Partisan Strategy and Path Dependence: The Post-War Emergence of Health Systems in the UK and Sweden

Abstract

Why did a highly redistributive, nationalised health-care system emerge in the UK, where the Left was comparatively weak, while a more redistributively-neutral, cash-centric, insurance-based system was pursued in Sweden, where the Left was strong? I argue that the explanation is twofold. First, the weakness of the British Labour Party constrained it to pursue redistribution via health policy, while the Swedish Social Democrats were unconstrained in this way. Second, given the redistributive goals of the NHS, it became imperative for the Labour Party to construct a system that would be difficult for future Conservative governments to retrench. Thus, they created structures for the NHS that would persist. More generally, this formulation posits rational actors operating in the kinds of processes typically studied by historical institutionalists. The result is a tendency for a type of path dependence by design. Thus, the UK got the NHS because left-wing policy-makers were weak and feared the Conservatives, while no such fear existed in Sweden.