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The New Politics of the Welfare State$
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Paul Pierson

Print publication date: 2001

Print ISBN-13: 9780198297567

Published to Oxford Scholarship Online: November 2003

DOI: 10.1093/0198297564.001.0001

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Who Pays for Health Care Reform?

Who Pays for Health Care Reform?

(p.334) 11 Who Pays for Health Care Reform?
The New Politics of the Welfare State

Susan Giaimo

Oxford University Press

In this second of three chapters on the distinctive policy dynamics of particular areas of social provision, Susan Giaimo addresses the issue of whether the success of the reformed welfare state in the shape of payers’ and policy makers’ cost‐containment projects have had as their price the sacrifice of equity and solidarity. These questions are explored through the lens of health care reform in Britain, Germany, and the US since the late 1980s: each a country with a distinctive health care system, which undertook major reform initiatives designed to control health care outlays, and addressed the efficiency and equity goals in markedly different ways. Section I provides a broad background to situate the contemporary politics of health care reform, explaining how and why health care systems in Western countries have come under the stress of increasing cost pressures even as governments and employers have become more apprehensive about the possible effects of the welfare state on economic competitiveness. Section 2 develops the argument in greater depth, explaining how existing health care and political systems provide different opportunities or constraints for payers and the state to pursue unilateral cost‐containment strategies, how health care institutions themselves shape policy preferences and strategies of payers, and how some systems require compromise solutions that reconcile equity with efficiency. Section 3 presents each country's case, and the concluding section considers the broader lessons from health care reform for the contemporary politics of welfare state adjustment.

Keywords:   Britain, cost containment, cost pressure, economic competitiveness, efficiency, equity, Germany, health care, health care institutions, health care reform, policy preferences, political systems, solidarity, US, welfare state, welfare state adjustment, welfare state reform

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