Sven Steinmo,"Historical Institutionalism in Comparative Politics," in Structuring Politics. This generalization does not, of course, apply to all historical institutionalists, some of whom have been quite sensitive to temporal questions and issues of institutional change. Still, as Paul Pierson notes, "The significance of temporal processes in historical institutionalist analysis is often left implicit or downplayed. Much of this work has been essentially inductive in orientation, and in general practitioners have not been inclined to reflect on their methods." Paul Pierson, "Path Dependence, Increasing Returns, and the Study of Politics," Program for the Study of Germany and Europe Working Paper Series 7.7 (Center for European Studies, Harvard University, Sept, 1997), 35. Peter Hall and Rosemary Taylor similarly contend that despite having "something of a comparative advantage with regard to the study of institutional origins and change over rational choice theorists," historical institutionalists "have been slow to capitalize on it," and, as a result, "broader theories about processes of institutional change. . . have yet to emerge." Peter A. Hall and Rosemary C. R. Taylor, "Political Science and the Four New Institutionalisms" (paper prepared for the Annual Meeting of the American Political Science Association, New York, Sept 1994), 21.
88. Kathleen Thelen and Sven Steinmo,"Historical Institutionalism in Comparative Politics," in Structuring Politics. This generalization does not, of course, apply to all historical institutionalists, some of whom have been quite sensitive to temporal questions and issues of institutional change. Still, as Paul Pierson notes, "The significance of temporal processes in historical institutionalist analysis is often left implicit or downplayed. Much of this work has been essentially inductive in orientation, and in general practitioners have not been inclined to reflect on their methods." Paul Pierson, "Path Dependence, Increasing Returns, and the Study of Politics," Program for the Study of Germany and Europe Working Paper Series 7.7 (Center for European Studies, Harvard University, Sept, 1997), 35. Peter Hall and Rosemary Taylor similarly contend that despite having "something of a comparative advantage with regard to the study of institutional origins and change over rational choice theorists," historical institutionalists "have been slow to capitalize on it," and, as a result, "broader theories about processes of institutional change. . . have yet to emerge." Peter A. Hall and Rosemary C. R. Taylor, "Political Science and the Four New Institutionalisms" (paper prepared for the Annual Meeting of the American Political Science Association, New York, Sept 1994), 21.
89. Kathleen Thelen and Sven Steinmo,"Historical Institutionalism in Comparative Politics," in Structuring Politics. This generalization does not, of course, apply to all historical institutionalists, some of whom have been quite sensitive to temporal questions and issues of institutional change. Still, as Paul Pierson notes, "The significance of temporal processes in historical institutionalist analysis is often left implicit or downplayed. Much of this work has been essentially inductive in orientation, and in general practitioners have not been inclined to reflect on their methods." Paul Pierson, "Path Dependence, Increasing Returns, and the Study of Politics," Program for the Study of Germany and Europe Working Paper Series 7.7 (Center for European Studies, Harvard University, Sept, 1997), 35. Peter Hall and Rosemary Taylor similarly contend that despite having "something of a comparative advantage with regard to the study of institutional origins and change over rational choice theorists," historical institutionalists "have been slow to capitalize on it," and, as a result, "broader theories about processes of institutional change. . . have yet to emerge." Peter A. Hall and Rosemary C. R. Taylor, "Political Science and the Four New Institutionalisms" (paper prepared for the Annual Meeting of the American Political Science Association, New York, Sept 1994), 21.
90. For an early and influential article criticizing postwar behavioralism on just these grounds, see Samuel P. Huntington, "The Change to Change: Modernization, Development, and Politics," Comparative Politics 3 (1971): 283-322. The concept of structure-induced equilibrium was introduced by Kenneth Shepsle, one of the founders of the rational choice variant of institutionalism. See his "Institutional Arrangements and Equilibrium in Multidimensional Voting Models," American Journal of Political Science 2 (1979): 27-59; and William Riker, "Implications from the Disequilibrium of Majority Rule for the Study of Institutions," American Political Science Review 74 (1980): 432-47. Although rational choice institutionalism and historical institutionalism overlap substantially, the former is primarily concerned with the way in which political institutions, particularly legislative institutions, stabilize social choice processes and allow rational actors to solve collective action problems. For this reason, rational choice institutionalism has tended to focus narrowly on formal rules and to view institutions as intentional, functional, and often voluntary responses to shared dilemmas of cooperation. This puts the perspective at odds with the broader focus and strongly antifunctionalist thrust of historical institutionalism.
91. For an early and influential article criticizing postwar behavioralism on just these grounds, see Samuel P. Huntington, "The Change to Change: Modernization, Development, and Politics," Comparative Politics 3 (1971): 283-322. The concept of structure-induced equilibrium was introduced by Kenneth Shepsle, one of the founders of the rational choice variant of institutionalism. See his "Institutional Arrangements and Equilibrium in Multidimensional Voting Models," American Journal of Political Science 2 (1979): 27-59; and William Riker, "Implications from the Disequilibrium of Majority Rule for the Study of Institutions," American Political Science Review 74 (1980): 432-47. Although rational choice institutionalism and historical institutionalism overlap substantially, the former is primarily concerned with the way in which political institutions, particularly legislative institutions, stabilize social choice processes and allow rational actors to solve collective action problems. For this reason, rational choice institutionalism has tended to focus narrowly on formal rules and to view institutions as intentional, functional, and often voluntary responses to shared dilemmas of cooperation. This puts the perspective at odds with the broader focus and strongly antifunctionalist thrust of historical institutionalism.
92. For an early and influential article criticizing postwar behavioralism on just these grounds, see Samuel P. Huntington, "The Change to Change: Modernization, Development, and Politics," Comparative Politics 3 (1971): 283-322. The concept of structure-induced equilibrium was introduced by Kenneth Shepsle, one of the founders of the rational choice variant of institutionalism. See his "Institutional Arrangements and Equilibrium in Multidimensional Voting Models," American Journal of Political Science 2 (1979): 27-59; and William Riker, "Implications from the Disequilibrium of Majority Rule for the Study of Institutions," American Political Science Review 74 (1980): 432-47. Although rational choice institutionalism and historical institutionalism overlap substantially, the former is primarily concerned with the way in which political institutions, particularly legislative institutions, stabilize social choice processes and allow rational actors to solve collective action problems. For this reason, rational choice institutionalism has tended to focus narrowly on formal rules and to view institutions as intentional, functional, and often voluntary responses to shared dilemmas of cooperation. This puts the perspective at odds with the broader focus and strongly antifunctionalist thrust of historical institutionalism.
93. Karen Orren and Stephen Skowronek, "Beyond the Iconography of Order: Notes for a "New Institutionalism," in Dynamics of American Politics.
94. Carolyn Tuohy, "Response to the Clinton Proposal: A Comparative Perspective," Journal of Health Politics, Policy and Law 19 (1994): 249-54.
