The Importance of Being Evergreen


A comparative overview of national healthcare systems

In an employer-sponsored healthcare system like that of the United States, deteriorating labor market protections have immediate consequences for access to healthcare. Democratic primary candidates have presented a number of proposals to address declining rates of insurance, ranging in degrees of accessibility, coverage, and number of providers.

In her 1992 book, Healthcare Politics, ELLEN M. IMMERGUT seeks to explain America’s healthcare system through a comparison of its history to Switzerland’s, France’s, and Sweden’s. From the author’s preface:

“I compare the politics of three countries where national health insurance had been proposed, but where, as a result of political struggles, the final policy results are diverse. Medical associations in all three countries had opposed national health insurance on the grounds that doctors preferred to work as private practitioners and not as government employees. How then could one explain the fact that Switzerland rejected national health insurance, France accepted it, and Sweden not only enacted national health insurance, but later converted its health system to a de facto national health service? The history of each case pointed insistently to the role played by standard political institutions. The Swiss referendum, the French parliament, and the Swedish executive bureaucracy emerged as key elements in an explanation of national health insurance politics in those countries.

The resulting book argues for the primacy of these institutions in explaining policy outcomes precisely because they facilitate or impede the entry of different groups into the policy-making process. In Switzerland, the public interest on any specific policy issue is viewed as the sum of the demands of individual citizens as expressed in national referenda. In Sweden, on the other hand, proper representation for policy issues is a matter of consensual agreements between interest groups, whose large memberships and democratic procedures ensure their responsiveness to the public. In France, the rules of representation stress the importance of an impartial executive standing above the particularistic claims of interest groups. But there is no linear relationship between a specific set of political institutions and the interest groups that will succeed or the health system that results. These histories are filled with unexpected events, sudden about faces, and new strategies. This book is a call to look at these histories, not just at the broad sweep of major events, but also at the seemingly minor struggles that make up daily political life. These are the battles that establish the constraints on politics, but they are also the junctures that extend the limits of the possible.”

Link to a downloadable copy of the book.

  • “The postwar growth of public expenditures in the health sector and the growth of universalism in coverage of benefits is tied to the strength of the labor movement in each country.” Vincent Navarro’s influential 1989 paper situates healthcare policies within a broader distributional framework. Link.
  • “The idea of a British hospital system funded by its users is one which emerged only late in the 19th century. Before this, care was provided through thousands of voluntary hospitals.” Martin Gorsky, John Mohan, and Tim Willis on “Mutualism and Healthcare” in the UK. And in a similar vein, David T. Beito’s 2000 book on the fraternal societies which provided healthcare to millions of Americans throughout the 19th and early 20th centuries. Link and link.
  • A recent paper by Stefan Bauernschuster, Anastasia Driva, and Erik Hornung uses “the introduction of compulsory health insurance in the German Empire in 1884 as a natural experiment to study the impact of social health insurance on mortality,” finding that “Bismarck’s health insurance generated a significant mortality reduction.” Link.

New Researchers

The effects of food assistance take-up on infant health

UC Berkeley Ph.D. candidate LEAH SHIFERAW examines both the mechanisms of cash transfer program take-up and their effects on health, using the adoption of the Electronic Benefit Transfer card in California as a case study.

From the paper:

“Throughout the decline of traditional cash assistance and movement towards in-work tax credits and transfers, SNAP has remained an essential source of income support, currently lifting more children out of deep poverty than any other federal means-tested program. Yet despite its centrality in the safety net, take-up of program benefits has been persistently incomplete. Almost half of the individuals estimated to be eligible for the program in 2001 were not enrolled, and although participation has risen over time, there are still over 7 million people annually who are eligible to enroll in SNAP and do not participate. I estimate event study regressions using the county level rollout of EBT in California between 2002 and 2004 and find that EBT adoption led to a large and persistent increase in caseloads and applications for the program, as well as higher retailer participation in high poverty neighborhoods. I document that this rise in food stamp benefit take-up led to a meaningful increase in average birth weight for births most likely impacted by the policy, with effects concentrated in the bottom half of the birth weight distribution. These estimates provide new evidence that reducing the barriers to participation in food assistance programs can lead to potentially large gains in health for disadvantaged children.”

