Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-30T03:05:48.236Z Has data issue: false hasContentIssue false

Postretrenchment Politics: Policy Feedback in Chile's Health and Pension Reforms

Published online by Cambridge University Press:  02 January 2018

Christina Ewig
Affiliation:
University of Wisconsin, Madison. cewig@wisc.edu
Stephen J. Kay
Affiliation:
Federal Reserve Bank of Atlanta. stephen.kay@atl.frb.org

Abstract

Through a comparison of three periods of health and pension reform in Chile, this article develops an explanation for the incremental form of social policy change that some Latin American nations have witnessed in recent years, despite the dramatic rise of left governments. It describes “postretrenchment politics,” which constitutes a realignment in the way politics plays out in countries that have undergone social policy retrenchment. In postretrenchment politics, the strengthened position of private business interests, combined with political learning legacies and lock-in effects generated by reforms, results in incremental political change, despite renewed efforts by left parties to address inequality. Global capital also plays an important contextual role, and may influence postretrenchment politics. In postretrenchment politics, newly reformed systems may achieve greater equity, but they do so in fragmented form.

Type
Research Article
Copyright
Copyright © University of Miami 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anonymous C01. 2005. Member of the Government Health Reform Technical Commission. Author interview. Santiago, June 2.Google Scholar
Anonymous C02. 2005. Leader of the Colegio Médico of Chile. Author interview. Santiago, May 31.Google Scholar
Arenas de Mesa, Alberto, and Montecinos, Veronica. 1999. The Privatization of Social Security and Women's Welfare: Gender Effects of the Chilean Reform. Latin American Research Review 34, 3: 737.CrossRefGoogle Scholar
Arenas de Mesa, Alberto, Bravo, David, Behrman, Jere R., Mitchell, Olivia S., and Todd, Petra E.. 2008. The Chilean Pension Reform Turns 25: Lessons from the Social Protection Survey. In Lessons from Pension Reform in the Americas, ed. Kay, Stephen J. and Sinha, Tapen. Oxford : Oxford University Press. 2358.Google Scholar
Avelino, George, Brown, David, and Hunter, Wendy. 2005. The Effects of Capital Mobility, Trade Openness, and Democracy on Social Spending in Latin America, 1980–1999. American Journal of Political Science 49, 3: 625–41.Google Scholar
Berstein, Solange, Larraín, Guillermo, and Pino, Francisco. 2006. Chilean Pension Reform: Coverage Facts and Policy Alternatives. Economía 6, 2: 227–79.CrossRefGoogle Scholar
Bertranou, Fabio M. 2001. Pension Reform and Gender Gaps in Latin America: What Are the Policy Options? World Development 29, 5: 911–23.Google Scholar
Biblioteca del Congreso Nacional de Chile. 2002. Conceptualización del Plan de Acceso Universal con Garantías Explícitas (AUGE), Eje de la Actual Reforma de Salud. Serie de Estudios de Anticipación /CEA/BCN año 1, no. 1 (April). Valparaíso : Biblioteca del Congreso Nacional de Chile. http://www.bcn.cl/histley/historias-de-la-ley-ordenadas-por-materia.Google Scholar
Biblioteca del Congreso Nacional de Chile. 2004. Historia de la ley: Ley 19.966 establece un régimen de garantías de salud. Valparaíso : Biblioteca del Congreso Nacional de Chile.Google Scholar
Biblioteca del Congreso Nacional de Chile. 2005. Historia de la ley: Ley 20.015 modifica la Ley 18.933, sobre instituciones de salud previsional. Valparaíso : Biblioteca del Congreso Nacional de Chile.Google Scholar
Biblioteca del Congreso Nacional de Chile. 2008. Historia de la ley: Ley 20.255 establece reforma previsional. Valparaíso : Biblioteca del Congreso Nacional de Chile.Google Scholar
