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

Illan Nam, Colgate University, Feb 2011Draft in progress, please do not quote or citesegments, we may expect to these groups to play a “vanguard” role in organizing crossclasscoalitions.Electoral competitionFinally, recent literature highlights the important role that electoral competition innew democracies played in determining social policy outcomes. In his account ofhealthcare policy expansion in Taiwan and South Korea, Wong claimed that the pressuresof democratic competition motivated politicians to respond pre-emptively to theiropposition by advocating for healthcare expansion in the late 1980s. In particular, Wongidentified the terms of democratic breakthrough as critical to shaping the competitivepressures on ruling regime parties. Variation in how democratic breakthrough wasachieved – whether the transition was managed by political elites or the abrupt outcomeof violent social mobilization from below, the timing of founding elections – affected theextent of the threat to ruling regime parties from opposition parties, which in turn, shapedthe trajectories of expansionist policy. Wong also noted that the absence of salientpolitical cleavages afforded an opportunity for politicians to introduce socioeconomicissues in an effort to articulate new channels of partisan attachments. Thus, welfareexpansion in both these East Asian countries reflected responses by the ruling parties topre-empt the opposition and shore up voter support. Others working in this region havealso noted the importance of electoral pressures in motivating politicians to use socialpolicy initiatives as a means for attracting voters (Yang).These insights help explain why healthcare policy expansion in East Asia did notseem to correspond to any partisan color of the parties that introduced these measures.23