Adapting the Welfare State

Abstract

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.