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Why is health care reform so difficult politically? One prominent explanation holds that "it's the institutions, stupid!" What then can the literature on institutional change tell us about health care reform? Drawing on the notion of belief cascades, we argue that various crises in the health care can challenge the beliefs that support and maintain a given institutional arrangement, and that the resulting quandary creates the possibility of triggering a belief cascade that results in institutional change. We demonstrate how the advent of long waiting lists within the British National Health Service (NHS) created just such a quandary about a system that was widely supported while at the same time widely criticized in regards to its provision of service. We further show how Thatcher was able to engage in a heresthetical maneuver that depicted the waitlists as resulting from inefficiencies within the NHS, and not a lack of resources (e.g., insufficient money, physicians, nurses, or hospitals). In doing so, she was able to trigger a belief cascade that supported the introduction of a previously unviable feature, namely an internal market within the NHS. We also show that the advent of the waitlists did not directly challenge the strongly held belief that the NHS should remain public, and therefore did not allow for the complete privatization of the Service as some had hoped. We generalize our findings by arguing that such crises and quandaries are likely to emerge in the near future as the baby-boomers age, putting increases pressure on already strained health care systems. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

This paper examines how creating or changing property rights affects the politics of interest representation by exploring the movement towards a fully funded, multi-pillar pension system in Hungary. I argue that to more fully account for Hungarian experience, we must include an analysis of the competing domestic interests in regard to pension reform, and the ability of these groups to effectively organize. My central thesis is that both interests and the ability to overcome the challenges inherent in collective action were significantly affected by the redistribution and privatization of state-owned assets. To assess this argument, I combine the distributional consequences of Hungarian privatization methods with a model of collective action to derive hypotheses about which groups were likely to both organize and achieve a degree of political influence. These hypotheses are then tested by tracing the legislative and lobbying efforts which resulted in the rejection of new, mandatory private accounts. Check author’s web site for an updated version of the paper. [ABSTRACT FROM AUTHOR]

By the late 1990s, every nation in Central and Eastern Europe had been forced to make changes in its provision of old-age retirement benefits. Following the example of several Latin American states, and under intense pressure from the World Bank, every country moved towards the imposition of mandatory private pension accounts. Every country that is except the Czech Republic. Previous studies of the exceptional Czechs have focused on the role of external debt and the fiscal deficits of the Pay-As-You-Go system, downplaying the significance of domestic politics. I argue that to more fully account for Czech experience, we must include an analysis of the competing domestic interests in regard to pension reform, and the ability of these groups to effectively organize. My central thesis is that both interests and the ability to overcome the challenges inherent in collective action were significantly affected by the redistribution and privatization of state-owned assets. To assess this argument, I combine the distributional consequences of Czech privatization methods with a model of collective action to derive hypotheses about which groups were likely to both organize and achieve a degree of political influence. These hypotheses are then tested by tracing the legislative and lobbying efforts which resulted in the rejection of new, mandatory private accounts. Check author’s web site for an updated version of the paper. [ABSTRACT FROM AUTHOR]

This paper tests five competing theories of support for integration previously examined within the EU-15 among the 10 new member states, with the goal of better understanding the kinds of policy demands likely to emanate from the region. ..PAT.-Conference Proceeding [ABSTRACT FROM AUTHOR]