Health Policy and the History of Welfare States: A Reinterpretation

Journal of Policy History

Volumn 10, Issue 2, 1998, Pages 239-256

  Fox, Daniel M ^a  

^a Milbank Memorial Fund   (United States)

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[No Author keywords available]

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EID: 84903680206     PISSN: 08980306     EISSN: 15284190     Source Type: Journal    
DOI: 10.1017/S0898030600005625     Document Type: Article

References (38)

1. Peter Flora, ed. The Western European Welfare States Since World War II (Berlin and New York, 1986), l:xii.
2. Diane B. Kunz, Butter and Guns: America's Cold War Economic Diplomacy (New York, 1997), 118. Kunz (102) makes the useful point that according to the “American postwar bargain … the middle and lower classes would not demand the cradle-to-grave economic security that democratic socialist governments had installed in Europe…. Instead they would accept lower taxes and upward mobility, they could rely on the most unfettered capitalist system in the world to provide them with lives far better than their parents had enjoyed.”
3. Barry Eichengreen, “Institutions and Economic Growth: Europe After World War II,” in Nicholas Crafts and Gianni Toniolo, eds. Economic Growth in Europe Since 1945 (Cambridge, 1996), 65.
4. There is a vast literature on these points. A good introduction is Douglas E. Ashford, “The Historical and Political Foundations of the Welfare State: A Lost Opportunity for the Left?” Journal of Policy History 5:3 (1993): 311-34· A witty summary is “The Changing Face of the Welfare State,” The Economist, 16 August 1995, 41-42.
5. For a more traditional view, see Daniel Levine, Poverty and Society: The Growth of the American Welfare State in International Comparison (New Brunswick, N.J. 1988).
6. A solid comparative study skeptical of polemical interpretations is Peter Baldwin, The Politics of Social Solidarity: Class Bases of the European Welfare State, 1875-1975 (Cambridge, 1990).
7. Another study attempting ideological neutrality is Ewan Ferlie, Lynn Ashburner, Louise Fitzgerald, and Andrew Pettigrew, The New Public Management in Action (Oxford, 1996).
8. Douglas Ashford, The Emergence of the Welfare States (Oxford, 1986), 27.
9. Stein Ringen, The Possibility of Politics: A Study in the Political Economy of the Welfare State (Oxford, 1987), 207.
10. Rudolf Klein, “O’Goffe's Tale, Or, What Can We Learn from the Success of the Capitalist Welfare State?” in Patricia Day, ed. Oniy Dissect: Rudolf Klein on Politics and Society (Oxford, 1996), 310.
11. Edmund S. Phelps, “On the Damaging Side Effects of the Welfare System: How, Why, and What to Do?” and
12. Edmond Malinvaud, “Is the European Welfare State Unsustainable?” in Mario Baldassari, Luigi Paganetto, and Edmund S. Phelps, eds. Equity, Efficiency, and Growth: The Future of the Welfare State (New York, 1996).
13. Mancur Olson, “The Varieties of Eurosclerosis: The Rise and Decline of Nations Since 1982,” in Economic Growth in Europe Since 1945 (above, note 4)
14. Hans Keman, “Proliferation of the Welfare State: Comparative Profiles of Public Sector Management, 1965-1990,” in Kjell A. Eliassen and Jan Kooiman, eds. Managing Public Organizations: Lessons from Contemporary European Experience, 2d ed. (London, 1993), 33.
15. Gosta Esping-Anderson, The Three Worlds of Welfare Capitalism (Oxford, 1990), 9, 33.
16. Sven Steinmo, Taxation and Democracy: Swedish, British, and American Approaches to Financing the Modern State (New Haven, 1993), 173, 196.
17. Ellen M. Immergut, Health Politics: Interests and Institutions in Western Europe (Cambridge and New York, 1992), 11.
18. Similarly, Mary Ruggie, Realignments in the Welfare State: Health Policy in the United States, Britain, and Canada (New York, 1996), insists that health policy does not differ from other social policies (260-66) but addresses mainly financing and organization, with the exception of a brief discussion of rationing.
19. Nicholas Barr, “Economic Theory and the Welfare State: A Survey and Interpretation,” Journal of Economic Literature 30 (June 1992): 742, 745.
20. Daniel M. Fox, Health Policies, Health Politics: The British and American Experience, 1911-1965 (Princeton, 1986), 3-36, documents this point for these countries. There is considerable evidence that the same generalizations hold for Canada and the countries of Western Europe.
21. Health Policies, Health Politics: The British and American Experience, 1911-1965, chaps. 2-4.
22. Daniel M. Fox, Power and Illness: The Failure and Future of American Health Policy (Berkeley and Los Angeles, 1995), 32-36.
23. Organization for Economic Cooperation and Development (OECD), New Directions in Health Policy, Health Policy Studies No. 7 (Paris, 1995), 13.