95. On window of opportunity, see John W. Kingdon, Agendas, Alternatives, and Public Policies (New York: Harper Collins, 1984), 173-80. Kingdon's model of agenda setting is extremely for understanding how problems, solutions, and political opportunities come together at critical junctures. It it less useful for understanding how the evolution of policies and institutions narrows the range of viable alternatives over time.
96. For a similar analysis that focuses on intellectual trends in U.S. health policy debates, see Paul Starr, "Transformation in Defeat: The Changing Objectives of National Health Insurance, 1915-1980," in Compulsory Health Insurance: The Continuing American Debate, ed, Ronald L. Numbers (Westport, CT; Greenwood, 1982).
97. This point is also emphasized by Tuohy in her "Response to the Clinton proposal," although she seems to have in mind intellectual trends pertaining to health policy alone.
98. Marmor, The Politics of Medicare, 69.
99. Lawrence R. Jacobs, "Politics of America's Supply State: Health Reform and Technology," Health Affairs (summer 1995): 143-57.
100. My methodology thus conforms to the advice of King, Keohane, and Verba, who argue that comparing across time and across geographic subunits is a useful way to avoid indeterminate research designs in small-n studies. Gary King, Robert O. Keohane, and Sidney Verba, Designing Social Inquiry: Scientific Inference in Qualitative Research (Princeton, NJ: Princeton Unversity Press, 1994), 217-28. In their otherwise helpful commentary, however, King, Keohane, and Verba portray historical analysis as simply a means to obtain additional observations of dependent and independent variables for multivariate analysis. This is not the methodological approach taken here, nor do I think it describes how most historically minded political scientists view their work. In theoretically guided historical analysis, what is of interest is not the relationship among variables at any particular moment but the way in which multifaceted causal processes take place over time. The focus of such classics of macrohistorical analysis as Alexis de Tocqueville's Democracy in America and Max Weber's The Protestant Ethic and the Spirit of Capitalism is "less on the causal importance of this or that variable contrasted with others [and] more on how variables are joined together in specific historical instances," Ira Katznelson, "Structure and Configuration in Comparative Politics," in Comparative Politics: Rationality, Culture, and Structure, ed, Mark Irving Lichbach and Alan S, Zuckerman (New York: Cambridge University Press, 1997), 99. Policy feedback, statebuilding, the timing and sequence of institutional change-these are not "values" of a particular variable but rather complex causal processes that unfold historically and involve large numbers of interlocking, often inseparable causes. For this reason, I am sympathetic with Charles Ragin's argument that qualitative, case-oriented research differs from large-n, statistical analysis in its greater emphasis on "causal conjuctures" and "outcome complexity." Charles C. Ragin, "Introduction to Qualitative Comparative Analysis," The Comparative Political Economy of the Welfare State, edited by Thomas Janoski and Alexander M. Hicks (New York: Cambridge University Press, 1994), 299-319. However, Ragin's Boolean algebra approach seems suspect, not only because it conceives of causality in deterministic rather than probabilistic terms, but also because its conception of cases (usually nations) as a holistic set of conditions does not seem well suited to historical comparison. Even when these conditions are stated in historical terms (for example, "at least five years of social democratic rule"), the approach obscures changes within and among cases over time and therefore shares diffculties with simple statistical models based on point-in-time comparisons. A similar critique could be leveled against research based on Mill's famous methods of difference and agreement, which were widely introduced to comparative-historical scholars by Theda Skocpol and Margaret Somer's important essay on "The Uses of Comparative History in Macrosocial Analysis," Comparative Studies in Society and History 22 (1980): 174-97. However useful as a guide to case selection and research design. Mill's twin methods of comparison also encourage analysis to treat cases as sets of static conditions that can be disaggregated into distinctive,comparable variables.
101. My methodology thus conforms to the advice of King, Keohane, and Verba, who argue that comparing across time and across geographic subunits is a useful way to avoid indeterminate research designs in small-n studies. Gary King, Robert O. Keohane, and Sidney Verba, Designing Social Inquiry: Scientific Inference in Qualitative Research (Princeton, NJ: Princeton Unversity Press, 1994), 217-28. In their otherwise helpful commentary, however, King, Keohane, and Verba portray historical analysis as simply a means to obtain additional observations of dependent and independent variables for multivariate analysis. This is not the methodological approach taken here, nor do I think it describes how most historically minded political scientists view their work. In theoretically guided historical analysis, what is of interest is not the relationship among variables at any particular moment but the way in which multifaceted causal processes take place over time. The focus of such classics of macrohistorical analysis as Alexis de Tocqueville's Democracy in America and Max Weber's The Protestant Ethic and the Spirit of Capitalism is "less on the causal importance of this or that variable contrasted with others [and] more on how variables are joined together in specific historical instances," Ira Katznelson, "Structure and Configuration in Comparative Politics," in Comparative Politics: Rationality, Culture, and Structure, ed, Mark Irving Lichbach and Alan S, Zuckerman (New York: Cambridge University Press, 1997), 99. Policy feedback, statebuilding, the timing and sequence of institutional change-these are not "values" of a particular variable but rather complex causal processes that unfold historically and involve large numbers of interlocking, often inseparable causes. For this reason, I am sympathetic with Charles Ragin's argument that qualitative, case-oriented research differs from large-n, statistical analysis in its greater emphasis on "causal conjuctures" and "outcome complexity." Charles C. Ragin, "Introduction to Qualitative Comparative Analysis," The Comparative Political Economy of the Welfare State, edited by Thomas Janoski and Alexander M. Hicks (New York: Cambridge University Press, 1994), 299-319. However, Ragin's Boolean algebra approach seems suspect, not only because it conceives of causality in deterministic rather than probabilistic terms, but also because its conception of cases (usually nations) as a holistic set of conditions does not seem well suited to historical comparison. Even when these conditions are stated in historical terms (for example, "at least five years of social democratic rule"), the approach obscures changes within and among cases over time and therefore shares diffculties with simple statistical models based on point-in-time comparisons. A similar critique could be leveled against research based on Mill's famous methods of difference and agreement, which were widely introduced to comparative-historical scholars by Theda Skocpol and Margaret Somer's important essay on "The Uses of Comparative History in Macrosocial Analysis," Comparative Studies in Society and History 22 (1980): 174-97. However useful as a guide to case selection and research design. Mill's twin methods of comparison also encourage analysis to treat cases as sets of static conditions that can be disaggregated into distinctive,comparable variables.