Blackburn, Stephen, Espinosa, Consuelo, and Tokman, Marcelo. 2004. Alternativas para reducir la discriminación y segmentación por riesgo en el sistema de salud chileno. No. 152, Serie Financiamiento del Desarrollo. Santiago : Comisión Económica Para América Latina y el Caribe, Unidad de Financiamiento para el Desarrollo.Google Scholar
Blofield, Merike, and Haas, Liesl. 2005. Defining a Democracy: Reforming the Laws on Women's Rights in Chile, 1990–2002. Latin American Politics and Society 47, 3 (Fall): 3568.Google Scholar
Borzutzky, Silvia. 2002. Vital Connections: Politics, Social Security, and Inequality in Chile. Notre Dame : University of Notre Dame Press.Google Scholar
Bradley, David, Huber, Evelyne, Moller, Stephanie, Nielsen, François, and Stephens, John D.. 2003. Distribution and Redistribution in Postindustrial Democracies. World Politics 55, 2: 193228.Google Scholar
Brooks, Sarah M. 2009. Social Protection and the Market in Latin America. Cambridge : Cambridge University Press.Google Scholar
Cartin, Brian. 1998. Chile: The Effectiveness of Reform. In Do Options Exist? The Reform of Pension and Health Care Systems in Latin America, ed. Cruz-Saco, María Amparo and Mesa-Lago, Carmelo. Pittsburgh : University of Pittsburgh Press. 205–24.Google Scholar
Castañeda, Jorge G. 2006. Latin America's Left Turn: a Tale of Two Lefts. Foreign Affairs 85, 3: 2843.CrossRefGoogle Scholar
Castiglioni, Rossana. 2005. The Politics of Social Policy Change in Chile and Uruguay: Retrenchment Versus Maintenance, 1973–1998. New York : Routledge.Google Scholar
Castiglioni, Rossana. 2006. Cambios y continuidad en política social: educación, pensiones y salud. In El gobierno de Ricardo Lagos: la nueva vía chilena hacía el socialismo, ed. Funk, Robert L.. Santiago : Universidad Diego Portales. 6986.Google Scholar
Chile. Cámera de Diputados. Comisión de Salud. 2002. Informe de la Comisión de Salud sobre el proyecto de ley que establece un régimen de garantías en salud. Boletín No. 2947–11. Santiago : Biblioteca del Congreso Nacional.Google Scholar
Chile. Ministerio de Salud (MINSAL). 2005. El sistema de salud chileno. Presentation by Dra. Nelly Alvarado Aguilar, División de Rectoría y Regulación Sanitaria, Ministerio de Salud. http://www.bcn.cl/carpeta_temas/temas_portada.2005-10-27.7644862447/documentos_pdf.2005-10-28.2320771530.Google Scholar
Consejo Asesor Presidencial para la Reforma Previsional. 2006. El derecho a una vida digna en la vejez: hacia un contrato social con la previsión en Chile. Santiago : Presidencia de la República de Chile.Google Scholar
Cooperativa.cl. 2004. Apoyo ciudadano compromete a “trabajar más y mejor” al Gobierno. December 11. http://www.cooperativa.cl/apoyo-ciudadano-compromete-a-trabajar-mas-y-mejor-al-gobierno/prontus_nots/2004-12-11/143035.html Accessed October 10, 2011.Google Scholar
Couso, Javier, and Coddou, Alberto. 2009. Las asignaturas pendientes de la reforma constitucional chilena. Working paper. Santiago : Instituto de Investigación en Ciencias Sociales, Universidad Diego Portales.Google Scholar
Crepaz, Markus M. L., and Moser, Ann W.. 2004. The Impact of Collective and Competitive Veto Points on Public Expenditures in a Global Age. Comparative Political Studies 37: 259–85.Google Scholar
Dávila, Mireya. 2005. Health Reform in Contemporary Chile: Does Politics Matter? Master's thesis. Department of Political Science, University of North Carolina, Chapel Hill .Google Scholar
El Diario (Santiago). 2002a. Isapres reiteran fuerte crítica a Plan Auge. August 12. http://www.eldiario.cl.Google Scholar
El Diario (Santiago). 2002b. Gobierno dispuesto a evaluar aplicación gradual del Plan Auge. November 18.Google Scholar
El Diario (Santiago). 2002c. Trabajadores de la salud realizan paro en hospitales y consultorios contra el Plan Auge. December 16.Google Scholar
