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Health, federalism and the European Union: lessons from comparative federalism about the European Union

Published online by Cambridge University Press:  30 April 2020

Scott L. Greer Open the ORCID record for Scott L. Greer [Opens in a new window]
Scott L. Greer*
Affiliation:
Professor, Health Management and Policy, Global Public Health, and Political Science, University of Michigan, School of Public Health, Ann Arbor, MI48109-2029, USA
*
Corresponding author. Email: [email protected]
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Abstract

Bringing together the results of a large-scale review of European Union (EU) policies affecting health and a large-scale analysis of social policy and federalism, this paper uses comparative federalism to identify the scope and tensions of EU health policy at the end of the Juncker Commission. Viewing health care and public health policy through the lens of comparative federalism highlights some serious structural flaws in EU health policy. The regulatory state form in which the EU has evolved makes it difficult for the EU to formulate a health policy that actually focuses on health. Of the three faces of EU health policy, which are health policy, internal market policy and fiscal governance, health policy is legally, politically and financially the weakest. A comparison of the EU to other federations suggests that this creates basic weaknesses in the EU's design: its key powers are regulatory and its redistribution minimal. No federal welfare state so clearly pools risks at a low level while making markets so forcefully or creating rights whose costs are born by other levels of government. This structure, understandable in light of the EU's history and development, limits its health and social policy initiatives and might not be stable over the long term.

Keywords

European Unionfederalismhealth policypublic health
Type
Article
Information
Health Economics, Policy and Law , Volume 16 , Special Issue 1: SPECIAL ISSUE: The future of EU health law and policy , January 2021 , pp. 90 - 103
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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