102. My methodology thus conforms to the advice of King, Keohane, and Verba, who argue that comparing across time and across geographic subunits is a useful way to avoid indeterminate research designs in small-n studies. Gary King, Robert O. Keohane, and Sidney Verba, Designing Social Inquiry: Scientific Inference in Qualitative Research (Princeton, NJ: Princeton Unversity Press, 1994), 217-28. In their otherwise helpful commentary, however, King, Keohane, and Verba portray historical analysis as simply a means to obtain additional observations of dependent and independent variables for multivariate analysis. This is not the methodological approach taken here, nor do I think it describes how most historically minded political scientists view their work. In theoretically guided historical analysis, what is of interest is not the relationship among variables at any particular moment but the way in which multifaceted causal processes take place over time. The focus of such classics of macrohistorical analysis as Alexis de Tocqueville's Democracy in America and Max Weber's The Protestant Ethic and the Spirit of Capitalism is "less on the causal importance of this or that variable contrasted with others [and] more on how variables are joined together in specific historical instances," Ira Katznelson, "Structure and Configuration in Comparative Politics," in Comparative Politics: Rationality, Culture, and Structure, ed, Mark Irving Lichbach and Alan S, Zuckerman (New York: Cambridge University Press, 1997), 99. Policy feedback, statebuilding, the timing and sequence of institutional change-these are not "values" of a particular variable but rather complex causal processes that unfold historically and involve large numbers of interlocking, often inseparable causes. For this reason, I am sympathetic with Charles Ragin's argument that qualitative, case-oriented research differs from large-n, statistical analysis in its greater emphasis on "causal conjuctures" and "outcome complexity." Charles C. Ragin, "Introduction to Qualitative Comparative Analysis," The Comparative Political Economy of the Welfare State, edited by Thomas Janoski and Alexander M. Hicks (New York: Cambridge University Press, 1994), 299-319. However, Ragin's Boolean algebra approach seems suspect, not only because it conceives of causality in deterministic rather than probabilistic terms, but also because its conception of cases (usually nations) as a holistic set of conditions does not seem well suited to historical comparison. Even when these conditions are stated in historical terms (for example, "at least five years of social democratic rule"), the approach obscures changes within and among cases over time and therefore shares diffculties with simple statistical models based on point-in-time comparisons. A similar critique could be leveled against research based on Mill's famous methods of difference and agreement, which were widely introduced to comparative-historical scholars by Theda Skocpol and Margaret Somer's important essay on "The Uses of Comparative History in Macrosocial Analysis," Comparative Studies in Society and History 22 (1980): 174-97. However useful as a guide to case selection and research design. Mill's twin methods of comparison also encourage analysis to treat cases as sets of static conditions that can be disaggregated into distinctive,comparable variables.
103. My methodology thus conforms to the advice of King, Keohane, and Verba, who argue that comparing across time and across geographic subunits is a useful way to avoid indeterminate research designs in small-n studies. Gary King, Robert O. Keohane, and Sidney Verba, Designing Social Inquiry: Scientific Inference in Qualitative Research (Princeton, NJ: Princeton Unversity Press, 1994), 217-28. In their otherwise helpful commentary, however, King, Keohane, and Verba portray historical analysis as simply a means to obtain additional observations of dependent and independent variables for multivariate analysis. This is not the methodological approach taken here, nor do I think it describes how most historically minded political scientists view their work. In theoretically guided historical analysis, what is of interest is not the relationship among variables at any particular moment but the way in which multifaceted causal processes take place over time. The focus of such classics of macrohistorical analysis as Alexis de Tocqueville's Democracy in America and Max Weber's The Protestant Ethic and the Spirit of Capitalism is "less on the causal importance of this or that variable contrasted with others [and] more on how variables are joined together in specific historical instances," Ira Katznelson, "Structure and Configuration in Comparative Politics," in Comparative Politics: Rationality, Culture, and Structure, ed, Mark Irving Lichbach and Alan S, Zuckerman (New York: Cambridge University Press, 1997), 99. Policy feedback, statebuilding, the timing and sequence of institutional change-these are not "values" of a particular variable but rather complex causal processes that unfold historically and involve large numbers of interlocking, often inseparable causes. For this reason, I am sympathetic with Charles Ragin's argument that qualitative, case-oriented research differs from large-n, statistical analysis in its greater emphasis on "causal conjuctures" and "outcome complexity." Charles C. Ragin, "Introduction to Qualitative Comparative Analysis," The Comparative Political Economy of the Welfare State, edited by Thomas Janoski and Alexander M. Hicks (New York: Cambridge University Press, 1994), 299-319. However, Ragin's Boolean algebra approach seems suspect, not only because it conceives of causality in deterministic rather than probabilistic terms, but also because its conception of cases (usually nations) as a holistic set of conditions does not seem well suited to historical comparison. Even when these conditions are stated in historical terms (for example, "at least five years of social democratic rule"), the approach obscures changes within and among cases over time and therefore shares diffculties with simple statistical models based on point-in-time comparisons. A similar critique could be leveled against research based on Mill's famous methods of difference and agreement, which were widely introduced to comparative-historical scholars by Theda Skocpol and Margaret Somer's important essay on "The Uses of Comparative History in Macrosocial Analysis," Comparative Studies in Society and History 22 (1980): 174-97. However useful as a guide to case selection and research design. Mill's twin methods of comparison also encourage analysis to treat cases as sets of static conditions that can be disaggregated into distinctive,comparable variables.
104. Klein, Politics of the National Health Service, 2.
105. Skocpol, Protecting Soldiers and Mothers, 250-51.
106. Samuel H, Beer, Modern British Politics: Parties and Pressure Groups in the Collectivist Age (1965; New York: W. W. Norton, 1982), 146.
107. A. I. Ogus, "Great Britain," in Evolution of Social Insurance, 170-71.
108. Starr, The Social Transformation of American Medicine, 240.
109. Norman R. Eder, National Health Insurance and the Medical Profession, 1913-1939 (New York: Garland, 1982), 15-22.
110. Ibid., 25.
111. Eckstein, The English Health Service, 127.
112. Quoted in Frank Honigsbaum, Health, Happiness, and Security: The Creation of the National Health Service (London: Routledge, 1989), 2.
113. Eckstein, The English Health Service, 29. This paragraph draws heavily on Eckstein's analysis.
114. Honigsbaum, Health, Happiness, and Security, 4.
115. Jacobs, "Institutions and Culture," 193-96, 201-2.
116. Bentley B. Gilbert, The Evolution of National Insurance in Britain (London: Michael Joseph, 1966), 255.
117. Ibid., 255.
118. Eckstein, The English Health Service, 34.
119. John E. Pater, The Making of the National Health Service (London.: King Edward's Hospital Fund for London, 1981), 22.
120. Peter Flora and Arnold J, Heidenheimer, eds., The Development of the Welfare State in Europe and America (New Brunswick, NJ: Transaction, 1984).
121. Andrew Shonfield, Modern, Capitalism: The Changing Balance of Public and Private Power (New York: Oxford University Press, 1965).
122. Klein, The Politics of the National Health Service, 1.
123. Pierson provides a more extensive discussion of these channels in "When Effect Becomes Cause."
124. Beer, Modern British Politics, 179-87.
125. Klein, The Politics of the National Health Service, 17.
126. Eckstein, The English Health Service, 3-4, 161-63.
127. If the 1942 report of the BMA's medical planning commission is any indication, the ideal proposal envisioned by much of the profession was a system of government health insurance covering most of the population and paying for a wide range of services on a nonsalaried basis (Eckstein, The English Health Service, 118-22).
