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Environmental and Healthcare Reform: Thoughts From Someone who Teaches Intro to Comparative Politics

- July 29, 2009

As both the cap and trade and health care debates have played out in recent months, I’ve found myself thinking about the effect of our presidential, single-member district system of government on the ultimate policies that are going to emerge from this process. We have heard again and again that the reason we are not getting the “best” policies – especially in the cap and trade debate – is because of the need to buy off individual legislatures who have particular constituencies that they need to satisfy. The results, many fear, will be less effective policies than we might have had. Theoretically, if we had a parliamentary system of government in this country using a proportional representation national list system for electing the Congress, we shouldn’t run into these problems. A government elected with a large popular mandate should be able to come into office and implements its preferred policies, which, without the need to buy off individual legislators, should lead to ultimately “better” bills.

As this is far from my own research area, I wanted to throw out the question to readers of the Monkey Cage: is there any research out there on this topic? Do we have any sense of whether parliamentary/PR systems tend to produce “better” large scale policy reforms than countries with presidential systems of government and single-member districts for electing legislators? Is either healthcare reform or environmental reform more likely to occur at all in such systems? Keeping in mind the Monkey Cage’s mission of bringing political science to ongoing policy debates, this might be very interesting information from framing the current policy debates going on in the United States.

A quick look at Google Scholar revealed a review article by Jacob Hacker from five years ago in the _British Journal of Political Science_ (“gated”:http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=246451), but I would be interested in learning about other work on the relationship between large scale institutional factors and major policy reforms. Here’s the abstract from Hacker’s article:

bq. This article examines the recent pattern and progress of health care reform in affluent democracies, focusing in particular on Britain, Canada, Germany, the Netherlands and the United States. Its main contention is that efforts to reform health care in advanced industrial states have been marked by a paradoxical pattern of ‘reform without change and change without reform’, in which large-scale structural reforms have had surprisingly modest effects yet major ground-level shifts have, nonetheless, frequently occurred as a result of decentralized adjustments to cost control. The main task of the article is to investigate the reasons for and effects of this puzzling pattern by plumbing the largely unexplored theoretical territory between comparative health policy analysis and cross-national research on the welfare state. Along the way, the article develops a simple model of the politics of reform that helps explain cross-national variation in legislative and policy outcomes – particularly outcomes that occur through decentralized processes of internal policy ‘conversion’ and policy ‘drift’, rather than through formal legislative reform. It also takes up a number of other intriguing issues raised by recent trends: why, for example, market reforms are clustered in centralized political and medical frameworks; why these reforms have generally enhanced state authority rather than market autonomy; why, despite fragmentation, decentralized political and medical systems shifted towards an expanded government role; and why significant retrenchment of the public-private structure of health benefits occurred in the United States.