National Values, Institutions and Health Policies: What do they Imply for Medicare Reform?

Abstract

This contribution explores the relation between national values and national health policy. The article emphasizes the difficulty in describing “national values” in nations with heterogeneous populations. Values, we characterize as general, and as conflicting with one another. And the article briefly describes the factors besides ideas (including values) that shape national policy: interests and social institutions. The article demonstrates substantial differences in the OECD countries' institutional arrangements – differences in the extent of health insurance coverage, in how organized interest groups bargain about the rules of health financing policy, and which policy instruments are adopted, maintained, or changed over time. At the same time the article provides evidence of widespread public support among the populations of industrialized democracies for the principle of universal access for health care, with the sharing of costs according to ability to pay. This evidence supports the argument that a wide variety of institutions are consistent with the same set of values.

Acknowledgements

This paper was previously published for the Commission on the Future of Health Care in Canada, known as the Romanow Commission. Discussion paper no. 5, July 2002. It has been edited and revised for this Journal of Comparative Policy Analysis, Special Issue, 12(1–2), February–April 2010.

Notes

1. Equally, institutions can shape opinions (Immergut 1992).

2. The terms “sentiments” and “attitudes” are used as synonyms in this section. Both can be based upon (the more fundamental) values, perhaps in combination with factual understanding and emotional commitment.

Additional information

Notes on contributors

Theodore R. Marmor

Ted Marmor is Professor Emeritus of Management at Yale. Among his writings are The Politics of Medicare (1970, 2000), America's Misunderstood Welfare State (with Jerry Mashaw and Philip Harvey), and, most recently, Fads, Fallacies, and Foolishness in Medical Care Management and Policy (2007). Marmor is now an adjunct Professor of Public Policy at Harvard's JF Kennedy School of Government.

Kieke G. H. Okma

Kieke Okma works as an international health consultant and academic and is Adjunct Associate Professor at the Wagner School of Public Services, New York University and Visiting Professor at the Catholic University in Leuven.

Stephen R. Latham

Stephen R. Latham is Deputy Director of Yale University's Interdisciplinary Center on Bioethics, and a Senior Research Fellow in Yale's Program on Ethics, Politics and Economics. His writings on professionalism, biomedical ethics and health policy have appeared in numerous medical, legal, and bioethics journals.