128. Brian Abel-Smith, The Hospitals, 1800-1948 (London: Heinemann, 1964), 480.
129. What is more, appeasing the Royal Colleges allowed Bevan to split the medical opposition, leaving the general practitioners of the BMA as the sole professional opponents of the NHS.
130. Robert T. Kudrle and Theodore R. Marmor, "The Development of the Welfare State in North America," in Development of the Welfare State in Europe and America.
131. Carolyn J. Tuohy, Polity and Politics in Canada: Institutionalized Ambivalence (Philadelphia: Temple University Press, 1992), 109.
132. Taylor, Health Insurance and Canadian Public Policy, 6.
133. Ibid., 9-10.
134. Tuohy, "Response to the Clinton Proposal," 250-51.
135. Gray, for example, contends that it "is at least arguable that policy development was advanced as quickly by the successful introduction of comprehensive measures at the provincial level, which were later taken up nationally, as it would have been if the limited federal proposals had been implemented" (Gray, Federalism and Health Policy, 34). It remains true nonetheless that federalism posed obstacles to the passage of national health reforms in Canada that were not faced by leaders in Britain.
136. C, Howard Shillington, The Road to Medicare in Canada (Toronto: Del Graphics Publishing, 1972), 202-3.
137. Robert G, Evans, Strained Mercy: The Economics of Canadian Health Care (Toronto: Butterworths, 1984), 29.
138. Taylor, Health Insurance and Canadian Public Policy, 190.
139. Badgley and Wolfe, Doctors' Strike.
140. Taylor, Health Insurance and Canadian Public Policy, 329.
141. Ibid., 265.
142. This was extremely important in Saskatchewan: The national government's assumption of nearly half the cost of Saskatchewan's hospital insurance program allowed the CCF to finally pursue a comprehensive plan.
143. The evidence from other countries of the British Commonwealth is ambiguous on this score, though it, like the Canada-U.S. comparison, suggests that federalism slows the initial adoption of a national health program but also presents opportunities for leadership by subnational governments. In the unitary polity of New Zealand, for instance, the government was able to enact a fairly comprehensive national health service in 1938, albeit one that embodied important concessions to the medical profession. Australia's federal system, by contrast, proved less hospitable to national health reforms after World War II. Like Canada, Australia failed to enact a national health program during the 1940s. Yet the continuing centralization Australian federalism in subsequent years prevented the Australian states from moving forward in the way that Saskatchewan and other Canadian provinces did during the 1950s and 1960s. As a result, federal politicians in Australia did not face reform demands from subnational governments or regionally based parties, and the ruling conservative coalition instead pursued a federal policy of subsidizing voluntary health insurance through the 1960s. The New Zealand and Australian experiences therefore seem to support the claim that federalism does in fact present barriers to the passage of national social policies but that these barriers may be reduced or even outweighed by countervailing factors, such as the opportunities that federalism creates for policy innovation or the emergence of regional social movements. The implication of this claim is that the net effect of federalism cannot be ascertained a priori but rather depends on the specific structure and context of federal institutions.
144. Taylor, Health Insurance and Canadian Public Policy, 331-32.
145. Tuohy, Policy and Politics in Canada, 36.
146. Shilllington, The Road to Medicare in Canada, 139.
147. Evans, Strained Mercy, 14. "Intensity" refers to the amount of inputs per patient day.
148. Gray, Federalism and Health Policy, 42.
149. Taylor, Health Insurance and Canadian Public Policy, 333.
150. Alexis de Tocqueville, Democracy in America (1835; New York: Harper & Row, 1969), 280.
151. Werner Sombat, Why is There No Socialism in the United States? (1906; White Plains, NY: International Arts and Sciences Press, 1976).
152. On American political culture, see Louis Hartz, The Liberal Tradition in America (New York: Harcourt, Brace, 1955); and Gordon S. Wood, The Creation of the American Republic, 1776-1787 (New York: Norton, 1969); on the failure of social democracy, see Richard Oestreicher, "Urban Working-Class Political Behavior and Theories American Electoral Politics, 1870-1940," Journal of American History 74 (1988): 1257-86; and on the American welfare state, see Paul Pierson, "The Scope and Nature of Business Power: Employers and the American Welfare State, 1900-1935"(Harvard University and Russell Sage Foundation, photocopy, 1995); Steinmo,"American Exceptionalism Reconsidered", and Skocpol, Protecting Soldiers and Mothers.
153. On American political culture, see Louis Hartz, The Liberal Tradition in America (New York: Harcourt, Brace, 1955); and Gordon S. Wood, The Creation of the American Republic, 1776-1787 (New York: Norton, 1969); on the failure of social democracy, see Richard Oestreicher, "Urban Working-Class Political Behavior and Theories American Electoral Politics, 1870-1940," Journal of American History 74 (1988): 1257-86; and on the American welfare state, see Paul Pierson, "The Scope and Nature of Business Power: Employers and the American Welfare State, 1900-1935"(Harvard University and Russell Sage Foundation, photocopy, 1995); Steinmo,"American Exceptionalism Reconsidered", and Skocpol, Protecting Soldiers and Mothers.
154. On American political culture, see Louis Hartz, The Liberal Tradition in America (New York: Harcourt, Brace, 1955); and Gordon S. Wood, The Creation of the American Republic, 1776-1787 (New York: Norton, 1969); on the failure of social democracy, see Richard Oestreicher, "Urban Working-Class Political Behavior and Theories American Electoral Politics, 1870-1940," Journal of American History 74 (1988): 1257-86; and on the American welfare state, see Paul Pierson, "The Scope and Nature of Business Power: Employers and the American Welfare State, 1900-1935"(Harvard University and Russell Sage Foundation, photocopy, 1995); Steinmo,"American Exceptionalism Reconsidered", and Skocpol, Protecting Soldiers and Mothers.
155. On American political culture, see Louis Hartz, The Liberal Tradition in America (New York: Harcourt, Brace, 1955); and Gordon S. Wood, The Creation of the American Republic, 1776-1787 (New York: Norton, 1969); on the failure of social democracy, see Richard Oestreicher, "Urban Working-Class Political Behavior and Theories American Electoral Politics, 1870-1940," Journal of American History 74 (1988): 1257-86; and on the American welfare state, see Paul Pierson, "The Scope and Nature of Business Power: Employers and the American Welfare State, 1900-1935"(Harvard University and Russell Sage Foundation, photocopy, 1995); Steinmo,"American Exceptionalism Reconsidered", and Skocpol, Protecting Soldiers and Mothers.
