School of Social and Political Sciences - Theses

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Author: Hannah, Adam × Subject: social policy ×

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    The new politics of old ideas: A comparative study of welfare state reform in Sweden and the United States
    Hannah, Adam ( 2017)
    This study seeks to explain why governments engage in welfare state reform, despite apparent risks, and why they sometimes do so contrary to policy regime type. In so doing, it advances our understanding of the role played by ideas in welfare reform. The study argues that persistent policy problems, described as functional pressure, provide opportunities for ideationally motivated leaders to engage in reform. This pressure allows for the return of previously dormant, non- viable or unsuccessful ideas as alternatives to the status quo. Drawing upon literature on institutions, policy change and decision theory, a distinctive account of reform is developed and then tested through the close analysis of four case studies, from two distinctive welfare systems: Sweden and the United States. In health care, it compares the development of the US Affordable Care Act (popularly known as “Obamacare”), with Sweden’s 2009 vårdval (patient choice) reform in primary care. For pensions, the cases are Sweden’s replacement of its national pension scheme, completed in 1998 and the similar, but failed effort to partly privatise Social Security, led by President Bush in 2005. Ideas are found to play important roles in delegitimising the status quo and providing persuasive links between problem and solution, especially under conditions of uncertainty. However, the causal effects of ideas are mediated by material and perceived institutional and policy constraints. These constraints necessitate bricolage, the piecing together and reframing of existing solutions to fit the political and policy circumstances, as well as learning from previous failures. The analysis of the case studies suggests that in the long-term, innovation through bricolage may spur unexpected bouts of reform. The study therefore challenges the dominant view of the welfare state as highly change resistant. It appears that policy problems will continue to provide opportunities for reform-minded actors to implement long-held ideas, especially if they are able to engage successfully in strategic learning. Although developed welfare states are unlikely to move radically away from established regime types in one fell swoop, this study makes clear that there is significant room for continued evolution and hybridisation, even in “exceptional” welfare states.