Welfare states in all advanced industrialized countries are under severe financial stress. Many observers argue that in responding to such pressures, governments are converging on a path of marketization and privatization of social risks, which ultimately leads to the unraveling of solidarity. Recent health care reforms in Britain, Germany, and the United States serve as case studies that challenge this argument. Far from converging on a market path, each country has pursued a distinctive reform response combining markets with other policy instruments. Moreover, where state actors lead the way in constructing health care markets, the extent of desolidarity is limited. The structure of each nation's health care system shapes the policy preferences and reform strategies of key actors, and thereby helps explain the distinctiveness of health care reform patterns.
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References
1.
Aaron, Henry J. (Ed.). (1996). The problem that won't go away. Washington, DC: Brookings Institution.
2.
Aaron, Henry , & Schwartz, William B. (1984). The painful prescription: Rationing hospital care. Washington, DC: Brookings Institution.
3.
Acs, Gregory , Long, Stephen H., Marquis, M. Susan, & Short, Pamela Farley. (1996, Summer). Self-insured employer health plans: Prevalence, profile, provisions, and premiums. Health Affairs, 15(2), Summer, 266-278.
4.
Alber, Jens . (1988). Die Gesundheitssysteme der OECD-Länder im Vergleich [State activities. Historic and international comparative analyses]. In Manfred G. Schmidt (Ed.), Staatstätigkeit. Historisch und international vergleichende Analysen (pp. 116-150). Opladen, Germany: Westdeutscher Verlag.
5.
Baldwin, Peter . (1990). The politics of social solidarity. Cambridge, UK: Cambridge University Press.
6.
Blanke, Bernhard , & Perschke-Hartmann, Christiane. (1994, August). The 1992 health reform. Victory over pressure group politics. German Politics, 3(2), 233-248.
7.
Chirba-Martin , Mary Ann, & Brennan, Troyen A. (1994, Spring). The critical role of ERISA in state health reform. Health Affairs, 13, 142-156.
8.
Clymer, Adam , Pear, Robert, & Toner, Robin. (1994, August 29). For health care, time was a killer. New York Times, pp. A1, A8-A9.
9.
Cooper, Philip F. , & Schone, Barbara Steinberg. (1997, November/December). More offers, fewer takers for employment-based health insurance: 1987 and 1996. Health Affairs, 16(6), 142-149.
10.
Döhler, Marian , & Manow-Borgwardt, Philip. (1992). Korporatisierung als gesundheitspolitische Strategie [Corporatization as a strategy in health policy]. Staatswissenschaften und Staatspraxis, 3, 64-106.
11.
Döhler, Marian , & Manow, Philip. (1995). Staatliche Reformpolitik und die Rolle der Verbände in der Gesundheitspolitik [Health care reforms and the role of associations in German health policy]. In Renate Mayntz & Fritz W. Scharpf (Eds.), Gesellschaftliche Selbstregelung und politische Steuerung (pp. 140-168). Frankfurt am Main, Germany: Campus.
12.
Döhler, Marian , & Manow, Philip. (1997). Strukturbildung von Politikfeldern. Das Beispiel bundesdeutscher Gesundheitspolitik seit den fünfziger Jahren [Policy sector formation. The case of German health policy since the 1950s]. Opladen, Germany: Leske + Budrich.
13.
Dyson, Kenneth . (1982). West Germany: The search for a rationalist consensus. In Jeremy Richardson (Ed.), Policy styles in Western Europe (pp. 17-46). London: Allen & Unwin.
14.
Employee Benefits Research Institute (EBRI) . (1997). Trends in health insurance coverage. EBRI Issue Brief, no. 185.
15.
Enquete-Kommission . (1990). Endbericht der Enquete-Kommission “Strukturreform der gesetzlichen Krankenversicherung” [Final report of the commission on “Reform of the health insurance system”]. Bundestags-Drucksache 11/6380.
16.
Enthoven, Alain C. (1985). Reflections on the Management of the National Health Service: An American Looks at Incentives to Efficiency in Health Services Management in the UK. London: The Nuffield Provincial Hospitals Trust.
17.
Enthoven, Alain C. (1988). Managed competition: An agenda for action. Health Affairs, 7(3), 25-47.
18.
Enthoven, Alain C. (1993). The history and principles of managed competition. Health Affairs, 12(Suppl.), 24-48.
19.
Esping-Andersen, Gosta . (1985). Politics against markets. Princeton, NJ: Princeton University Press.
20.
Esping-Andersen, Gosta . (1990). The three worlds of welfare capitalism. Princeton, NJ: Princeton University Press.
21.
