The political anatomy of community health policy in Australia, 1972–1982

This article seeks to account for the survival of the 1973–1975 Labor government's new Community Health policy during the conservative coalition government (1975–1983) (which had managed to completely abolish Labor's national Medibank health insurance program). Through extensive interviews with 74 people who were directly involved in the policy process at national, state and local levels, as well as from other sources of information, inquiry is made into the issues and circumstances that were taken into account in the decisions that affected the course of policy from 1972–82. The important political and economic forces included party politics, federal‐state relations, the national economy, the direction of other fiscal and health policies, private and governmental interest groups, administrative nets, and the mass media. The not surprising conclusion is that changes in Community Health policy did not depend on its effectiveness but rather on the balance of political, economic and organizational power of interested groups at particular points in time. Policy‐relevant issues facing the 1983 Labor government are pointed out.     

The National Insurance Acts 1911-1947, the Approved Societies and the Prudential Assurance Company

The role of the British major life assurance companies in administeringthe National Insurance Acts in the guise of approved societieshas long been controversial. The companies have been accusedof profiteering rather than civic duty or social altruism. Thisarticle, using the Prudential Assurance Company as a case study,questions this argument. Life assurance companies such as thePrudential were fundamental to the operational running of nationalhealth insurance in the first half of the twentieth centurydue to their scale, scope and expertise. In addition, they werekeen to extend the scope of national health insurance and campaignedto make the acts more comprehensive. Finally, while the companiescertainly did see benefits in administering the acts, thesewere related more to corporate identity, branding and publicrelations than to direct pecuniary gain. An analysis of theinclusion of the life insurance companies in the administrationof the National Health Insurance Acts is thus as important foran understanding of twentieth-century Britain as it is for thedevelopment of modern social welfare.     

Engendered/endangered: women,tuberculosis, and the project of citizenship

The anti-tuberculosis campaign of the late nineteenth and early twentieth centuries was an unprecedented display of medical authority and public health purview. With accumulating evidence that the disease disproportionately struck the poor, tuberculosis by the early decades of the century was perceived epidemiologically as embedded in individual practices including hygiene and domestic order. Tuberculosis was in a sense a trope for national degeneration, and as such it became the vehicle for a self-conscious thrust towards national renewal and moral regeneration. This paper uses a feminist Foucauldian framework in its analysis of the anti-tuberculosis campaign. In the case of San Francisco, efforts to combat tuberculosis centred in part on women in their roles as wives and mothers. Women were the gatekeepers of health because they were responsible for keeping the home clean and bacillus free. Not only did this focus become a medical legitimization of women's domestic duties, but it also became a discourse of citizenship. Whether explicitly or implicitly, physicians concentrated their attention on white middle class women in their messages of health maintenance. Within sanatoria, a primary agenda of tuberculosis treatment was the inculcation of middle class behaviour into the working class patients. The anti-tuberculosis campaign was thus a part of the early-twentieth-century project of nationhood where citizenship was largely calculated through the lens of class and race.     

Privatisation: An attempt that failed

Throughout the twentieth century doctors in most western countries strongly resisted government attempts to intervene in private medical markets. The support for privatisation that has developed during the current economic recession is welcomed therefore by the medical profession. In several countries campaigns have been staged for a full or partial return to market forces in the health care field. This article traces the course of one such push in Canada where doctors and other advocates of privatisation demanded a larger role for the private sector in the funding and management of Medicare, the national health insurance system. The policy outcome is contrary to the general privatising tendency in many countries: after a period of intense controversy the federal government passed legislation to preserve and strengthen the public aspects of the scheme. The normally powerful medical profession lost its campaign for an infusion of private funds into the health system and for the retention of the right of doctors to set their own fees. Consumer and other non‐producer groups, which have not traditionally played a central role in health policy, mobilised in defense of Medicare and were able to achieve most of their aims.     

Mamlakhtiyut,Education and Religion in the Struggle over the Mass Immigration

The replacement of the fragmented education system of party-controlled “streams” with a unified system of state education was a central goal of David Ben-Gurion's mamlakhtiyut (statism). But in his attempt to realize this goal Ben-Gurion had to overcome the strong opposition of the loyalists of the streams, who formed a powerful coalition that was supported by a majority of Knesset members. For this purpose Ben-Gurion took advantage of the fierce competition between the streams over the education of the children who came during the period of the mass immigration in the early years of independence. He pursued a deliberate policy of exacerbating the crisis to the point that even advocates of the stream system realized that it had become a severe threat to national unity and political stability as well as to vital interests of the parties involved.     

