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Destabilization rights and restabilization politics: Policy and political reactions to European Union healthcare services law

Scott Greer (University of Michigan) & Simone Rauscher Singh (University of Michigan)

Developments around EU healthcare services law have been characterized by a puzzling phenomenon. Buzzing political activity in Brussels and member state officials vying to shape EU law in accordance with their respective preferences contrasts with minimal practical changes in national healthcare systems. In their article “Destabilization rights and restabilization politics: Policy and political reactions to European Union healthcare services law” published in the Journal of European Public Policy, Scott Greer and Simone Rauscher Singh explain this disjunction. Drawing on evidence from interviews with German and British public health officials, members of EU institutions and lobbyists, Scott and Simone show that the observed pattern of a broadening political activity at the European level and few actual changes on the ground is a consequence of policy-makers’ strategic choices. Given broad compliance with the patchy legal framework of EU healthcare law is costly for member states, healthcare policy-makers opt for the smallest possible change necessary to comply whenever a national practice is at odds with EU law. Relative to compliance, stepping up their political engagement at the European level to wrest back control over healthcare policy from EU institutions is far less costly for member states. Scott and Simone’s analysis shows that member states’ political engagement in Brussels does not necessarily imply their preference for European policies on healthcare services but “reflects states’ desire to restabilize healthcare law.”

The making of a European healthcare union: a federalist perspective

Hans Vollaard (Utrecht University), Hester van de Bovenkamp (Erasmus University Rotterdam) & Dorte Sindbjerg Martinsen (University of Copenhagen)

Ever since the 1950s, EU member states have sought to protect national competences to organize, finance and provide healthcare from integration at the European level. Despite these efforts, the EU has a become a significant player in public health, regulating key questions on the access to and delivery of healthcare in member states. In their article “The making of a European healthcare union: a federalist perspective” published in the Journal of European Public Policy, Hans Vollaard, Hester van de Bovenkamp and Dorte Sindbjerg Martinsen explain how the EU attained authority in public health against all odds, and offer an outlook on a European healthcare union in the making. Hans, Hester and Dorte show that the free movement of goods, services and workers allowed the European Commission to expand its involvement in healthcare, complemented by the Court of Justice’s favourable interpretations of EU healthcare legislation. Member states’ use of EU fora to pursue voluntary co-operations in the health sector and their willingness to delegate competences to the EU-level in exchange for financial support further facilitated the development of a European healthcare union. However, Hans, Hester and Dorte caution that this union remains fragile. While EU officials see the Europeanization of healthcare as an “instrument to foster a European sense of belonging among the citizens of the EU member states”, evidence that a European healthcare union cultivates citizens’ loyalty toward the EU appears thin at best.

Clientelistic budget cycles: evidence from health policy in the Italian regions

Francesco Stolfi (Macquarie University) & Mark Hallerberg (Hertie School)

When elections are around the corner, incumbent governments face incentives to ramp up their redistributive spending to attract the support of voters, giving rise to so-called political budget cycles (PBCs). In their article “Clientelistic budget cycles: evidence from health policy in the Italian regions” published in the Journal of European Public Policy, Francesco Stolfi and Mark Hallerberg argue that clientelistic fiscal expansions prior to elections are more prevalent in jurisdictions with few employment opportunities offered by the private sector. Clientelistic public expenditures are a particularly promising strategy for incumbents seeking re-election in poorer jurisdictions with a large share of voters relying on jobs in the public sector to support their livelihoods. Francesco and Mark support their claim with original data on income and public health personnel spending in Italy’s 21 regions between 1989 and 2012. Their analysis shows that prior to elections regions with higher per-capita incomes were less likely to see increases in public health personnel spending than poorer regions. Francesco and Mark conclude that “[i]f we take into account the incentives of incumbents and voters in poorer societies, then clientelism becomes a powerful factor explaining differences in the extent of PBCs between countries at different levels of development.”

EU Actors Under Pressure: Politicisation and Depoliticisation as Strategic Responses

Edoardo Bressanelli (Sant’Anna School, Pisa & King’s College London), Christel Koop (King’s College London) & Christine Reh (Hertie School, Berlin)

By Edoardo Bressanelli, Christel Koop & Christine Reh

As the unfolding coronavirus crisis powerfully shows, long gone are the days when EU decisions – including decisions not to act – left Europe’s citizens indifferent, and when the supranational was largely irrelevant for public opinion and electoral politics across the member states. Indeed, the current pandemic is only the last in a string of existential crises that have struck and unsettled the Union over a decade. These crises have politicised Europe, tested the endurance and survival of the supranational system to its core, and put EU-level actors under unprecedented pressure. Our Special Issue “EU Actors Under Pressure: Politicisation and Depoliticisation as Strategic Responses” explores how and why actors respond to the various, sometimes competing, ‘bottom up’ demands.

