Supply-Side Policy Feedback: Resource Distribution for the Under-Privileged

• In Event: Health Policy in Comparative Perspective

Abstract

Why do some governments provide generous public services to the under-privileged, when these clients lack both the political clout and the purchasing power to voice their demands? This paper proposes a theory of “supply-side” policy feedback in response. Absent powerful clients, the maintenance and expansion of public services depends on public workers. Their trade unions advance policies that raise wages, protect employment, and feed resources back into public services. Moreover, the ability of public workers to organize together with their managers constitutes a unique source of influence. Where a labor-management coalition forms, governments maintain and expand services. Where it does not, negative feedback ensues. A comparative-historical analysis of French and American mental health policy in the late twentieth century demonstrates the long-term effects of these two contrasting feedback cycles. The presence of a public labor-management coalition in France expanded the supply of public services for people with chronic and severe mental illness, while its absence in the United States resulted in the retrenchment of both the public mental health system and its workforce.

Author

• Isabel Maria Perera, University of Pennsylvania