The New South Wales doctors' dispute 1984–85: An interpretation

The NSW doctors’ dispute 1984–85 has had a lasting effect on the Australian health care system. Militant surgeons were effective in securing some modifications to regulations and administrative arrangements governing the role and remuneration of certain groups of doctors in NSW public hospitals and some changes to the federal government's Medicare scheme.

This paper examines the causes, actors, issues and outcome of the dispute. The key to understanding the dispute is a knowledge of both the specific issues debated by militant doctors and the federal and NSW Labor governments and the broader historical forces that have shaped the politics of national health insurance throughout the twentieth century. In contrast to media reports, the outcome of the dispute is interpreted as a compromise rather than a victory for the doctors. It is further argued that a theoretical generalisation formulated by two American political scientists, Marmor and Thomas, about disputes between doctors and governments over payment methods is only partially useful in explaining the outcome.

Two prominent and well‐documented historical themes from the politics of national health insurance in Australia — namely, the resistance of sections of the medical profession to any contraction of the private market for medicine and the fragmentation of the organised medical profession during periods of disputation with governments at the state and federal level — are discussed. These themes, and some generalisations about the capacity of the medical profession to influence public policy outcomes, are illuminated by the study.     

Tense Layering and Synthetic Policy Paradigms: The Politics of Health Insurance in Australia

This paper analyses the substantial financial subsidy, alongside other regulatory changes, introduced to support private health insurance in Australia at the end of the 1990s. The concept of policy layering is developed and refined theoretically in terms of changes in policy paradigms in order to chart a lengthy period of tense layering in Australian health-care politics between private and public health insurance and the bipartisan convergence on a universalism plus choice policy paradigm during the 1990s. This is the key dynamic underlying the Coalition's support of private health insurance after 1996 rather than a neo-liberal ambition to dismantle the health-care state and return to a predominately privately financed health-care system with a residual, public safety net.     

Between clinical medicine and the laboratory: medical research funding in France from 1945 to the present

By focusing on funding methods, this paper considers the way in which medical research eventually led to the science-based medicine that is prevalent in France today. This process seems to have taken place in three stages during the second half of the twentieth century. In the 1940s and 1950s, two major events occurred. The first was the creation of a national health insurance fund in France, which opened up new reasons for, and ways of, funding medical research. The second was the development of antibiotics, which triggered a revival of clinical medicine. In the 1960s and 1970s, a proactive government science policy allowed the life sciences and medical research to come together in the wake of a burgeoning new science: molecular biology. Thus, in 1964, the creation of the National Health and Medical Research Institute (Institut national de la santé et de la recherche médicale or INSERM), destined to "molecularize" medical research, was seen as the fulfillment of the government's ambitious research policy. Today, with medicine irreversibly embedded in scientific and technical rationality, health has become a major issue in modern societies. This paper therefore touches on some of the key features of biomedical research, including the revival of funding systems for clinical research and the development of a system of research grants that was made possible by patient organizations and the creation of new funding agencies.     

The Perpetuation of Regime Security in Gulf Cooperation Council States: A Multi‐Lens Approach

Gulf Cooperation Council (GCC) states have been engaging in diversification efforts, yet the types of efforts suggest that the primary interest is regime security. Regional foreign policy is complex; hence we propose a multi‐lens approach to analyze overlapping and complementary political, economic, and social forces. The international political economy of hydrocarbons demonstrates the similarities among GCC states, regional dynamics illustrate interstate relations and similar patterns, while economic diversification suggests individual state trajectories and comparative and competitive patterns. By outlining the contemporary context for GCC states, we argue that low oil prices, regional dependence on hydrocarbons, and trends in economic diversification efforts signal GCC states' preference to reinforce their rentier systems with alternative state revenue streams. GCC states' diversification into new markets and sectors and use of state‐owned enterprises in microcompetitions indicate a new search for alternative revenue streams and prestige, which in turn are used to assure the perpetuation of regime security. This finding sets trajectories and implications for the region, specifically economic stagnation and supplementary diversification processes.     

