Path Dependency and the Politics of Socialized Medicine
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Rich democracies exhibit vast cross-national and historical variation in the socialization of healthcare. Yet, cross-national analyses remain rare in the health policy literature, and healthcare has been relatively neglected by the welfare state literature. In his lecture, Brady analyzes the public share of total health spending with pooled time series data on 18 rich democracies, 1960-2010. Building on path dependency theory, he presents a novel strategy for modeling the relationship between the initial 1960 public share and the current public share. He also examines two contrasting accounts for how the 1960 public share interacts with conventional welfare state predictors: the self-reinforcing hypothesis expecting positive feedbacks and the counteracting hypothesis expecting negative feedbacks. Brady demonstrates that most of the variation in the public share from 1960 to 2010 can be explained by a country’s initial value in 1960, and that including the 1960 value alters the interpretation of conventional welfare state predictors. He shows that the 1960 values predict individual preferences for government spending on health and demonstrates that these values interact significantly with conventional welfare state predictors. Some interactions support the self-reinforcing hypothesis, while others support the counteracting hypothesis. The lecture is based on a study conducted jointly with Susanne Marquardt, Gordan Gauchat, and Megan M. Reynolds.
David Brady is Director of the Inequality and Social Policy Department at the WZB Berlin Social Science Center and Adjunct Professor at the School of Public and Environmental Affairs of Indiana University. He is the author of Rich Democracies, Poor People (OUP 2009) and studies poverty, inequality, social policy, politics, political economy, health, and other topics.