24. See also Howard Oxley and Maitland MacFarlan, “Health Care Reform: Controlling Spending and Increasing Efficiency,” OECD Economic Development Working Papers, No. 149, 1994
25. Howard Oxley and Maitland MacFarlan, “Health Care Reform: Controlling Spending and Increasing Efficiency,” OECD Economic Studies, No. 24, 1995, 1: 7–52.
26. Brian Abel-Smith, “The Escalation of Health Care Costs: How Did We Get There?” in Organization for Economic Cooperation and Development (OECD), Health Care Reform: The Will to Change, Health Policy Studies No. 8 (Paris, OECD, 1996).
27. For the history of health-care cost containment, see Brian Abel-Smith, “Cost Containment and New Priorities in the European Community,” The Milbank Quarterly 70:3 (1992): 393-416.
28. For the history of the budget crisis of welfare states, see Jan Pen, “Expanding Budgets in a Stagnating Economy: The Experience to the 1970s,” in Charles S. Maier, ed. ChangingBoundaries of the Political: Essays on the Evolving Balance Between the State and Society, Public and Private, in Europe (Cambridge, 1987), 321-61.
29. Abel-Smith, note 20 above. See also James A. Morone and Janice M. Goggin, eds. “European Health Policies: Welfare States in a Market Era,” Journal of Health Politics, Policy and Law 20 (1995): 557-785.
30. As in other comments in this article about contemporary health policy, I rely on voluminous published and unpublished sources to which I have access because my principal employment brings me into daily contact with decision makers in health policy in the public and private sectors of the United States and, to a lesser extent, other countries. Much of what I know from primary sources is privileged, not because the information cannot be made public but because 1 learned it under conditions in which I did not request permission to use information in publications. Readers seeking more information from published sources about any of the issues raised here can seek them through any of the health or medical databases readily available on the Internet. Readers curious about methods of translating information received as a participant in policymaking into scholarly publications might see Daniel M. Fox, “From Piety to Platitudes to Pork: The Changing Politics of Health Workforce Policy,” Journal of Health Politics, Policy and Law 21 (Winter 1996): 825-44.
31. Daniel M. Fox, “Chronic Disease and Policy in the Twentieth Century,” Proceedings of the First World Congress of Medicine and Philosophy, Bulletin of the European Society for the Philosophy of Medicine and Health Care (1995), 3: Special Issue (compact disk)
32. a Dutch version is in Gezondheit 3 (1995): 136-44.
33. Paul Pierson, Dismantling the Welfare State: Reagan, Thatcher, and the Politics of Retrenchment (Cambridge and New York, 1994), 181.
34. Ruggie, Realignment in the Welfare State, 264.
35. Similarly, Monika Steffen, The Fight Against AIDS: An International Public Policy Comparison Between Four European Countries-France, Great Britain, Germany, Italy (Grenoble, France, 1996), regards the response to AIDS as a triumph of the welfare state. I interpret the same data as evidence about the ability of industrial countries to mobilize for emergencies, and note that in the late 1990s, when AIDS is no longer conceptualized as a plague, policy for treating persons with AIDS/HIV infection has the same strengths and weakness in each country as policy for treating persons with other chronic diseases. Another approach, argued by the director of the School of Management Studies at Oxford, holds that the “great paradox of the market revolution … is that an emphasis on market forces and individual rights has led to an increase in State spending on social support…. We have transferred many of the costs of … insecurity from corporations to individuals and hence to the state.”
36. John Kay, “Taxation: The Issue That Mattters Too Much to Be Talked About, Times Literary Supplement, 25 April 1997, 15.
37. “The Withering Away of the State,” The Economist, 6 April 1996, 82. On the other hand, an article that has received little notice argues, on the basis of statistical analysis, that “in 1990, not only were suicide rates higher in [American] states that spent less for public welfare than in states that spent more, but states' spending for public welfare was the only variable that accounted for the widening of differences in states' suicide rates:”
38. Shirley L. Zimmerman, “Psychache [sic] in Context: States' Spending for Public Welfare and Their Suicide Rates,” Journal of Nervous and Mental Disease 183:7, 425–34. Professor Zimmerman was unable to refer me to other research making a similar point.