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

Illan Nam, Colgate University, Feb 2011Draft in progress, please do not quote or citewillingness to subsidize lower-income workers through a more redistributive program.This change in perception, especially among white-collar formal sector workers, waspivotal in spawning the formation of a broad cross-class coalition between labororganizations and more “middle-class”-based civil society groups that generated supportfrom both white-collar and working class voters for a more solidaristic single-payer fund.In contrast, in countries that were plagued by higher inequality, I argue that theincrease in labor market insecurity did not generate as much of a perception of sharedrisks between formal and informal sector workers. In these countries, workers across allsegments also experienced growing precariousness during the 1990s. Labor marketsurveys reveal that labor market flexibilization affected all classes of workers – fromunskilled and skilled manual labor to white-collar workers; across all segments, moreworkers were hired on short-term or fixed-term (honorario) as opposed to open-endedcontracts, which heightened employment instability and correspondingly, the risk ofbeing unable to afford healthcare insurance or being bumped out of company-basedinsurance pools. But despite the growth in insecurity, workers – blue-collar and whitecollarremained atomized and virtually no cross-class coalitions of grassrootsorganizations emerged. While many have argued that the paucity of grassrootsmobilization was rooted in neoliberal labor market policies (most prominently, thedismantling of the public sector and the diminution of labor unions), funding constraintsfor NGOs in Latin America, and the decimation of grassroots organizations during theauthoritarian periods, an alternative explanation for the absence of cross-classmobilization may lie in the barriers posed by high levels of inequality. Even whenupscale and downscale workers faced some measure of shared insecurity, the chasm that28