Divergent Trajectories: Healthcare Insurance Reforms in East Asia ...

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Illan Nam, Colgate University, Feb 2011Draft in progress, please do not quote or citeSecond, the healthcare insurance initiatives – as well as other welfare reformssuch as pensions and social assistance programs – were spearheaded by governments onboth sides of the partisan spectrum across the three countries and sometimes withincountries. In South Korea, the earlier initiatives to expand coverage were undertaken bya right government (headed by the military regime’s candidate), while the 2001“Integration Reform” that established a single-payer system was the legislativeachievement of a left-of-center government. In Thailand, the right-wing Thaksingovernment was the key architect of the “30-baht card” scheme. Finally, Chile’s AUGElegislation was proposed by the left-of-center Concertacion coalition. The lack of aconsistent relationship between partisanship and policy preferences casts doubt upon thepossibility that differences in ideological commitments accounted for the outcomes.More intriguingly, even in those cases where left parties were responsible for expansivepolicy initiatives, such as the Integration Reform in South Korea and Plan AUGE inChile, the ambitions of the reforms did not correspond to the strength and maturity ofparty organization and party system institutionalization. Party systems in South Koreaand Chile, for example, were characterized by significant disparities ininstitutionalization. On one hand, the Chilean party system ranking as one of the moststable in Latin America, 10 while on the other, South Korean parties have long beenidentified as short-lived vehicles of electoral ambitions for charismatic politicians thatwere not characterized by any meaningful ideological distinctions. 11 Accordingly,conventional wisdom would lead us to expect the Concertación to implement more10 See Arturo Valenzuela, Chile: Politics and Society, Scott Mainwaring and Tim Scully, BuildingDemocratic Institutions: Party Systems in Latin America, Siavelis, Peter, The President and Congress inPostauthoritarian Chile: Institutional Constraints to Democratic Consolidation11 Chung-In Moon and Jongryn Mo, Democratization and Globalization in Korea: Assessment andProspects (Seoul: Yonsei University Press 1999).12
Illan Nam, Colgate University, Feb 2011Draft in progress, please do not quote or citeprogrammatically left policies. But in fact, the organizationally weak South Korean leftparty achieved some success in constructing resonant ideological cleavages aroundsocial, political, and economic issues such as North-South reunification, corporategovernance, economic redistribution, and welfare policy, and pushed through policiesconsistent with these preferences, even in the face of a divided government. 12Third, these three cases exhibit strong and relatively consistent economicperformances. Between 1990 and 2002, Chile grew by an average rate of 5.7%, SouthKorea by 6.3% and Thailand by 5.0%. Second, the three governments demonstratedprudent budgetary management during this time. Chile reported a fiscal surplus of 1.4%,while South Korea recorded a fiscal deficit of -1.0% and Thailand a deficit of -1.5%. 13While there is some dispersion in these performances, nonetheless, the gap isconsiderably narrower than other East Asian and Latin American countries. These threecases exhibited reasonably comparable macroeconomic indicators that reduce thelikelihood that sharp contrasts in macroeconomic management inevitably forced themtowards divergent social policy choices.Fourth, the three countries have coherent state apparatuses that have high internalunity and organization. The developmental state scholarship informed our understandingof the importance of state structures in not only achieving industrial growth but also inimplementing social policy. As Evans stated, “[D]ifferent kinds of state structures createdifferent capacities for action. Structures define the range of roles that the state iscapable of playing.” 14In his study of redistributive policy in Brazil, Weyland argues that12 Song Ho Keun, “Politics, Generation, and the Making of New Leadership in South Korea” Developmentand Society 32:1 (2003)13 World Development Indicators, 2006 14 Peter Evans, Embedded Autonomy (Princeton: Princeton University Press, 1995) 11.13
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