Esping-Andersen, Gosta . (1996). After the golden age? Welfare state dilemmas in a global economy. In Welfare states in transition. National adaptations in global economies (pp. 1-31). London: Sage.
22.
Evans, Peter B. , Rueschemeyer, Dietrich, & Skocpol, Theda. (Eds.). (1985). Bringing the state back in. Cambridge, UK: Cambridge University Press.
23.
Freeman, Richard B. (1994). How labor fares in advanced economies. In Working under different rules (pp. 1-28). New York: Russell Sage Foundation.
24.
Freudenheim, Milt . (1994, September 6). To economists, managed care is no cure-all. New York Times, pp. A1, A10.
25.
Freudenheim, Milt . (1997, January 21). Health care costs edging up and a bigger surge is feared. New York Times, pp. A1, D20.
26.
Freudenheim, Milt . (1998, April 24). Health insurers seek big increases in their premiums. New York Times, pp. A1, C4.
27.
Fuchs, Beth C. , Lyke, Bob, Price, Richard, & Smith, Madeleine. (1997). The Health Insurance Portability and Accountability Act of 1996: Guidance on frequently asked questions (CRS Report for Congress). Updated April 10, 1997. Congressional Research Service/The Library of Congress. 96-805 EPW.
28.
Gamble, Andrew . (1994). The free economy and the strong state: The politics of Thatcherism. Durham: Duke University Press.
29.
Garrett, Geoffrey , & Lange, Peter. (1996). Internationalization, institutions and political change. In Robert O. Keohane & Helen V. Milner (Eds.), Internationalization and domestic politics (pp. 48-75). Cambridge, UK: Cambridge University Press.
30.
General Accounting Office (GAO) (US) . (1995). Employer-based health plans: Issues, trends, and challenges posed by ERISA (GAO/HEHS-95-167). July 1995. Washington, DC: Author.
31.
General Accounting Office (GAO) (US) . (1998). (Report to the Chairman, Committee on Labor and Human Resources, U.S. Senate). Health Insurance Standards: New Federal Law Creates Challenges for Consumers, Insurers, Regulators. (GAO/HEHS-98-67). February 1998. Washington, DC: Author.
32.
Giaimo, Susan M. (1994). Health care reform in Britain and Germany: Recasting the political bargain between the state and the medical profession. Unpublished doctoral dissertation, Department of Political Science, University of Wisconsin-Madison.
33.
Giaimo, Susan M. (1995, July). Health care reform in Britain and Germany: Recasting the political bargain with the medical profession. Governance, 8(3), 354-379.
34.
Giaimo, Susan M. (1996, 29 May-2 June). Health care reform in Britain and Germany: Lessons for the United States. Paper presented at the meeting of the Robert Wood Johnson Foundation Scholars in Health Policy Research Program, Aspen, CO.
35.
Given, Ruth S. (1997). Ensuring competition in the market for HMO services. In John D. Wilkerson, Kelly J. Devers, & Ruth S. Given (Eds.), Competitive managed care (pp. 167-197). San Francisco: Jossey-Bass.
36.
Glennerster, Howard , Matsaganis, Manos, & Owens, Pat. (1992). A foothold for funding: A preliminary report on the introduction of GP fundholding. London: King's Fund Institute.
37.
Grogan, Colleen . (1995, Summer). Hope in federalism: What can the states do and what are they likely to do?Journal of Health Politics. Policy and Law, 20(2), 477-484.
38.
Harrison, Stephen . (1988). Managing the National Health Service: Shifting the frontier?London: Chapman and Hall.
39.
Immergut, Ellen M. (1992). Health politics: Interests and institutions in Western Europe. Cambridge, UK: Cambridge University Press.
40.
James, John H. (1995, Spring). Reforming the British National Health Service: Implementation problems in London. Journal of Health Politics, Policy and Law, 20(1), 191-210.
41.
Jenkins, Peter . (1987). Mrs. Thatcher's revolution: The ending of the Socialist era. London: Jonathan Cape.
42.
Judis, John B. (1995, Spring). Abandoned surgery: Business and the failure of health care reform. The American Prospect, 2, 65-73.
43.
Katzenstein, Peter J. (1987). Policy and politics in West Germany: The growth of a semisovereign state. Philadelphia: Temple University Press.
44.
Kavanagh, Denis . (1990). Thatcherism and British politics: The end of consensus?Second edition. Oxford, UK: Oxford University Press.
45.
Klein, Rudolf . (1995). The new politics of the National Health Service (3rd ed.). London: Longman.
46.
Light, Donald W. (1997). Lessons for the United States: Britain's experience with managed competition. In John W. Wilkerson, Kelly J. Devers, & Ruth S. Given (Eds.), Competitive managed care (pp. 322-356). San Francisco: Jossey-Bass.