Link to the paper, link to Shiferaw’s website.

Each week we highlight great work from a graduate student, postdoc, or early-career professor. Have you read any excellent research recently that you’d like to see shared here? Send it our way:

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  • At the Phenomenal World: Marshall Steinbaum and Jack Gross interview Kim Phillips-Fein, author of Pulitzer finalist Fear City, about austerity politics and public goods at the height of NYC’s 1970s fiscal crisis. Link.
  • “We find that $10,000 in higher tuition causally reduces the probability of graduating with a graduate degree by 6.2 percentage points and increases student debt by $2,961.” New research on “Tuition, Debt, and Human Capital,” by Rajashri Chakrabarti, Vyacheslav Fos, Andres Liberman, and Constantine Yannelis. Link.
  • Andreas Bergh looks at pensions in Sweden to theorize the coexistence of economic freedom and big government—“in the Hayekian sense of requiring knowledge that is difficult to acquire from a central authority.” Link.
  • “For centuries, maps have codified human geographic knowledge and shaped economic decision-making.” In the Winter issue of the Journal of Economic Perspectives, Abhishek Nagaraj and Scott Stern on “The Economics of Maps.” Link. (Also in the issue, global employment composition, electrification & development, and refugee labor market integration. Link, link, and link.)
  • Three new briefs on the effects of guaranteed income, from Columbia’s Center on Poverty and Social Policy: the first on feasibility, the second on design, and the third on financing. Link. h/t Steve
  • A December article by Arun Kumar “examines the emergence of mass letter-writing in the late nineteenth- and early twentieth-century colonial north India, a region marked by unprecedented labor mobility, postal expansion, vernacular print, and workers’ literacy.” Link.
  • In the EPI Macroeconomics Newsletter, Josh Bivens considers the “changing significance of the unemployment rate” in different historical contexts. Link.
  • A data visualization of the relationship between life expectancy and quality of housing in more than 300 NYCHA properties. Link. h/t Halah
  • More notable data viz: an incredible “Map of Mathematics,” connecting number theory to geometry, symmetry, and infinity. Link. h/t Francis
  • “How can we widen the scope of our thinking beyond the idea that money bail is unfair to poor people, to a deeper understanding of the harms of pretrial detention and even criminal adjudication itself?” Jocelyn Simonson introduces an LPE roundtable on cash bail. Link.
  • A new Cleveland Fed paper collects data on advance layoff notices filed under the WARN Act, which requires firms to notify workers 60 days in advance of layoffs, and finds “the number of workers affected by WARN notices leads to state-level initial unemployment insurance claims, changes in the unemployment rate, and changes in private employment.” Link.
  • From 2018, Zachary Davis Cuyler on the distributional politics of Lebanon’s Trans-Arabian pipeline between 1950-1964. Link.
  • Janet Currie, Henrik Kleven, and Esmée Zwiers use text mining to map changes in economics methodology: “Trends towards demanding greater credibility and transparency from researchers in applied economics and a ‘collage’ approach to assembling evidence will likely continue.” Link.
  • “This article examines one of the most consequential legal–political models for the confiscation of private property in the twentieth century: the Trading with the Enemy Acts (TEAs). Two laws with this name were passed in Britain (1914) and the United States (1917), enabling the large-scale expropriation of ‘enemies’ and ‘aliens’. The extra-territorial application of these laws during the era of total war led to the globalization of its paradigm of expropriation in Latin America, Asia, and Africa. The US law was repurposed for domestic use during the New Deal, while its British counterpart played an unforeseen role during decolonization and the great partitions of the late 1940s, as the nascent nation-states of India, Pakistan, and Israel used it to constitute themselves as territorial and economic units by taking land and property from ‘evacuees’ and ‘absentees’. The article provides a short history of these four national cases in their international context, and argues that the history of the TEAs shows that state-driven mass expropriation was much more common throughout the mid twentieth century than usually supposed; the ‘age of extremes’ was also in part an ‘age of expropriation’.” By Nicholas Mulder. Link.

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