Healthy Democracies

Book excerpt: Do the pressures of economic globalization undermine the welfare state? Contrary to the expectations of many analysts, Taiwan and South Korea have embarked on a new trajectory, toward a strengthened welfare state and universal inclusion. In Healthy Democracies, Joseph Wong offers a political explanation for health care reform in these two countries. He focuses specifically on the ways in which democratic change in Taiwan and South Korea altered the incentives and ultimately the decisions of policymakers and social policy activists in contemporary health care debates.Wong uses extensive field research and interviews to explore both similarities and subtle differences in the processes of political change and health care reform in Taiwan and South Korea. During the period of authoritarian rule, he argues, state leaders in both places could politically afford to pursue selective social policies—reform was piecemeal and health care policy outcomes far from universal. Wong finds that the introduction of democratic reform changed the political logic of social policy reform: vote-seeking politicians needed to promote popular policies, and health care reform advocates, from bureaucrats to grassroots activists, adapted to this new political context. In Wong's view, the politics of democratic transition in Taiwan and South Korea has served as an effective antidote to the presumed economic imperatives of social welfare retrenchment during the process of globalization.