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Illan Nam, Colgate University, Feb 2011Draft in progress, please do not quote or citegains by championing universal versus targeted social policy. In poorly institutionalizedand regionalized party systems, where partisan attachments were fluid or regionallyrooted, parties, in order to attract new voters or consolidate a more stable coreconstituency, had incentives to cultivate new cleavages that would either attach morefirmly floating voters or cross-cut or complement existing regional attachments.Extending universal social policy benefits was an efficacious strategy for achieving this.To the extent that linkages with voters were based on non-programmatic or clientelisticnetworks, universal social benefits could woo away or attract voters whose loyaltiesderived from patronage goods. Second, for parties looking to expand beyond a regionalbase, social policy represented a potential wedge that could cross-cut regional (or ethnic,as in the case of Taiwan) cleavages and potentially attract voters who might previouslyhave voted based on these bases of identification. Here, universal social policy could beused as an electoral strategy to introduce a programmatic cleavage that could becultivated to override regional or patronage-based partisanship. In party systems whereparties’ vote shares were hampered by fragmentation, unstable because of the presence oflarge numbers of floating voters or limited by regional loyalties, universal social policy,in its sweep of breadth, could reach more potential adherents than targeted policy.In contrast, in party systems where parties had already achieved greaternationalization, institutionalization, and partisan attachments, universalizing social policywas not an efficient electoral gambit. Because voter attachments to their parties isalready firmer, there is less scope for social policy to serve as an issue that could detachvoters from competing bases of party identification. In more institutionalized systems,where the “territory” of new potential voters is less open, universal policy has a lower32
Illan Nam, Colgate University, Feb 2011Draft in progress, please do not quote or citeprobability of returning votes and could result in “wasted” resources. In a more stableelectoral environment, where existing cleavages already divided the electorate, detachingvoters is more costly. In this environment, sweeping universal benefits may not yield thesame efficacy at wooing voters than in a more fluid party system. Thus, the costs ofmore universal policies may not be worth the narrower benefits. Instead, a policy thattargets benefits at specific constituencies whose loyalties a party may want to attract orreinforce may be more cost-effective.CONCLUSIONThis study of healthcare reform outcomes in middle-income developingdemocracies generates a number of interesting theoretical possibilities. First, it suggeststhat globalization can elicit demands for compensatory policy, but the form of thesedemands depends on whether the structure of the domestic political economy mediatesthe pressures of globalization in such ways as to foster cross-class solidarity. The studyalso elucidates that power resources may reside in more transient organizational formsthat are not as institutionalized as they emerged in the post-WWII advanced industrialeconomy landscape. Nonetheless, the mobilization of these organizational resources bysomewhat different class actors appears to make a difference in shaping policy outcomes.Second, the study suggests that there is further room for studying the effects of partysystem institutionalization. While we are led to believe that well-institutionalized partiesand party systems are more conducive to greater accountability, stability, and moreequitable outcomes, the outcome of the cases here suggest that in perhaps intermediatezones of institutionalization – where parties systems are weakly institutionalized but33
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