Health Care and the Fate of Social Europe

Abstract

Public health care systems are, in a sense, a very concrete representation of what a "social Europe" exemplifies: universality, solidarity, well-being, and inclusiveness. As Europe moved toward greater political integration in the early 1990s, the hope for many was that the principle of solidarity that informed many national health care systems could be incorporated into a European-wide schema of robust public health care. But, because the historical trajectory of these states' health care systems led to an array of different models of financing, provision, and regulation, formal integration presupposed a heroic (and arguably unattainable) degree of institutional and political reform. As the health systems of many European Union (EU) member states are a substantial component of their public sectors (and often their public culture), they are messily entangled with larger issues of national sovereignty. While the vision of a wider European health care "system" was one many member states supported at an abstract level, they resisted surrendering control of their health care systems because of fears that the "Europeanization" of health care could result in a system informed, not by solidarity, but by liberalization and the relentless pull of market forces. In consequence, little attempt was made to harmonize national health care systems directly. Member states' health care systems remain formally under national, not EU, jurisdiction, and, as such, the articulation of a "social Europe" within the domain of health policy would seem a rather limited subject for discussion. But the role that health policy plays in the pursuit of a social Europe is more substantial, more complex, and more contingent than the narrative

Politics and governance for co-benefits

“…However, those ministries' actions often reflect deep political disagreement rather than a problem of bureaucratic politics. Just consider the resistance of health sectors to the austerity imposed in many European countries after the 2008 financial crisis -a failure of coordination in the eyes of many finance ministries and central banks but a laudable fight to maintain essential health services in the eyes of many in the health sector (Fierlbeck, 2021;Greer & Brooks, 2020).…”

Closer in hard times? The drivers of European solidarity in ‘normal’ and ‘crisis’ times

“…The initial phase of the pandemic occasioned an almost reflexive reversion to ‘nationalized modes of governance’ (Favell and Recchi 2020 , p. 884), including border closures and export bans. An acrimonious debate over financial assistance to the most affected member states followed, and the risk that ‘the health and economic challenges generated by Covid-19 [could] strain the frayed political bonds of the EU beyond repair’ was perceived as real (Fierlbeck 2021 , p. 18). Nonetheless, in July 2020 EU leaders were able to agree on a massive recovery plan, the Next Generation EU (NGEU) (Bremer et al 2021 ).…”