Institutional Complementarity and Hierarchy in Dutch Housing and Health Care
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Institutional complementarity and hierarchy in Dutch housing and health care Jan-Kees Helderman ii Bringing the Market Back In? Institutional complementarity and hierarchy in Dutch housing and healthcare Terug naar de markt? Institutionele complementariteit en hiërarchie in de Nederlandse volkshuisvesting en gezondheidszorg Thesis to obtain the degree of Doctor from the Erasmus University Rotterdam by command of the rector magnificus Prof.dr. S.W.J. Lamberts and in accordance with the decision of the Doctorate Board. The public defence shall be held on Thursday October 11, 2007 at 16.00 hours by Jan-Kees Helderman born at Waddinxveen iii Doctoral Committee Promoters: Prof.dr. T.E.D. van der Grinten Prof.dr. J. van der Schaar Other members: Prof.dr. A.C. Hemerijck Prof.dr. W.J.M. Kickert Prof.dr. P. Schnabel Bringing the Market Back In? Institutional complementarity and hierarchy in Dutch housing and health care Helderman, Jan-Kees Proefschrift Erasmus Universiteit Rotterdam Trefwoord: verzorgingsstaat / volkshuisvesting / gezondheidszorg © Jan-Kees Helderman No part of this book may be reproduced in any form, by print, photoprint, microfilm or any other means without written permission from the author. Contact: [email protected] iv Contents Preface vii Introduction 1 1. The welfare state in transition 9 1.1 Introduction 9 1.2 Between state and market: great transformations 10 1.3 Market-oriented reforms in the Dutch welfare state 14 1.4 From welfare regimes to social policy regimes 19 1.5 The two logics of social policy regimes 26 1.6 Social policy regimes and governance 33 1.7 Conclusions 38 2. Social provisions and the welfare state 43 2.1 Introduction 43 2.2 Wobbly pillars and second-best solutions 45 2.3 Market-failures in housing and health care 51 2.4 Social provisions and social risk governance 62 2.5 From public health to health care (insurance) 69 2.6 From public health to (social) housing 76 2.7 Housing and health care as common risk pools 81 2.8 Conclusions 86 3. Social policy regimes 89 3.1 Introduction 89 3.2 Three institutional perspectives 90 3.3 Path dependency: institutions as constraints 93 3.4 Reformative policies: ideas and policy learning 98 3.5 Institutional complementarity and hierarchy 103 3.6 Four ideal typical governance arrangements 107 3.7 Gradual institutional transformations 116 3.8 Conclusions 120 4. The wobbly pillar of the welfare state? 123 4.1 Introduction 123 4.2 Dutch housing: a divided policy regime 127 4.3 Captured by the state, shaken by the market 136 4.4 Creating positive feedback; building a housing stock 143 4.5 Housing in the 1970s: Noah’s Ark in stormy waters 148 4.6 Opening the windows in housing 154 4.7 Housing associations and societal entrepreneurship 161 4.8 The cleavage between the haves and the haves-not 168 4.9 Conclusions 170 5. In search of second best solutions? 175 5.1 Introduction 175 5.2 Dutch health care: a complex policy regime 177 5.3 Reluctant reformers and unstable markets 191 5.4 Etatist interventions: planning and cost-containment 196 5.5 The Health Insurance Access Act of 1986 205 5.6 Bringing the market in: the Dekker proposal 208 5.7 Closing the window for reforms 215 5.8 The ‘purple coalition’: reforms undercover 218 5.9 Health care reforms: the end-game 225 5.10 Conclusions 231 6. Restructuring the welfare state 235 6.1 Introduction 235 6.2 The moral boundaries of the market 238 6.3 The uncertain state of wealth, needs and risks 241 6.4 The twilight zone between retrenchment and reform 250 6.5 The quasi-market illusion 255 6.6 Demand-side tensions: towards an associational democracy? 259 6.7 Supply side conditions: innovations in Social Provision Regimes 265 6.8 Making constraints productive: societal entrepreneurs 270 6.9 Conclusions 271 References 275 Samenvatting 295 Acknowledgements 313 Curriculum vitae 317 vi Preface This study had to follow its own ‘path dependent trajectory’ before it could finally be completed. Fortunately, though, I have been able to stick to my original intention of writing this study. I could not have done that without the help and support of many good colleagues and friends who I will thank more personally in the acknowledgements section at the end of this book (when the final words have been written and read). In this preface I wish to clarify some of the choices that have been made in this study, and in particular my choice of the housing and health care sectors as the two critical cases with respect to market-oriented reforms in the Dutch welfare state. I honestly admit that this was partly a pragmatic choice, but it also reveals the need for combining what Reinhard Bendix (1984: 2), following Karl Popper, calls the logic of discovery with a logic of justification in