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Institutions and Culture Health Policy and Public Opinion in the U.S. and Britain

Published online by Cambridge University Press:  13 June 2011

Lawrence R. Jacobs
Lawrence R. Jacobs
Affiliation:
University of Michigan
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Abstract

This article argues that explaining institutional differentiation requires the incorporation of public preferences and understandings into accounts of state development. Using primary evidence concerning policy discussions and public opinion, it suggests that culture determined the specific features of both the British National Health Service Act of 1946 and the American Medicare Act of 1965, as well as the differences between them. Examining the interaction of institutions and culture inserts democratic standards into the top-heavy Weberian discussions of state autonomy and accounts for the seemingly inexplicable failure of policymakers to ensure cost control over the new health programs.

Type
Research Article
Information
World Politics , Volume 44 , Issue 2 , January 1992 , pp. 179 - 209
Copyright
Copyright © Trustees of Princeton University 1992

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63 E.g., see Skocpol and Finegold (fn. 10).

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85 Rather than being able to assess their society in terms of two contending classes and of class-specific behavior such as rioting, policymakers have been faced with intense fragmentation created by ethnic and other cleavages. The emergence and operation of liberal democracy has been identified as a major cause of the fragmentation of society and, especially, of the working class. See Poulantzas, Nicos, State, Power, Socialism (London: New Left Books, 1978)Google Scholar; Przeworski, Adam, Capitalism and Social Democracy (Cambridge: Cambridge Univer sity Press, 1986)Google Scholar; and Ginsberg, Benjamin, The Captive Public (New York: Basic Books, 1986)Google Scholar.

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