156. On American political culture, see Louis Hartz, The Liberal Tradition in America (New York: Harcourt, Brace, 1955); and Gordon S. Wood, The Creation of the American Republic, 1776-1787 (New York: Norton, 1969); on the failure of social democracy, see Richard Oestreicher, "Urban Working-Class Political Behavior and Theories American Electoral Politics, 1870-1940," Journal of American History 74 (1988): 1257-86; and on the American welfare state, see Paul Pierson, "The Scope and Nature of Business Power: Employers and the American Welfare State, 1900-1935"(Harvard University and Russell Sage Foundation, photocopy, 1995); Steinmo,"American Exceptionalism Reconsidered", and Skocpol, Protecting Soldiers and Mothers.
157. On American political culture, see Louis Hartz, The Liberal Tradition in America (New York: Harcourt, Brace, 1955); and Gordon S. Wood, The Creation of the American Republic, 1776-1787 (New York: Norton, 1969); on the failure of social democracy, see Richard Oestreicher, "Urban Working-Class Political Behavior and Theories American Electoral Politics, 1870-1940," Journal of American History 74 (1988): 1257-86; and on the American welfare state, see Paul Pierson, "The Scope and Nature of Business Power: Employers and the American Welfare State, 1900-1935"(Harvard University and Russell Sage Foundation, photocopy, 1995); Steinmo,"American Exceptionalism Reconsidered", and Skocpol, Protecting Soldiers and Mothers.
158. See, for example, Sean Wilentz, "Against Exeptionalism: Class Consciousness and the American Labor Movement, 1790-1920," International Labor and Working Class History 26 (1984): 1-24; and Jens Alber, "Towards a Comparison of Recent Welfare State Development in Germany and the U.S." (University of Konstanz, photocopy, 1996).
159. See, for example, Sean Wilentz, "Against Exeptionalism: Class Consciousness and the American Labor Movement, 1790-1920," International Labor and Working Class History 26 (1984): 1-24; and Jens Alber, "Towards a Comparison of Recent Welfare State Development in Germany and the U.S." (University of Konstanz, photocopy, 1996).
160. See I, M. Rubinow, Social Insurance with Special Reference to American Conditions (New York: Henry Holt and Company, 1916); and the discussion in Skocpol, Protecting Soldiers and Mothers, chap. 3.
161. See I, M. Rubinow, Social Insurance with Special Reference to American Conditions (New York: Henry Holt and Company, 1916); and the discussion in Skocpol, Protecting Soldiers and Mothers, chap. 3.
162. Roosevelt's Progressive (Bull Moose) Party had "minimal success at the state and local levels, winning approximately 13 House seats but electing no senators or governors." And those thirteen or so seats comprised a motley band of Progressive legislators representing different factions within the larger movement. Congressional Quarterly's Guide to U.S. Elections, 3d ed. (Washington, DC: Congressional Quarterly Inc., 1994), 267.
163. Oestreicher, "Urban Working-Class Political Behavior," 1270.
164. Stephen Skowronek, Building a New American State: The Expansion of National Administrative Capacities, 1877-1920 (New York: Cambridge University Press, 1982), 1970.
165. James W. Ceasar, Reforming the Reforms: A Critical Analysis of the Presidential Selection Process (Cambridge, MA; Ballingen 1982), 18.
166. Steinmo, "American Exceptionalism Reconsidered," 118-19.
167. David Brian Robertson, "The Bias of American Federalism: The Limits of Welfare State Development in the Progressive Era," Journal of Policy History 1 (1989): 261-91.
168. Pierson, "The Scope and Nature of Business Power," 24.
169. According to Lubove, "Employers condemned health insurance as un-American and inequitable, a further imposition on businessmen already overladen with taxes. The unfair burden it imposed on employers would drive industry from the state" (Lubove, The Struggle for Social Security, 85).
170. Ibid.,chap. 4; Ronald L. Numbers, Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912-1920 (Baltimore: John Hopkins University Press, 1978), chap. 7.
171. Ibid.,chap. 4; Ronald L. Numbers, Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912-1920 (Baltimore: John Hopkins University Press, 1978), chap. 7.
172. Starr, The Social Transformation of American Medicine, 253.
173. Numbers, Almost Persuaded, 91.
174. The American public's culturally grounded opposition to compulsory health insurance during this period has also been overemphasized. It is true that strong public support for the AALL campaign never existed. But, as we have seen, there is no evidence that such support was of crucial importance in the passage of the National Insurance Act In Britain. The difference between Britain and the United States was that the AALL campaign needed such support to have any chance of success. As for the results of the California referendum, it should only be noted that the referendum took place at the height of the war amid a fervent propaganda campaign against the bill, that referenda favor the organized over the apathetic, and, most important, that no such referenda were ever held or needed to be held in Britain, Canada, or many other European nations and that where they were held, as in Switzerland, opponents of reform gained the upper hand (see, for example, Immergut, Health Politics, chap. 4).
175. On the fate of other social policy proposals, see Pierson, "The Scope and Nature of Business Power," 23.
176. Numbers, Almost Persuaded, 113.
177. Ibid., 81-82.
178. Odin W. Anderson, Health Services as a Growth Enterprise in the United States Since 1875 (Ann Arbor: Health Administration Press, 1990), chaps. 2, 4.
179. Numbers, Almost Persuaded, 114.
180. Ibid., 113.
181. Starr, The Social Transformation of American Medicine, 260.
182. Quoted in Anderson, Health Services as a Growth Enterprise, 79.
183. Numbers, Almost Persuaded, 27; Starr The Social Transformation of American Medicine, 273.
184. Numbers, Almost Persuaded, 27; Starr The Social Transformation of American Medicine, 273.
185. Numbers, Almost Persuaded, 28.
186. Skocpol, Protecting Soldiers and Mothers, 55.
187. Starr, The Social Transformation of American Medicine, 260.
188. James L. Sundquist, Dynamics of the Party System: Alignment and Realignment of Political Parties in the United States, rev. ed. (Washington, DC: Brookings, 1983), chaps. 10-12.
189. William E. Leuchtenburg, Franklin D. Roosevelt and the New Deal, 1932-1940 (Ithaca, NY: Cornell University Press, 1963).
190. Starr, The Social Transformation of American Medicine, 269.
191. Edwin E. Witte, The Development of the Social Security Act (Madison, WI: Wisconsin Press, 1962), 184, 185, 188.
192. Starr, The Social Transformation of American Medicine, 273.
193. Alonzo L. Hamby, Beyond the New Deal: Harry S, Truman and American Liberalism (New York: Columbia University Press 1973), 4.
194. Monte M, Poen, Harry S. Truman Versus the Medical Lobby: The Genesis of Medicare (Columbia, MO: University of Missouri Press, 1979), 29-31.
195. HIAA, Source Book of Health Insurance Data, 24.
196. Beth Stevens, "Blurring the Boundaries: How the Federal Government Has Influenced Welfare Benefits in the Private Sector," in The Politics of Social Policy in the United States, ed. Margaret Weir, Ann Shola Orloff, and Theda Skocpol (Princeton, NJ: Princeton University Press, 1988).
197. Nelson Litchenstein, "From Corporatism to Collective Bargaining: Organized Labor and the Eclipse of Social Democracy in the Postwar Era," in The Rise and Fall of the New Deal Order, ed. Steve Fraser and Gary Gerstle (Princeton, NJ: Princeton University Press, 1989), 139.