El Diario (Santiago). 2003a. Pablo Lorenzini—“No hay piso político para aprobar el financiamiento del Plan Auge.” January 7.Google Scholar
El Diario (Santiago). 2003b. Colegio Médico entrega alternativa a Plan Auge. January 10.Google Scholar
Diario Financiero (Santiago). 2003. Médicos anuncian movilizaciones. November 11. http://www.df.cl.Google Scholar
Diario Financiero (Santiago). 2006. Afp se preparan para una dura batalla por el proyecto de reforma provisional. December 22.Google Scholar
Diario Financiero (Santiago). 2007. Mario Marcel: Preveo un cambio en el modelo de negocios de las Afp. January 12.Google Scholar
Dion, Michelle. 2010. Workers and Welfare: Comparative Institutional Change In Twentieth-Century Mexico. Pittsburgh : University of Pittsburgh Press.Google Scholar
Dow Jones International News. 2008. Chile's Fin Min Calls for Caution on Record Copper Price. April 10.Google Scholar
Esping-Andersen, Gøsta. 1990. The Three Worlds of Welfare Capitalism. Princeton : Princeton University Press.Google Scholar
Ewig, Christina. 2008. Reproduction, Re-reform, and the Reconfigured State: Feminists and Neoliberal Health Reforms in Chile. In Beyond States and Markets: The Challenges of Social Reproduction, ed. Bakker, Isabella and Silvey, Rachel. New York : Routledge. 143–58.Google Scholar
Fairfield, Tasha. 2010. Business Power and Tax Reform: Taxing Income and Profits in Chile and Argentina. Latin American Politics and Society 52, 2 (Summer): 3766.CrossRefGoogle Scholar
Federación Internacional de Administradoras de Fondos de Pensiones (FIAP). 2007. Estructura de Comisiones. January 12. http://www.fiap.cl.Google Scholar
Fondo Nacional de Salud (FONASA). 2011. Estadísticas demografías. Santiago : FONASA. http://www.fonasa.cl/wps/wcm/connect/internet/sa-general/informacion+corporativa/estadisticas+institucionales. Accessed October 19, 2011.Google Scholar
Garrett, Geoffrey. 2001. Globalization and Government Spending around the World. Studies in Comparative International Development 35, 4: 329.CrossRefGoogle Scholar
Gottschalk, Marie. 2000. The Shadow Welfare State: Labor, Business, and the Politics of Health Care in the United States. Ithaca : Cornell University Press.CrossRefGoogle Scholar
Hacker, Jacob. 2002. The Divided Welfare State: The Battle over Public and Private Social Benefits in the United States. Cambridge : Cambridge University Press.CrossRefGoogle Scholar
Hacker, Jacob. 2004. Privatizing Risk without Privatizing the Welfare State: the Hidden Politics of Social Policy Retrenchment in the United States. American Political Science Review 98, 2: 243–60.Google Scholar
Haggard, Stephan, and Kaufman, Robert R.. 2008. Development, Democracy, and Welfare States: Latin America, East Asia, and Eastern Europe. Princeton : Princeton University Press.Google Scholar
Heclo, Hugh. 1974. Modern Social Politics in Britain and Sweden. New Haven : Yale University Press.Google Scholar
Howard, Christopher. 1997. The Hidden Welfare State: Tax Expenditures and Social Policy in the United States. Princeton : Princeton University Press.Google Scholar
Huber, Evelyne. 1996. Options for Social Policy in Latin America: Neoliberal Ve rsus Social Democratic Models. In Welfare States in Transition: National Adaptations in Global Economies, ed. Esping-Andersen, Gøsta. New York : United Nations Research Institute for Social Development/Sage. 141–91.Google Scholar
Huber, Evelyne, and Stephens, John D.. 2001. Development and Crisis of the Welfare State: Parties and Policies in Global Markets. Chicago : University of Chicago Press.Google Scholar
Huber, Evelyne, Ragin, Charles, and Stephens, John D.. 1993. Social Democracy, Christian Democracy, Constitutional Structure, and the Welfare State. American Journal of Sociology 99, 3: 711–49.Google Scholar