the inductive/deductive cycle so characteristic of the social sciences. Wondering around After finishing my MA in spatial planning, I worked at the Dutch tenants association for two years. At that time, in the early 1990s, Dutch housing was undergoing major reforms that had been formally launched in 1989 by the Government paper Housing in the Nineties under the responsibility of the Christian Democrat Secretary of State of housing, Enneüs Heerma. Being a junior member of the Dutch housing policy community, I wondered why and how the Dutch social rental sector could be reformed in such a short time and in such an apparently radical way. And since I have a strange tendency to feel more sympathy for the interests of the others, regardless of the interest association by which I am employed, I decided to go back to university, to the Department of Public Administration of the Erasmus University in Rotterdam to be more precise, and write my PhD. on these reforms. Founding moments: a garbage can? When I began this study, my sole interest was in the politics and policies of Dutch housing reforms. My original question was how the reforms in Dutch housing were possible at all, given the fact that from the Second World War onwards, Dutch housing had been constrained by socio-economic policies. As a consequence, housing had become more or Bringing the Market Back In? less imprisoned by the iron triangle of its own ‘rent and subsidy policies’ that had been developed in the past (Van der Schaar, 1987; Salet, 1987). Until the mid-1980s, housing seemed to be a classical example of the ‘lock-in’ effects of previous policies. Yet by the 1990s, these lock-in effects apparently had lost their relevance to Dutch housing in the sense that reforms became possible. Moreover, while the post-war struggle against the housing shortage used to be considered as a highly politicized issue within the Dutch welfare state, in the 1990s, reforms were accomplished without any notable political and public attention. Dutch housing underwent a largely ‘silent revolution’ in which far-reaching reforms were achieved without serious opposition from political parties (from the left), interest groups (especially those of the housing association) and without serious attention from the media and the wider public. There was opposition from the National Tenants Association; yet, tenants did not have any serious veto-powers with which to block the reforms. At first glance, the housing reforms seem to have many of the characteristics of an open ‘garbage can’ (March and Olsen, 1976) in which the coming together of independent problem-streams, policy–streams and decision-makers (Kingdon, 1995), together with exogenous pressures, created a ‘window of opportunity’ for far reaching reforms. A historical-institutional perspective After a second more detailed (and historical) look, it became questionable how revolutionary the reforms in fact were. Many of the ideas behind these housing reforms (the policy stream) were not new, but had already had a long history in Dutch housing. In fact, the idea that the social rental stock could function as a ‘revolving fund’ able to finance itself from its own revenues was one of the founding ideas of the Dutch housing system, dating back to 1901 when the first Dutch Housing Act was passed by Parliament. Moreover, the devolution of public responsibility for social housing to the private not-for-profit housing associations has always been one leading principles in the Dutch housing system. A historical institutional perspective, thus, suggested that many of the reformative ideas had had a long incubation period before they could be transformed into policies and implemented. From a historical- institutional perspective, they were simply a coherent and consistent set of ideas ‘whose time had come’. This in turn added a new puzzle-piece to my study: why did it take almost one century to accomplish these reforms? viii Preface Having arrived at this point in my own process of discovery, I had already passed close to the fallacy of retrospective determinism, meaning that in retrospect it always seems as if everything was destined to develop just the way it did. In order to escape this fallacy, which is especially relevant to single historical case studies, I increasingly felt the need for a comparative perspective. By going beyond the unique case of Dutch housing reforms, I hoped to get a better understanding of the causal factors that could explain the relative ease with which the public housing sector was being reformed in the Netherlands. The peculiarities of housing Due to personal circumstances, I could not choose an cross-national comparison of housing reforms in different European welfare states, though I did learn from the extensive literature on this subject that this ease of reform was not unique to the Dutch case.