Participation in Policy Streams: Testing the Separation of Problems and Solutions in Subnational Policy Systems

The multiple streams theory of national policymaking has been influential in the study of public administration and public policy—if not without a fair bit of controversy. While some laud the model for its openness to the important role of policy entrepreneurs and the irrationalities of the decision‐making processes, others criticize the model for its lack of readily testable propositions. This article identifies a series of testable propositions in the multiple streams model (particularly that discussed by Kingdon). We assess whether participation in local policymaking (focusing on school district policymaking related to violence prevention) is characterized by “separate streams” of participants or is dominated by organized participants like interest groups or policy specialists. We found evidence of unity (rather than separation) in the policymaking process and scant evidence of elite, organized interests dominating the policymaking process. The results call into question a key assumption of the multiple streams model.     

Multiple Partial Couplings in the Multiple Streams Framework: The Case of Extreme Weather and Climate Change Adaptation

In this paper, I draw insights from a detailed case study of adaptation policymaking to develop a novel interpretation of John Kingdon's original work that shows how policy entrepreneurs can couple the problem, policy, and political streams through multiple partial couplings. Researchers and policymakers often assume that extreme weather opens a window to adopt policies aimed at adapting to long‐term climate change. However, empirical evidence shows that crises can redirect attention to urgent, short‐term goals. Using the Multiple Streams lens in an abductive case study, I investigate how these competing forces interact to influence the policy process. By unpacking Kingdon's familiar “streams” metaphor and elaborating his overlooked concept of partial couplings, I illustrate how the policy entrepreneurs' strategy of issue linking explains Australia's adoption of the 2007 Water Act, one of the world's first major adaptation policies, at the height of its decade‐long Millennium Drought. Employing this novel theoretical understanding offers new insights into this important case. I conclude by developing tentative hypotheses for testing in future studies.     

Treatment or Placebo: Are State Programs Decreasing the Proportion of Uninsured?

Currently there are over 45 million Americans without health insurance. Recent growth in Medicaid and State Children's Health Insurance Program (SCHIP) enrollment of children has filled in the sizable gap created by decreased employer‐sponsored insurance since 2000. While the share of children who are uninsured actually decreased between 2000 and 2003, little progress was made in expanding public insurance to adults. As a result, advocates and policymakers at the federal and state level are searching for approaches to deal with the growing number of the uninsured. Conservatives advocate encouraging individuals to buy private insurance while liberals advocate the provision of health coverage through publicly financed health care. Using a 50‐state multilevel individual growth model, this study estimates the net effect of two state approaches in terms of reducing the uninsured: tax incentives (the conservative approach) and direct‐coverage programs (the liberal approach). The results suggest that these approaches have not achieved the results that many advocates had suggested. In the case of tax incentives, the results suggest that states with tax incentives experience increases in the rate of the uninsured. In the case of direct‐coverage programs, results suggest that states receive no relief in the number of uninsured individuals. Finally, the analysis suggests that the efforts originating at the federal level are most successful. These programs are a continuation of the incremental approach policymakers in America have taken to address the problem of the uninsured, rather than taking steps toward a truly comprehensive solution.     

Migrant workers,self‐reliance,and the propensity to hold income protection insurance by country of residence

Utilising a large comparative survey across 11 countries, it is shown that country effects condition the individual uptake of income protection insurance and that shared attributes, including labour market status, are important factors in determining the take‐up of income protection insurance, whatever the respondents' country of residence. We observed differences in the respondents' coping strategies, including self‐reliance, and were able to distinguish between migrant workers and those who work in their country of origin, along with the “special” case of the Australian respondents. These findings have implications for the ongoing debate on the labour market effects of globalisation and the significance of national institutions and regulatory practices.     

Global Poverty and Inequality: Change and Continuity in Late Development

This contribution assesses the ‘converging divergence’ thesis that global inequality is falling and national inequality is rising. The article argues that falling global inequality is primarily due to China's development and that national inequality has risen in some developing countries and fallen in others. In light of the dominance of China's development in the global picture, questions arise as to what has changed and what has not changed outside of China. A set of changes and continuities is presented. It is then argued that these changes and continuities provide for the contemporary relevance an older conceptual lens — that of ‘late development’.     