198. Meltz, "Labor Movements in Canada and the United States," 315-18.
199. Lichenstein, "From Corporatism to Collective Bargaining," 125.
200. Richard E. Neustadt, "Congress and the Fair Deal: A Legislative Balance Sheet," in Harry S. Truman and the Fair Deal, ed. Alonzo L. Hamby (Lexington, MA: D.C. Health, 1974).
201. Poen, Harry S. Truman versus the Medical Lobby, 164-65.
202. Ibid., chap. 6.
203. James A. Marone, The Democratic Wish: Popular Participation and the Limits of American Government (New York: Basic, 1990), 259.
204. Nelson W. Polsby, "The Institutionalization of the U.S. House of Representative," American Political Science Review 62 (1968): 144-68; Samuel P. Huntington, "Congressional Responses to the Twentieth Century," in The Congress and America's Future, ed. David B. Truman (Englewood Cliffs, NJ: Prentice-Hall, 1965).
205. Nelson W. Polsby, "The Institutionalization of the U.S. House of Representative," American Political Science Review 62 (1968): 144-68; Samuel P. Huntington, "Congressional Responses to the Twentieth Century," in The Congress and America's Future, ed. David B. Truman (Englewood Cliffs, NJ: Prentice-Hall, 1965).
206. David R. Mayhew, "Innovative Midterm Elections" (Yale University, photocopy, 1995), 11.
207. Mayhew, Congress, 52-61.
208. Marmor, The Politics of Medicare, 59.
209. Quoted in Morone, The Democratic Wish, 263.
210. The former figures are from ibid., 266; the latter, from Congressional Budget Office, Trends in Health Spending: An Update (Washington, DC: Congressional Budget Office, 1993), 76.
211. The former figures are from ibid., 266; the latter, from Congressional Budget Office, Trends in Health Spending: An Update (Washington, DC: Congressional Budget Office, 1993), 76.
212. Growth in real health spending per capita fell from 6.5 percent in the 1960s to 3.8 percent in the 1970s (Joseph P. Newhouse, "An Iconoclastic View of Health Cost Containment," Health Affairs supplement [1993]: 156).
213. Starr, The Social Transformation of American Medicine, 411-17.
214. David W. Rohde, Parties and Leaders in the Postreform House (Chicago: University of Chicago Press, 1991).
215. Mark A. Peterson, "Congress in the 1990s: From Iron Triangles to Policy Networks," in The Politics of Health Care Reform: Lessons from the Past, Prospects for the Future, ed. James A. Morone and Gary S. Belkin (Durham, NC: Duke University Press, 1994), 125-31.
216. Anthony King, "The American Polity in the Late 1970s: Building Coalitions in the Sand," in The New American Political System, ed. Anthony King (Washington, DC: American Enterprise Institute, 1978); Roger H. Davidson, "The New Centralization on Capitol Hill," Review of Politics 50 (1989): 350-51.
217. Anthony King, "The American Polity in the Late 1970s: Building Coalitions in the Sand," in The New American Political System, ed. Anthony King (Washington, DC: American Enterprise Institute, 1978); Roger H. Davidson, "The New Centralization on Capitol Hill," Review of Politics 50 (1989): 350-51.
218. Jacob S. Hacker, "National Health Care Reform: An Idea Whose Time Came and Went," Journal Health Politics, Policy and Law 21 (1996): 647-96.
219. For that, see Theda Skocpol, Boomerang: Clinton's Health Security Effort and the Turn Against Government in U.S. Politics (New York: Norton, 1996); Haynes Johnson and David S. Broder, The System: The American Way of Politics at the Breaking Point (New York: Little, Brown,1996).
220. For that, see Theda Skocpol, Boomerang: Clinton's Health Security Effort and the Turn Against Government in U.S. Politics (New York: Norton, 1996); Haynes Johnson and David S. Broder, The System: The American Way of Politics at the Breaking Point (New York: Little, Brown,1996).
221. Jacob S. Hacker, The Road to Nowhere: The Genesis of President Clinton's Plan for Health Security (Princeton, NJ: Princeton University Press, 1997), 14-15, 58-60, 86-99, 162-70.
222. Mark A. Peterson, "Introduction: Health Care into the Next Century," Journal of Health Politics, Policy and Law 22 (1997): 297.
223. This is well illustrated by the contrasting records of the United States and Canada after 1971 - the year Canada consolidated its national insurance program. Although Canadian and U.S, levels of health spending followed almost identical paths for much of the twentieth century, they diverged in the early 1970s, and Canada now spends significantly less as a percentage of GDP than docs the United States. The limits of Canadian cost control relative to the European experience are often noted. But Canada, as we have seen, institutionalized a much more costly medical system than did most European nations. The relevant comparison for judging Canadian success at controlling costs is the United States, and by this measure Canadian national health insurance has had an impressive record.
224. Paul Pierson, Dismantling the Welfare State.
225. James Q. Wilson, Political Organization (New York: Basic Books, 1973), 330-37.
226. Paul D. Pierson and R. Kent Weaver, "Imposing Losses in Pension Policy," in Do Institutions Matter? Government Capabilities in the United States and Abroad (Washington, DC: Brookings, 1993) 111-12.
227. Ibid., 143. In the case of the Clinton plan at least, advocates of reform found it exceedingly difficult to coordinate their efforts around a single proposal, and legislators backed away from comprehensive measures as the 1994 elections approached for fear of individual electoral reprisals.
228. Sven Steinmo and Jon Watts, "It's the Institutions, Stupid! Why Comprehensive National Health Insurance Always Fails in America, "Journal of Health Politics, Policy and Law 20 (1995): 329-72.
229. Promising movement in this direction has been made by Esping-Anderson in Three Worlds.
230. Important recent works on indirect spending and "third-party" government include Christopher S. Howard, The Hidden Welfare State: Tax Expenditures and Social Policy in the United States (Princeton, NJ: Princeton University Press, 1997); Benjamin Gidron, Ralph M. Kramer, and Lester M. Salamon, Government and the Third Sector: Emerging Relationship in Welfare States (San Francisco: Jossey-Bass, 1992); Michael Lipsky and Steven Rathgeb Smith, "Nonprofit Organizations, Government, and the Welfare State," Political Science Quarterly 104 (1989-1990) : 625-48; Lester M. Salamon, ed., Beymd Privatization: The Tools of Government Action (Washington, DC: Urban Institute, 1989); Donald F. Kettl, Government by Proxy: (Mis?)Managing Federal Programs (Washington, DC: CQ Press, 1988); Stevens, "Blurring the Boundaries"; Herman B. Leonard, Checks Unbalanced: The Quiet Side of Public Spending (New York: Basic, 1986); Barry P. Bosworth, Andrew S. Carron, and Elisabeth H. Rhyne, The Economics of Federal Credit Programs (Washington, DC: Brookings, 1985); Stanley S. Surrey and Paul R. McDaniel, Tax Expenditures (Cambridges, MA: Harvard University Press, 1985); and Dennis S. Ippolito, Hidden Spending: The Politics of Federal Credit Programs (Chapel Hill, NC: University of North Carolina Press, 1984).