Huber, Evelyne, Pribble, Jennifer, and Stephens, John D.. 2008. The Chilean Left in Power: Achievements, Failures, and Omissions. Paper delivered at the seminar “The Performance of Leftist Governments in Latin America: What Does the Left Do Right?” University of Texas, Austin , March 6–7.Google Scholar
Illanes, María Angélica, and Riesco, Manuel. 2007. Developmentalism and Social Change in Chile. In Latin America: A New Developmental Welfare State in the Making? ed. Riesco, . New York : Palgrave. 378414.Google Scholar
Immergut, Ellen. 1992. The Political Construction of Interests: National Health Insurance Politics in Switzerland, France and Sweden, 1930–1970. New York : Cambridge University Press.Google Scholar
Kaufman, Robert R., and Segura-Ubiergo, Alex. 2001. Globalization, Domestic Politics, and Social Spending in Latin America: a Time-Series, Cross-Section Analysis, 1973–1997. World Politics 53, 4: 553–87.Google Scholar
Kaufman, Robert R., and Nelson, Joan M., eds. 2004. Crucial Needs, Weak Incentives: Social Sector Reform, Democratization, and Globalization in Latin America. Washington , DC / Baltimore : Woodrow Wilson Center Press/Johns Hopkins University Press.Google Scholar
Kay, Stephen J. 1999. Unexpected Privatizations: Politics and Social Security Reform in the Southern Cone. Comparative Politics 31, 4: 403–22.Google Scholar
Kay, Stephen J. 2009. Political Risk and Pension Privatization: the Case of Argentina (1994–2008). International Social Security Review 62, 3: 121.Google Scholar
Korpi, Walter. 1983. The Democratic Class Struggle. London : Routledge and Kegan Paul.Google Scholar
Kurtz, Marcus J. 1999. Chile's Neoliberal Revolution: Incremental Decisions and Structural Transformation, 1973–1989. Journal of Latin American Studies 31: 399427.Google Scholar
Kurzer, Paulette. 1993. Business and Banking: Political Change and Economic Integration in Western Europe. Ithaca : Cornell University Press.Google Scholar
Lloyd-Sherlock, Peter. 2004. Ambitious Plans, Modest Outcomes: the Politics of Health Care Reform in Argentina. In Kaufman and Nelson 2004. 93123.Google Scholar
Luna, Juan Pablo, and Filguera, Fernando. 2009. The Left Turns as Multiple Paradigmantic Crises. Third World Quarterly 30, 2: 371–95.Google Scholar
Mahoney, James, and Thelen, Kathleen, eds. 2010. Explaining Institutional Change: Ambiguity, Agency and Power. New York : Cambridge University Press.Google Scholar
Mensaje Presidencial. 2001. Discurso de S. E. El Presidente de la República D. Ricardo Lagos Escobar. Inicio de la Legislatura Ordinaria en el Congreso Nacional. Valparaíso, May 21. http://www.bcn.cl/susparlamentarios/mensajes_presidenciales/index_html.Google Scholar
Mensaje Presidencial. 2006. Mensaje de S. E. La Presidenta de la República con el que inicia un proyecto de ley que perfecciona el sistema previsional. Mensaje no. 558–354. Santiago, December 15. http://www.sil.senado.cl/docsil/proy5125.doc.Google Scholar
El Mercurio (Santiago). 2002a. Advierten que reforma de salud implicaría término de las Isapres. May 11.Google Scholar
El Mercurio (Santiago). 2002b. Lagos pone urgencia esta semana a proyectos que reforman la salud. July 1.Google Scholar
El Mercurio (Santiago). 2002c. El gobierno retoma el rumbo de las reformas. July 16: C3.Google Scholar
El Mercurio (Santiago). 2002d. Presidente de Isapres critica al plan Auge. November 14.Google Scholar
El Mercurio (Santiago). 2003a. Senador rechaza intención política en apoyo a impuestos al tabaco. July 9.Google Scholar
El Mercurio (Santiago). 2003b. Gobierno marcha atrás en reforma de salud. December 10.Google Scholar
El Mercurio (Santiago). 2008. Gobierno insistirá con la creación de administradora de pensiones estatal. May 9. http://www.elmercurio.com.Google Scholar
El Mercurio (Santiago). 2010. Encuesta Adimark: Bachelet mantiene 84% de aprobación tras el terremoto. March 9. http://www.emol.com/noticias/nacional/detalle/detallenoticias.asp?idnoticia=402477.Google Scholar