Our collection challenges the view – captured most prominently by the post-functionalist idea of a “constraining dissensus” – that domestic contestation necessarily limits EU-level room for manoeuvre. Strategic adaptation to the new, politically charged environment, we argue, opens space, too, for ‘enabling dissensus’. Actors may opt for self-restraint, but they may also seek to capitalise on pressures to advance their substantive goals, to expand their competences, and to bolster their long-term survival. As Frank Schimmelfennig argues in his contribution, EU-level actors have agency in response to bottom-up pressures, and they engage in “strategic politicisation management”.

In our introduction, we contend that actors will choose the response most likely to further their shared goal: the survival of the Union and, therefore, the long-term preservation (and, potentially, expansion) of their own powers. Behaviour at the supranational level, we argue, is based on how EU-level actors perceive and process the pressures from domestic politics. If acting ‘politically’ is acceptable for national political elites and the broader public, EU-level actors will attempt to politicise decision-making, behaviour or outcomes at the supranational level; if not, they will pursue depoliticisation strategies.

Depoliticisation strategies aim to ‘reclaim the shadow’ and to make new conflict over integration less visible and polarising. This is the case for the EU’s Court of Justice which, as Blauberger and Martinsen show in their contribution, engages in judicial self-restraint under high levels of contestation. This is also true, partially, for the European Commission, which, assertively, uses its power to withdraw legislation when facing domestic opposition (Reh, Bressanelli and Koop). Moreover, in the process of reforming the EU’s economic governance, Franchino and Mariotto point to a shift towards the more technocratic and implementation-focused supranational level.

By contrast, politicisation strategies are designed to move matters into the heart of politics. Hobolt and Wratil show that the Council of the EU shifts away from its consensual logic when policy issues are salient domestically; Moschella, Pinto and Martocchia Diodati observe that the European Central Bank, under conditions of domestic contestation, moves communication away from an exclusive focus on monetary policy. Bunea demonstrates that the Commission has recently increased openness and consultation beyond established stakeholders in inter-institutional negotiations, whilst Reh, Bressanelli and Koop find that an under-pressure Commission uses decisions not to withdraw legislation to pursue its own ‘responsive’ agenda. Finally, Kelemen explores a paradox of EU politicisation: a leader like Orban benefits from membership in the European People’s Party while consolidating his illiberal regime in Hungary. Growing Euroscepticism and the domestic politicisation of Europe do not necessarily lead to a stand-still. As our Special Issue shows, EU-level actors – facing intense pressure on the system they serve and on their own existence – choose differentiated strategic responses. Some limit and depoliticise EU action; others politicise and, even, empower the supranational level. As yet another crisis hits Europe, we will soon see which (de)politicisation strategies actors like the Commission and the ECB choose to pursue. ‘Business as usual’ would be a very risky and unlikely option indeed.

No match made in heaven: Parliamentary sovereignty, EU over-constitutionalization and Brexit

Susanna K. Schmidt (University of Bremen, photo credit: Lukas Klose)

The British electorate’s choice to leave the EU has been tied to a lack of European identity among the British public, high unemployment rates in some areas of the United Kingdom, as well as voters’ education and income. In her article “No match made in heaven: Parliamentary sovereignty, EU over-constitutionalization and Brexit” published as part of Journal of European Public Policy’s special issue on “The Brexit Policy Fiasco”, Susanne Schmidt argues that existing accounts explaining the Brexit referendum overlooked an important institutional factor. Susanne argues that the EU’s political system, riding on integration through European law interpreted and enforced by the Court of Justice of the European Union (CJEU), has always stood in stark contrast to the United Kingdom’s polity, with strong roots of parliamentary sovereignty and majoritarian decision-making. Focusing on one of the most politicized policy-fields in the context of the Brexit decision, Susanne traces how the CJEU’s case law gradually constitutionalised the EU’s policy-making on intra-EU migration, imposing limits on Member States’ majoritarian decision-making. Ironically, in light of its common-law tradition the United Kingdom’s administration ranked among the most effective compliers with EU law, magnifying the tension between EU law’s constraints on political decision-makers and the United Kingdom’s tradition of parliamentary sovereignty. Susanne’s analysis shows that recognizing the institutional mismatch between the EU’s and British political systems “is necessary to understand why ‘taking back control’ could resonate so easily with British voters.”

The threat of social decline: income inequality and radical right support radical right support

Sarah Engler (University of Zurich) & David Weisstanner (University of Oxford)

Recent research has sought to identify the drivers of the rise of radical right parties (RRPs) across Western democracies. Several observers point out that RRPs appeal to those who feel left behind in the course of globalisation, suggesting a link between rising income inequality and a surge in RRPs’ electoral prowess. In their article “The threat of social decline: income inequality and radical right support radical right support” recognized with the CES/JEPP Political Economy and Welfare Best Paper Prize 2019, Sarah Engler and David Weisstanner offer a novel perspective on the complex relationship between income inequality and voters’ support for RRPs. Increasingly unequal societies not only see a larger share of voters actually experience relative deprivation, voters higher up in the hierarchy also fear a steeper social decline. Sarah and David provide evidence from 14 OECD countries between 1987 and 2017 suggesting that RRPs’ stance against globalisation and rhetoric pitting natives against immigrants resonates particularly with middle-income workers concerned about protecting their status in the social hierarchy. Their analysis emphasizes the importance of looking beyond indicators of voters’ experience of actual decline, as “the voting behaviour of individuals higher up in the social hierarchy is even more crucial to understanding how income inequality fuels RRP support.”