231. Important recent works on indirect spending and "third-party" government include Christopher S. Howard, The Hidden Welfare State: Tax Expenditures and Social Policy in the United States (Princeton, NJ: Princeton University Press, 1997); Benjamin Gidron, Ralph M. Kramer, and Lester M. Salamon, Government and the Third Sector: Emerging Relationship in Welfare States (San Francisco: Jossey-Bass, 1992); Michael Lipsky and Steven Rathgeb Smith, "Nonprofit Organizations, Government, and the Welfare State," Political Science Quarterly 104 (1989-1990) : 625-48; Lester M. Salamon, ed., Beymd Privatization: The Tools of Government Action (Washington, DC: Urban Institute, 1989); Donald F. Kettl, Government by Proxy: (Mis?)Managing Federal Programs (Washington, DC: CQ Press, 1988); Stevens, "Blurring the Boundaries"; Herman B. Leonard, Checks Unbalanced: The Quiet Side of Public Spending (New York: Basic, 1986); Barry P. Bosworth, Andrew S. Carron, and Elisabeth H. Rhyne, The Economics of Federal Credit Programs (Washington, DC: Brookings, 1985); Stanley S. Surrey and Paul R. McDaniel, Tax Expenditures (Cambridges, MA: Harvard University Press, 1985); and Dennis S. Ippolito, Hidden Spending: The Politics of Federal Credit Programs (Chapel Hill, NC: University of North Carolina Press, 1984).
232. Important recent works on indirect spending and "third-party" government include Christopher S. Howard, The Hidden Welfare State: Tax Expenditures and Social Policy in the United States (Princeton, NJ: Princeton University Press, 1997); Benjamin Gidron, Ralph M. Kramer, and Lester M. Salamon, Government and the Third Sector: Emerging Relationship in Welfare States (San Francisco: Jossey-Bass, 1992); Michael Lipsky and Steven Rathgeb Smith, "Nonprofit Organizations, Government, and the Welfare State," Political Science Quarterly 104 (1989-1990) : 625-48; Lester M. Salamon, ed., Beymd Privatization: The Tools of Government Action (Washington, DC: Urban Institute, 1989); Donald F. Kettl, Government by Proxy: (Mis?)Managing Federal Programs (Washington, DC: CQ Press, 1988); Stevens, "Blurring the Boundaries"; Herman B. Leonard, Checks Unbalanced: The Quiet Side of Public Spending (New York: Basic, 1986); Barry P. Bosworth, Andrew S. Carron, and Elisabeth H. Rhyne, The Economics of Federal Credit Programs (Washington, DC: Brookings, 1985); Stanley S. Surrey and Paul R. McDaniel, Tax Expenditures (Cambridges, MA: Harvard University Press, 1985); and Dennis S. Ippolito, Hidden Spending: The Politics of Federal Credit Programs (Chapel Hill, NC: University of North Carolina Press, 1984).
233. Important recent works on indirect spending and "third-party" government include Christopher S. Howard, The Hidden Welfare State: Tax Expenditures and Social Policy in the United States (Princeton, NJ: Princeton University Press, 1997); Benjamin Gidron, Ralph M. Kramer, and Lester M. Salamon, Government and the Third Sector: Emerging Relationship in Welfare States (San Francisco: Jossey-Bass, 1992); Michael Lipsky and Steven Rathgeb Smith, "Nonprofit Organizations, Government, and the Welfare State," Political Science Quarterly 104 (1989-1990) : 625-48; Lester M. Salamon, ed., Beymd Privatization: The Tools of Government Action (Washington, DC: Urban Institute, 1989); Donald F. Kettl, Government by Proxy: (Mis?)Managing Federal Programs (Washington, DC: CQ Press, 1988); Stevens, "Blurring the Boundaries"; Herman B. Leonard, Checks Unbalanced: The Quiet Side of Public Spending (New York: Basic, 1986); Barry P. Bosworth, Andrew S. Carron, and Elisabeth H. Rhyne, The Economics of Federal Credit Programs (Washington, DC: Brookings, 1985); Stanley S. Surrey and Paul R. McDaniel, Tax Expenditures (Cambridges, MA: Harvard University Press, 1985); and Dennis S. Ippolito, Hidden Spending: The Politics of Federal Credit Programs (Chapel Hill, NC: University of North Carolina Press, 1984).
234. Important recent works on indirect spending and "third-party" government include Christopher S. Howard, The Hidden Welfare State: Tax Expenditures and Social Policy in the United States (Princeton, NJ: Princeton University Press, 1997); Benjamin Gidron, Ralph M. Kramer, and Lester M. Salamon, Government and the Third Sector: Emerging Relationship in Welfare States (San Francisco: Jossey-Bass, 1992); Michael Lipsky and Steven Rathgeb Smith, "Nonprofit Organizations, Government, and the Welfare State," Political Science Quarterly 104 (1989-1990) : 625-48; Lester M. Salamon, ed., Beymd Privatization: The Tools of Government Action (Washington, DC: Urban Institute, 1989); Donald F. Kettl, Government by Proxy: (Mis?)Managing Federal Programs (Washington, DC: CQ Press, 1988); Stevens, "Blurring the Boundaries"; Herman B. Leonard, Checks Unbalanced: The Quiet Side of Public Spending (New York: Basic, 1986); Barry P. Bosworth, Andrew S. Carron, and Elisabeth H. Rhyne, The Economics of Federal Credit Programs (Washington, DC: Brookings, 1985); Stanley S. Surrey and Paul R. McDaniel, Tax Expenditures (Cambridges, MA: Harvard University Press, 1985); and Dennis S. Ippolito, Hidden Spending: The Politics of Federal Credit Programs (Chapel Hill, NC: University of North Carolina Press, 1984).
235. Important recent works on indirect spending and "third-party" government include Christopher S. Howard, The Hidden Welfare State: Tax Expenditures and Social Policy in the United States (Princeton, NJ: Princeton University Press, 1997); Benjamin Gidron, Ralph M. Kramer, and Lester M. Salamon, Government and the Third Sector: Emerging Relationship in Welfare States (San Francisco: Jossey-Bass, 1992); Michael Lipsky and Steven Rathgeb Smith, "Nonprofit Organizations, Government, and the Welfare State," Political Science Quarterly 104 (1989-1990) : 625-48; Lester M. Salamon, ed., Beymd Privatization: The Tools of Government Action (Washington, DC: Urban Institute, 1989); Donald F. Kettl, Government by Proxy: (Mis?)Managing Federal Programs (Washington, DC: CQ Press, 1988); Stevens, "Blurring the Boundaries"; Herman B. Leonard, Checks Unbalanced: The Quiet Side of Public Spending (New York: Basic, 1986); Barry P. Bosworth, Andrew S. Carron, and Elisabeth H. Rhyne, The Economics of Federal Credit Programs (Washington, DC: Brookings, 1985); Stanley S. Surrey and Paul R. McDaniel, Tax Expenditures (Cambridges, MA: Harvard University Press, 1985); and Dennis S. Ippolito, Hidden Spending: The Politics of Federal Credit Programs (Chapel Hill, NC: University of North Carolina Press, 1984).