Merino, René. 2005. Ex-president of the Association of Isapres of Chile. Author interview. Santiago, July 7.Google Scholar
Mesa-Lago, Carmelo. 1989. Ascent to Bankruptcy: Financing Social Security in Latin America. Pittsburgh : University of Pittsburgh Press.Google Scholar
Mesa-Lago, Carmelo. 2008. Reassembling Social Security: A Survey of Pensions and Healthcare Reforms in Latin America. New York : Oxford University Press.Google Scholar
Montes, J. Esteban, and Vial, Tomás. 2005. The Constitution Building Processes in Chile: The Authoritarian Roots of a Stable Democracy. Working paper. Series: The Role of Constitution Building Processes in Democratization. Stockholm : International Institute for Democracy and Electoral Assistance.Google Scholar
Morales, Mauricio, Navia, Patrico, and Poveda, Antonio. 2008. ¿Somos estastistas los chilenos? In Chile 2008: Percepciones y actitudes sociales. Santiago : Universidad Diego Portales. http://pixeliaworks.cl/clientes/icso2/publicaciones.Google Scholar
Mosley, Layna. 2000. Room to Move: International Financial Markets and National Welfare States. International Organization 54, 4: 737–73.Google Scholar
Müller, Katherina. 2009. Contested Universalism: from Bonasol to Renta Dignidad in Bolivia. International Journal of Social Welfare 18: 163–72.Google Scholar
La Nación (Santiago). 2002. Reforma de la salud recibe sorpresivo apoyo de Isapres. May 11.Google Scholar
Oyarzo, César. 1994. Salud: la mezcla público-privada una reforma pendiente. Documento de trabajo 216. Santiago : Centro de Estudios Públicos.Google Scholar
Palacios-Valladares, Indira. 2010. From Militancy to Clientelism: Labor Union Strategies and Membership Trajectories in Contemporary Chile. Latin American Politics and Society 52, 2 (Summer): 73102.Google Scholar
Pierson, Paul. 1994. Dismantling the Welfare State? Reagan, Thatcher and the Politics of Retrenchment. Cambridge : Cambridge University Press.Google Scholar
Pierson, Paul. 2001. Coping with Permanent Austerity. In The New Politics of the Welfare State, ed. Pierson, . Oxford : Oxford University Press. 410–56.Google Scholar
Pollack, Molly E. 2002. Equidad de género en el sistema de salud chileno. Serie Financiamiento del Desarrollo no. 123. Santiago : Comisión Económica Para América Latina y el Caribe, Unidad de Financiamiento para el Desarrollo.Google Scholar
Pribble, Jennifer E. 2008. Protecting the Poor: Welfare Politics in Latin America's Free Market Era. Ph.D. diss., University of North Carolina, Chapel Hill .Google Scholar
Raczynski, Dagmar. 2000. Overcoming Poverty in Chile. In Social Development in Latin America, ed. Tulchin, Joseph S. and Garland, Allison. Boulder : Lynne Reinner. 119–48.Google Scholar
La Razón (La Paz). 2010. Bolivia estrena una nueva ley de pensiones. December 10.Google Scholar
Rodrik, Dani. 1998. Why Do More Open Economies Have Bigger Government? Journal of Political Economy 106: 9971032.Google Scholar
Rofman, Rafael. 2008. The Pension System in Argentina. In Lessons from Pension Reform in the Americas, ed. Kay, Stephen J. and Sinha, Tapen. Oxford : Oxford University Press. 379402.Google Scholar
Schamis, Hector E. 1999. Distributional Coalitions and the Politics of Economic Reform in Latin America. World Politics 51: 236–68.CrossRefGoogle Scholar
Schamis, Hector E. 2006. A “Left Turn” in Latin America? Populism, Socialism, and Democratic Institutions. Journal of Democracy 17, 4: 2034.Google Scholar
Siavelis, Peter M. 2000. The President and Congress in Postauthoritarian Chile: Institutional Constraints and Democratic Consolidation. University Park : Pennsylvania State University Press.Google Scholar
Siavelis, Peter M. 2006. Electoral Reform Doesn't Matter—Or Does It? a Moderate Proportional Representation System for Chile. Revista de Ciencia Política 26, 1: 216–25.Google Scholar
