Markets and Medicine

Are advanced industrialized countries converging on a market response to reform their systems of social protection? By comparing the health care reform experiences of Britain, Germany, and the United States in the 1990s, Susan Giaimo finds that countries have pursued diverse policy responses and that such variations reflect distinctive institutions, actors, and reform politics in each country.

In Britain, the Thatcher government's plan to inject a market into the state-administered national health service resulted in a circumscribed experiment orchestrated from above. In Germany, the Kohl government sought to repair defects in the corporatist arrangement with doctors and insurers, thus limiting the market experiment and designing it to safeguard and even enhance the solidarity of the national health insurance system. In the United States, private market actors foiled President Clinton's bid to expand the federal government's role in the private health care system through managed competition and national insurance. But market reform continued, albeit led by private employers and with government officials playing a reactive role. Actors and institutions surrounding the existing health care settlement in each country created particular reform politics that either militated against or fostered the deployment of competition.

Nevertheless, major transformations in governance arrangements are occurring in private as well as public systems of social protection. This finding suggests that studies of change in social policy expand their focus beyond statutory welfare state reform in advanced industrial societies. This book will be of interest to social scientists concerned with the changing balance among state, market, and societal interests in governance, as well as to health policy researchers, health policymakers, and health care professionals.

Susan Giaimo is an independent scholar. She completed her Ph.D. in Political Science at the University of Wisconsin-Madison, after which she was a postdoctoral fellow in the Robert Wood Johnson Foundation Scholars in Health Policy Research Program, University of California at Berkeley; and the Robert Bosch Foundation Scholarly Program in Comparative Public Policy and Comparative Institutions, American Institute for Contemporary German Studies, Johns Hopkins University. She taught in the Political Science Department at Massachusetts Institute of Technology for five years. During that period she won the Society for the Advancement of Socio-Economics Founder's Prize for "Adapting the Welfare State: The Case of Health Care Reform in Britain, Germany, and the United States," a paper she coauthored with Philip Manow.

Praise / Awards

• "Through the rigorous lens of three systems (Germany, Britain, the United States), Giaimo puts forth a powerful, nuanced argument about the capacities and limits of states, of markets, and of the medical profession in health care reform. So hold on, reformers! Take another look. All may not be as it seems in the universe of reforming health care systems as we strive toward the traditional goals of quality, equity, and efficiency. Through the comparative lens, Giaimo teaches us a lot, indeed."
  —David Wilsford, Ph.D., President, Institute for American Universities
  
• "Susan Giaimo's new book is a model of careful, comparative scholarship about the politics of German, British, and American health care reform in the 1990s. A synthesis of considerable writing and buttressed by substantial interviews with the relevant actors, this book will prompt attention and respect. It stands alongside the writings of Carolyn Tuohy, Richard Freeman, Michael Moran, David Wilsford, Joe White—to name her peers—as evidence of a revitalized scholarship on medical care and the welfare state."
  —Ted Marmor, author of Understanding Health Care Reform and Professor of Public Policy and Management at the Yale School of Management and Director of the Robert Wood Johnson Foundation's Postdoctoral Program in Health Policy
  
• "We should be grateful . . . for Susan Giaimo's solid and informative new book on the post-1980 health reform paths of Britain, Germany, and the United States. Although Giaimo tells a complex story, she also tells a crucially important story, and brings to her important task a strong grasp not only of the relevant academic debates, but also of the complicated ground-level changes that have taken place in these three nations."
   —Governance
  
• ". . . a solid book. Specialist readers will appreciate the useful contributions that this volume makes to the further development of the institutionalist literature on health-care politics and policymaking. Meanwhile, those with a more general interest will appreciate the clarity with which events in the three countries are described and compared."
  —Perspectives on Politics