The United Kingdom and France: Étatiste Traditions

Abstract

In both the United Kingdom (UK) and France the health care system has been highly centralised as was the case with the organisation of the public sector services in general, reflecting an underlying and parallel, étatisme. However, the form this has taken within each country has been rather different. UK represents the now classic ‘Beveridge’ model of a tax-funded state-directed national health system later adopted in Scandinavia and, more recently, Southern European countries, whereas the French health system is based on the ‘Bismarckian’ model and funded by sickness funds. As Esping-Anderson (1990:166–7) has pointed out, the social democratic potential of the Beveridge Plan was not ultimately realisable because the working-class basis for its success was not strong or cohesive enough to prevent the welfare regime becoming instead more of what will be referred here as a neo-liberal hybrid and the contributing ‘strain’ in the ‘mix’ is the social democratic. France too is something of a hybrid in that its health care system is corporatist (that is, Bismarckian) in its basic organisation and funding arrangements, but the French central state has ensured that it is the dominant organising force and not, in the case of health care, any of the health care actors and certainly not any of the health care professions. Unlike other corporatist regimes France has political culture that has actively rejected subsidiarity in favour of étatisme, legitimated by reference to Rousseau’s principle of the ‘general will’ (volonté général). This is interpreted as the state’s central responsibility is to interpret and represent everyone’s interests, which is rather different from the notion of the ‘middle field’ (Maatschappelijk middenveld) which characterises the state in The Netherlands (see Chapter 3) and quite different from the German federal model (see Chapter 5).