Silva, Eduardo. 1996. From Dictatorship to Democracy: the Business-State Nexus in Chile's Economic Transformation, 1975–1994. Comparative Politics 28, 3: 299320.Google Scholar
Silva, Eduardo. 1998. Organized Business, Neoliberal Economic Restructuring, and Redemocratization in Chile. In Organized Business, Economic Change, and Democracy in Latin America, ed. Durand, Fransico and Silva, . Coral Gables : North-South Center, University of Miami. 217–52.Google Scholar
Silva, Eduardo. 2000. Capital and the Lagos Presidency: Business as Usual? Bulletin of Latin American Research 12, 3: 339–57.Google Scholar
Silva, Patricio. 2009. In the Name of Reason: Technocrats and Politics in Chile. University Park : Pennsylvania State University Press.Google Scholar
Skocpol, Theda. 1988. The Limits of the New Deal System and the Roots of Contemporary Welfare Dilemmas. In The Politics of Social Policy in the United States, ed. Weir, Margaret, Orloff, Ann Shola, and Skocpol, . Princeton : Princeton University Press. 293312.Google Scholar
Stephens, John D. 1979. The Transition from Capitalism to Socialism. London : Macmillan.CrossRefGoogle Scholar
Streeck, Wolfgang, and Thelen, Kathleen. 2005. Introduction: Institutional Change in Advanced Political Economies. In Beyond Continuity: Institutional Change in Advanced Political Economies, ed. Streeck, and Thelen, . New York : Oxford University Press. 139.Google Scholar
Superintendencia de Salud de Chile. 2008. Estadísticas de Isapres, cartera beneficiarios. http://www.supersalud.gob.cl.Google Scholar
Teichman, Judith. 2001. The Politics of Freeing Markets in Latin America: Chile, Argentina, and Mexico. Chapel Hill : University of North Carolina Press.Google Scholar
La Tercera (Santiago). 2001. Lagos desafía públicamente a Isapres por reforma a la salud. May 10.Google Scholar
La Tercera (Santiago). 2002a. Desestiman propuesta liberal dc para financiar reforma a la salud. May 4.Google Scholar
La Tercera (Santiago). 2002b. La reforma a la salud, según Foxley y Boeninger. May 5.Google Scholar
La Tercera (Santiago). 2002c. Médicos critican seis puntos de la reforma. July 13.Google Scholar
La Tercera (Santiago). 2002d. Gobierno modifica algunos puntos de reforma de salud. November 17.Google Scholar
La Tercera (Santiago). 2008. Gobierno espera reducción de 2 puntos en la pobreza en primer año de la reforma previsional. June 1.Google Scholar
Thelen, Kathleen. 2003. How Institutions Evolve: Insights from Comparative Historical Analysis. In Comparative Historical Analysis in the Social Sciences, ed. Mahoney, James and Rueschemeyer, Dietrich. Cambridge : Cambridge University Press. 208–40.Google Scholar
Titelman, Daniel. 2000. Reformas al sistema de salud en Chile: desafíos pendientes. Serie Financiamiento del Desarrollo no. 104. Santiago: Comisión Económica Para América Latina y el Caribe, Unidad de Financiamiento para el Desarrollo.Google Scholar
Valdés-Prieto, Salvador. 2009. The 2008 Chilean Reform to First-Pillar Pensions. CESifo Working Paper no. 2520. Munich : CESifo Group. January.Google Scholar
Viveros-Long, Anamaría. 1986. Changes in Health Financing: the Chilean Experience. Social Science and Medicine 22, 3: 379–85.Google Scholar
Weyland, Kurt. 2005. The Diffusion of Innovations: How Cognitive Heuristics Shaped Bolivia's Pension Reform. Comparative Politics 38, 1: 2142.Google Scholar
Weyland, Kurt. 2006. Bounded Rationality and Policy Diffusion: Social Sector Reform in Latin America. Princeton : Princeton University Press.Google Scholar
Weyland, Kurt. 2009. The Rise of Latin America's Two Lefts: Insights from Rentier State Theory. Comparative Politics 41, 2: 145–64.Google Scholar
Wibbels, Erik. 2006. Dependency Revisited: International Markets, Business Cycles, and Social Spending in the Developing World. International Organization 60: 433–68.Google Scholar