Austerity and the path of least resistance: how fiscal consolidations crowd out long-term investments

Olivier Jacques (McGill University)

In the aftermath of economic crises and recession, fiscal austerity has been the measure of choice across many OECD countries. Against the backdrop of counter-cyclical spending and costly bailouts, governments need to make tough choices to keep their budget sheets balanced. In his article “Austerity and the path of least resistance: how fiscal consolidations crowd out long-term investments” published in the Journal of European Public Policy, Olivier Jacques analyses how governments choose which types of state expenditure fall victim to fiscal austerity. Drawing on budget data from 17 OECD countries between 1980 and 2014, Olivier shows that governments implementing fiscal austerity programmes tend to protect policies that enjoy broad support among their constituencies, such as health care expenditures and pensions. On the flipside, expenditures delivering societal benefits exclusively in the future, including investments into infrastructure as well as research and development, are more likely to be scaled back in the course of fiscal austerity programmes. Olivier warns that governments’ tendencies to prioritize short-term benefits over policies producing long-term gains “reduces the proportion of public investments that would benefit future generations, generating concerns about intergenerational equity.”

Money, power, glory: the linkages between EU conditionality and state capture in the Western Balkans

Solveig Richter (University of Erfurt) & Natasha Wunsch (Sciences Po & ETH Zurich)

Over the past few years, EU candidate countries in the Western Balkans have gradually improved their formal compliance with the EU’s membership criteria. At the same time, democratisation in the region has stagnated at best. How can we explain patterns of decoupling between formal compliance and democratic transformation in the Western Balkans? In their article “Money, power, glory: the linkages between EU conditionality and state capture in the Western Balkans” published in the Journal of European Public Policy, Solveig Richter and Natasha Wunsch identify informal, clientelist networks’ capture of political institutions as a formidable obstacle to the consolidation of democracy in the region. Solveig and Natasha argue that rather than countering state capture, EU conditionality involuntarily strengthened informal networks’ role instead. The weakening of political competition in the face of top-down conditionality and a liberalisation of markets have favoured a small ruling elite, whose interactions with EU officials have legitimized their influence in Western Balkans’ societies. Solveig and Natasha caution that “the current approach towards enlargement risks enabling and reinforcing informal networks by providing them with the resources to capture state institutions, undermine domestic mechanisms of accountability, and maintain their countries in a state of permanent hybridity.”

Unity in diversity? Polarization, issue diversity and satisfaction with democracy

Julian M. Hoerner (London School of Economics) & Sara B. Hobolt (London School of Economics)

Several recent studies have suggested that an increasing polarization of political views within a society is detrimental to voters’ satisfaction with democracy. Polarization may sour the political discourse and impede meaningful discussions among voters. However, voters may not only hold fundamentally diverging views on a number of political issues, but also disagree on which issues are important to them. In their article “Unity in diversity? Polarization, issue diversity and satisfaction with democracy” published in the Journal of European Public Policy, Julian Hoerner and Sara Hobolt argue that the negative effects of polarization on voters’ satisfaction with democracy are moderated by the number of political issues they consider as important. Drawing on Eurobarometer survey data and estimates of the polarization of party systems in 31 European countries between 2003 and 2018, Julian and Sara show that negative associations between polarization and satisfaction with democracy are diminished when the political discourse is not dominated by a single or small number of issues. Julian and Sara argue that these “findings suggest that we can be less concerned with an increase in ideological polarization if it manifests itself across a number of cross-cutting issues.”

Turning out to turn down the EU: the mobilisation of occasional voters and Brexit

Lukas Rudolph (ETH Zurich)

In June 2016 more than 70 percent of eligible voters turned out to cast their ballot in the United Kingdom’s referendum on membership in the EU, far above turnout rates usually seen for the UK’s general and European elections. Did voters who would not usually make their way to the ballot box sway the outcome of the Brexit referendum? In his article “Turning out to turn down the EU: the mobilisation of occasional voters and Brexit” published in the Journal of European Public Policy, Lukas Rudolph makes use of the fact that on the day of the referendum heavy rainfall in some of the UK’s regions induced occasional voters to stay at home. Comparing referendum results for regions with higher and lower turnout rates, Lukas shows that voters who would not usually turn out were more likely to vote in favour of Brexit. Drawing on survey data, he shows that occasional voters were not generally favouring Brexit. Instead, empirical evidence suggests that Leave-campaigners were more effective in mobilising occasional voters supportive of Brexit to turn up at the ballot box on referendum day. Drawing on these findings, Lukas concludes “that turnout is critical to understand electoral outcomes and policy choice in democracies, and even more so in single-issue referendums when partisan attachments are weak.”