The cult of Saint Denis and Capetian kingship

Throughout its history, the monastery of Saint-Denis sought to establish a tie with the ruling house, to make the abbey indispensable to the crown as the chief and privileged guardian of the royal presence. Beyond that, as the home of the principal Apostle of Gaul and the first bishop of Paris, it had a symbolic importance for the whole of France, independent of the monarchy itself. The representation of Saint Denis as a national saint, guiding, protecting, and promoting the well-being of the monarchy, was a monastic theme from the ninth century forward. The cult assumed its chief importance, however, in relation to the Capetians when, it is argued, it performed a critical function in the definition of French national identity under the aegis of the monarchy. In its importance for both France and the monarchy, the cult of Saint Denis helped make possible the fusion of two streams of national consciousness that might otherwise have remained distinct. Further, Capetian kings, by identifying themselves with the cult of Saint Denis, were able to tap a significant element of national devotion which contributed to the creation of a royal personality of national scope in France.     

The cult of Saint Denis and Capetian kingship

Throughout its history, the monastery of Saint-Denis sought to establish a tie with the ruling house, to make the abbey indispensable to the crown as the chief and privileged guardian of the royal presence. Beyond that, as the home of the principal Apostle of Gaul and the first bishop of Paris, it had a symbolic importance for the whole of France, independent of the monarchy itself.The representation of Saint Denis as a national saint, guiding, protecting, and promoting the well-being of the monarchy, was a monastic theme from the ninth century forward. The cult assumed its chief importance, however, in relation to the Capetians when, it is argued, it performed a critical function in the definition of French national identity under the aegis of the monarchy. In its importance for both France and the monarchy, the cult of Saint Denis helped make possible the fusion of two streams of national consciousness that might otherwise have remained distinct. Further, Capetian kings, by identifying themselves with the cult of Saint Denis, were able to tap a significant element of national devotion which contributed to the creation of a royal personality of national scope in France.     

Changing the national past: re‐creating the democratic Polish nation after 1989

ABSTRACT. Poland provides a critical example for studying how national identity is transformed to fit new domestic and global circumstances. While Poles must re‐identify themselves as a democratic nation, they have a choice of whether to incorporate aspects of the communist experience or to ignore it and draw solely from other historical sources. A comparison of holiday newspaper articles from before and after 1989 provides an opportunity to observe this process through the lens of national commemoration. This review shows that themes of national identity are influenced by political context and their potential to unify without contestation. In addition, while the communist period remained a salient unifying historical experience for Poles, democratic values did not act as a unifying theme during the first ten years of Polish democracy.     

Critical queer regionality and LGBTQ politics in Europe

This article examines what a critical focus on the region can contribute to the study of LGBTQ politics in Europe. It is argued that a regional lens can challenge methodological nationalism in existing studies of European LGBTQ politics. It can also contribute towards a broader examination of the politics of scale in relation to the Europeanisation of LGBTQ politics. The article discusses alternative theoretical approaches to the region and examines the queer affinities of these approaches in turn. The argument proceeds to consider the political effects of these alternative theoretical framings of the region in contemporary LGBTQ politics in Europe. It is suggested that a regional critical lens can foreground sub-national and transnational regional political formations, which otherwise may be overlooked in an uncritical focus on the national scale of LGBTQ politics. A regional perspective can also help unsettle Anglo-American framings of sexual politics.     

Varieties of nationalism in the political discourses of Habsburg Austria

Nationalism in the Habsburg Empire is traditionally viewed through an ethnic lens. Despite a growing literature on ‘national indifference’ that studies nationalism in Habsburg central Europe from a constructivist perspective and advances our knowledge concerning variations in national identifications, the nationalism implied in these works remains largely limited to an exclusionary ethnic type. This reductionist view of central European nationalism mirrors the traditional dichotomy of ethnic ‘Eastern’ versus civic ‘Western’ nationalism. In order to avoid this reduction, this article approaches nationalism as a thin-centred ideology and explores varieties of nationalism in Habsburg Austria during the long 19th century. Although certain ideational paths made ethno-nationalism appear, retrospectively, as a quasi-natural feature of central Europe, the findings show that there developed rival discursive traditions of nationalism and competing representations of nation.