47.
Mackscheidt, Klaus . (1990). Finanzausgleichsverfahren zwischen dem Bund und den Trägern der Sozialen Sicherung und zwischen den Trägern der Sozialen Sicherung untereinander [Financial transfers between the public budget and the social insurance schemes and among the social insurance systems]. In Willi Albers, Johannes Hackmann, & Klaus Mackscheidt (Eds.), Finanzierungsprobleme der Sozialen Sicherung I (pp. 145-182). Berlin: Duncker & Humblot.
48.
Mann, Thomas E. , & Ornstein, Norman J. (Eds.). (1995). Intensive care: How Congress shapes health policy. Washington, DC: American Enterprise Institute/Brookings Institution.
49.
Manow, Philip . (1997). Social insurance and the German political economy. MPIFG Discussion Paper 2/97. Cologne, Germany: Max Planck Institute for the Study of Societies.
50.
Manow, Philip , & Giaimo, Susan. (1995, 31 August-3 September). Welfare state regimes, globalization, and health care reform: The cases of Britain, Germany, and the United States. Paper presented at the annual meeting of the American Political Science Association, Chicago.
51.
Marshall, T. H. (1963). Citizenship and social class. In Sociology at the crossroads, and other essays (pp. 67-127). London: Heinemann.
52.
Martin, Cathie Jo. (1995a, December). Nature or nurture? Sources of firm preference for national health reform. American Political Science Review, 89(4), 898-913.
53.
Martin, Cathie Jo. (1995b, Summer). Stuck in neutral: Big business and the politics of national health reform. Journal of Health Politics, Policy and Law, 20(2), 431-436.
54.
Martin, Jurek . (1994, February 4). Business snubs Clinton health bill. Financial Times, p. 5.
55.
Maynard, Alan . (1991, September). Developing the health care market. Economic Journal, 101, 1277-1286.
56.
Miller, Robert , & Luft, Harold S. (1994, May 18). Managed care plan performance since 1980: A literature analysis. Journal of the American Medical Association, 271 (19), 1512-1519.
57.
Ministry of Health (Germany) . (1997). Daten des Gesundheitswesens—Ausgabe 1997 [Health care system data—1997 edition]. Baden-Baden, Germany: Nomos.
58.
Ministry of Health and Central Office of Information (UK) . (n.d.). The National Health Service. London: HMSO.
59.
Moe, Terry M. (1990). Political institutions: The neglected side of the story. Journal of Law, Economics, and Organization, 6, 213-253.
60.
National Health Service Management Executive . (1990). NHS trusts: A working guide. London: HMSO.
61.
Nullmeier, Frank . (1992). Der Zugriff des Bundes auf die Haushalte der Gemeinden und Parafisci [The central government's hold on the budgets of the local authorities and on the para-public budgets]. In Hans-Hermann Hartwich & Göttrick Wewer (Eds.), Regieren in der Bundesrepublik IV: Finanz- und wirtschaftspolitische Bestimmungsfaktoren des Regierens im Bundesstaat—unter besonderer Berücksichtigung des Vereinigungsprozesses (pp. 147-180). Opladen, Germany: Leske + Budrich.
62.
O'Keefe, Anne Marie . (1995, February). Will ERISA's wall come tumbling down?Business and Health, 13(2), 35-40.
63.
Organization for Economic Cooperation and Development (OECD) . (1992). Health care: Balancing quality and cost. Paris; Author.
64.
Pear, Robert . (1997a, March 27). Clinton names panel to draft health consumer bill of rights. New York Times, p. A29.
65.
Pear, Robert . (1997b, November 24). Clinton plans new health care fight. New York Times, A18.
66.
Pear, Robert . (1997c, March 10). Congress weighs more regulation on managed care. New York Times, p. A1.
67.
Pear, Robert . (1997d, October 23). Panel of experts urges broadening of patient rights. New York Times, pp. A1, A24.
68.
Pear, Robert . (1998a, May 11). Bipartisan support grows for managed care patients. New York Times, p. A12.
69.
Pear, Robert . (1998b, July 7). Clinton to punish insurers who deny health coverage. New York Times, pp. A1, A13.
70.
Pear, Robert . (1998c, March 13). Health panel declines to endorse laws for patients' Bill of Rights. New York Times, p. A1.
71.
Pear, Robert . (1999, October 4). House bills diverge over a patient's right to sue. New York Times, p. A24.
72.
Pfaller, Alfred , Gough, Ian, & Therborn, Goran. (1991). The issue. In Can the welfare state compete? A comparative study of five advanced capitalist countries (pp. 1-14). London: Macmillan.
73.