236. Important recent works on indirect spending and "third-party" government include Christopher S. Howard, The Hidden Welfare State: Tax Expenditures and Social Policy in the United States (Princeton, NJ: Princeton University Press, 1997); Benjamin Gidron, Ralph M. Kramer, and Lester M. Salamon, Government and the Third Sector: Emerging Relationship in Welfare States (San Francisco: Jossey-Bass, 1992); Michael Lipsky and Steven Rathgeb Smith, "Nonprofit Organizations, Government, and the Welfare State," Political Science Quarterly 104 (1989-1990) : 625-48; Lester M. Salamon, ed., Beymd Privatization: The Tools of Government Action (Washington, DC: Urban Institute, 1989); Donald F. Kettl, Government by Proxy: (Mis?)Managing Federal Programs (Washington, DC: CQ Press, 1988); Stevens, "Blurring the Boundaries"; Herman B. Leonard, Checks Unbalanced: The Quiet Side of Public Spending (New York: Basic, 1986); Barry P. Bosworth, Andrew S. Carron, and Elisabeth H. Rhyne, The Economics of Federal Credit Programs (Washington, DC: Brookings, 1985); Stanley S. Surrey and Paul R. McDaniel, Tax Expenditures (Cambridges, MA: Harvard University Press, 1985); and Dennis S. Ippolito, Hidden Spending: The Politics of Federal Credit Programs (Chapel Hill, NC: University of North Carolina Press, 1984).
237. Important recent works on indirect spending and "third-party" government include Christopher S. Howard, The Hidden Welfare State: Tax Expenditures and Social Policy in the United States (Princeton, NJ: Princeton University Press, 1997); Benjamin Gidron, Ralph M. Kramer, and Lester M. Salamon, Government and the Third Sector: Emerging Relationship in Welfare States (San Francisco: Jossey-Bass, 1992); Michael Lipsky and Steven Rathgeb Smith, "Nonprofit Organizations, Government, and the Welfare State," Political Science Quarterly 104 (1989-1990) : 625-48; Lester M. Salamon, ed., Beymd Privatization: The Tools of Government Action (Washington, DC: Urban Institute, 1989); Donald F. Kettl, Government by Proxy: (Mis?)Managing Federal Programs (Washington, DC: CQ Press, 1988); Stevens, "Blurring the Boundaries"; Herman B. Leonard, Checks Unbalanced: The Quiet Side of Public Spending (New York: Basic, 1986); Barry P. Bosworth, Andrew S. Carron, and Elisabeth H. Rhyne, The Economics of Federal Credit Programs (Washington, DC: Brookings, 1985); Stanley S. Surrey and Paul R. McDaniel, Tax Expenditures (Cambridges, MA: Harvard University Press, 1985); and Dennis S. Ippolito, Hidden Spending: The Politics of Federal Credit Programs (Chapel Hill, NC: University of North Carolina Press, 1984).
238. Important recent works on indirect spending and "third-party" government include Christopher S. Howard, The Hidden Welfare State: Tax Expenditures and Social Policy in the United States (Princeton, NJ: Princeton University Press, 1997); Benjamin Gidron, Ralph M. Kramer, and Lester M. Salamon, Government and the Third Sector: Emerging Relationship in Welfare States (San Francisco: Jossey-Bass, 1992); Michael Lipsky and Steven Rathgeb Smith, "Nonprofit Organizations, Government, and the Welfare State," Political Science Quarterly 104 (1989-1990) : 625-48; Lester M. Salamon, ed., Beymd Privatization: The Tools of Government Action (Washington, DC: Urban Institute, 1989); Donald F. Kettl, Government by Proxy: (Mis?)Managing Federal Programs (Washington, DC: CQ Press, 1988); Stevens, "Blurring the Boundaries"; Herman B. Leonard, Checks Unbalanced: The Quiet Side of Public Spending (New York: Basic, 1986); Barry P. Bosworth, Andrew S. Carron, and Elisabeth H. Rhyne, The Economics of Federal Credit Programs (Washington, DC: Brookings, 1985); Stanley S. Surrey and Paul R. McDaniel, Tax Expenditures (Cambridges, MA: Harvard University Press, 1985); and Dennis S. Ippolito, Hidden Spending: The Politics of Federal Credit Programs (Chapel Hill, NC: University of North Carolina Press, 1984).
239. Important recent works on indirect spending and "third-party" government include Christopher S. Howard, The Hidden Welfare State: Tax Expenditures and Social Policy in the United States (Princeton, NJ: Princeton University Press, 1997); Benjamin Gidron, Ralph M. Kramer, and Lester M. Salamon, Government and the Third Sector: Emerging Relationship in Welfare States (San Francisco: Jossey-Bass, 1992); Michael Lipsky and Steven Rathgeb Smith, "Nonprofit Organizations, Government, and the Welfare State," Political Science Quarterly 104 (1989-1990) : 625-48; Lester M. Salamon, ed., Beymd Privatization: The Tools of Government Action (Washington, DC: Urban Institute, 1989); Donald F. Kettl, Government by Proxy: (Mis?)Managing Federal Programs (Washington, DC: CQ Press, 1988); Stevens, "Blurring the Boundaries"; Herman B. Leonard, Checks Unbalanced: The Quiet Side of Public Spending (New York: Basic, 1986); Barry P. Bosworth, Andrew S. Carron, and Elisabeth H. Rhyne, The Economics of Federal Credit Programs (Washington, DC: Brookings, 1985); Stanley S. Surrey and Paul R. McDaniel, Tax Expenditures (Cambridges, MA: Harvard University Press, 1985); and Dennis S. Ippolito, Hidden Spending: The Politics of Federal Credit Programs (Chapel Hill, NC: University of North Carolina Press, 1984).
240. See, for example, Neil Gilbert and Barbara Gilbert, The Enabling State: Modern Welfare Capitalism in America (New York: Oxford University Press, 1989); and Richard Rose, "Common Goals but Different Roles; the State's Contribution to the Welfare Mix," in The Welfare State East and West, ed. Richard Rose and R. Shiratori (New York: Oxford University Press, 1986).
241. See, for example, Neil Gilbert and Barbara Gilbert, The Enabling State: Modern Welfare Capitalism in America (New York: Oxford University Press, 1989); and Richard Rose, "Common Goals but Different Roles; the State's Contribution to the Welfare Mix," in The Welfare State East and West, ed. Richard Rose and R. Shiratori (New York: Oxford University Press, 1986).