Pierson, Paul . (1993). When effect becomes cause: Policy feedback and political change. World Politics, 45, 595-628.
74.
Pierson, Paul . (1994). Dismantling the welfare state? Reagan, Thatcher, and the politics of retrenchment. Cambridge, UK: Cambridge University Press.
75.
Pike, Alan . (1992, September 5-6). NHS managers' wage bill soars. Financial Times, p. 4.
76.
Pike, Alan . (1993, December 11). Rise of 25% in NHS managers. Financial Times, p. 6.
77.
Polzer, Karl , & Butler, Patricia A. (1997, September/October). Employee health plan protection under ERISA. Health Affairs, 16(5), 93-102.
78.
President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry . (1998). Quality first: Better health care for all Americans. Final report. Washington, DC: Government Printing Office.
79.
Reinhardt, Uwe . (1995, Spring). Turning our gaze from bread and circus games. Health Affairs, 14(1), 33-36.
80.
Rhodes, Martin . (1995). “Subversive liberalism”: Market integration, globalization and the European welfare state. Journal of European Public Policy, 2(3), 384-406.
81.
Richardson, Jeremy . (1994, July). Doing less by doing more: British government 1979-1993. West European Politics, 17, 178-197.
82.
Safran, William . (1967). Veto group politics: The case of health care reform in West Germany. San Francisco: Chandler.
83.
Shalev, Michael . (1996). Introduction. In Michael Shalev (Ed.), The privatization of social policy? Occupational welfare and the welfare state in America, Scandinavia and Japan (pp. 1-23). Basingstoke and New York: Macmillan and St. Martin's.
84.
Shepsle, Kenneth A. (1989). Studying institutions. Some lessons from the rational choice approach. Journal of Theoretical Politics, 1, 131-147.
85.
Sherman, Jill . (1989, December 14). 16,000 pounds for budget-holding GPs. The Times (London), p. 22.
86.
Skocpol, Theda . (1996). Boomerang: Clinton's health security effort and the turn against government in U.S. politics. New York: Norton.
87.
Smith, Sheila , Freeland, Mark, Heffler, Stephen, McKusick, David, & the Health Expenditures Projection Team. (1998). The next ten years of health spending: What does the future hold?Health Affairs, 17(5), 128-140.
88.
Speller, S. R. (1948). The National Health Service Act, 1946 (Annotated). London: H. K. Lewis.
89.
Starr, Paul . (1994). The logic of health care reform: Why and how the president's plan will work. New York: Penguin/Whittle Books.
90.
Steinmo, Sven , & Watts, Jon. (1995). It's the institutions, stupid! Why comprehensive national health insurance always fails in America. Journal of Health Politics, Policy and Law, 20(2), 329-372.
91.
Streeck, Wolfgang , & Schmitter, Philippe C. (1985). Community, market, state—and associations? The prospective contribution of interest governance to social order. European Sociological Review, 1(2), 119-138.
92.
Timmins, Nicholas . (1995). The five giants: A biography of the welfare state. London: HarperCollins.
93.
Titmuss, Richard M. (1974). Social policy: An introduction. Edited by Brian Abel-Smith and Kay Titmuss. New York: Allen and Unwin.
94.
Titmuss, Richard M. (1987). The role of redistribution in social policy. In The philosophy of welfare (pp. 207-219). London: Allen and Unwin.
95.
Toner, Robin . (1994, September 27). Autopsy on health care. New York Times, pp. A1-cf.
96.
U.K. Department of Health, Welsh Office, Northern Ireland Office, Scottish Office . (1989). Working for patients (CM 555). London: HMSO.
97.
U.S. Department of Labor . (n.d.). Questions and answers: Recent changes in health care law. Washington, DC: Pension and Welfare Benefits Administration. Department of Labor. Reproduced by the Library of Congress, Congressional Research Service. Downloaded from the Internet, July 7, 1997.
98.
Vogel, Steven . (1996). Freer markets, more rules. Ithaca, NY, and London: Cornell University Press.
99.
Weaver, R. Kent . (1988). Automatic government: The politics of indexation. Washington, DC: The Brookings Institution.
100.
White House Domestic Policy Council (WHDPC) . (1993). The president's health security plan: The Clinton blueprint. New York: Times Books.
101.
Whitehead, Margaret . (1993). Is it fair? Evaluating the equity implications of the NHS reforms. In Ray Robinson & Julian Le Grand (Eds.), Evaluating the NHS reforms (pp. 208-242). London: King's Funds Institute.
102.
Wilkerson, John D. , Devers, Kelly J., & Given, Ruth S. (Eds.). (1997). Competitive managed care: The emerging health care system. San Francisco: Jossey-Bass.
