Governance and Global Affairs Blog

Care to Vote? Vote for Care!

Care to Vote? Vote for Care!

After the decentralization of long-term care in the Netherlands in 2015 it is important than ever to let our voices be heard in the municipal elections.

 On Wednesday March 21, Dutch citizens will vote in the municipal elections. It will be interesting to see how many people turn out. Local elections generally do not inspire much enthusiasm. In the 2014 municipal elections turnout was a mere 54%1. Nevertheless, the upcoming elections are more important than ever: they are the first municipal elections, after the decentralization of several social policy domains, including long-term care (LTC), in 2015. This means that municipalities now have the authority over this policy area instead of the central state. If Dutch citizens want to exert their democratic right to influence LTC, they best do it on March 21.

            The Netherlands was one of the first countries with a universal LTC insurance system, the Exceptional Medical Expenses Act (AWBZ, 1968). Almost half a century after its initiation, the AWBZ was dissolved in 2015, because the costs of this scheme were going through the roof. The Dutch government spent a whopping 4.3% of its GDP on LTC, making it the most expensive care of all OECD countries2. The recent restructuring of the Dutch LTC system can thus be said to be a case of welfare state retrenchment.

Political scientists have formulated an answer to the question why exactly welfare states are so hard to reform, let alone retrench. Paul Pierson3 famously introduced ‘The New Politics of the Welfare State’ theory, explaining there is an inherent negativity bias in welfare state retrenchment, which changes its political dynamic. The negativity bias explains that individuals have stronger negative feelings towards losing the things they have than positive feelings about gaining something new of an equal value. Instead of openly fighting for interests, the politics of welfare state retrenchment is thus characterized by blame avoidance. No politician wants to take responsibility for unpopular budget cuts in the welfare state and thus they try to lower the visibility of reforms by making the effects of policies hard to detect or by making it hard to trace responsibility for the policy changes.

However, I argue that this strategy of welfare state retrenchment does not work in a country like the Netherlands, which has a conservative-corporatist political culture. The liberal-labour coalition that eventually implemented the policy change in 2015 did not try to avoid blame at all: both parties openly promoted a similar policy change in their election promises4,5. Instead, Dutch LTC restructuring is better explained by tracing the process of implementation and focusing on policy discourse, following the example of Sciences-Po scholar Bruno Palier6. LTC restructuring in the Netherlands was a long process of strategic agreements between different interest groups. Moreover, politicians used ambiguous framing to convince voters of the need to reform, such as “care closeby”, “own responsibility”, being “in charge of your own life”, and “participation”4,5,7,8. These frames are all so vague, that it is hard to disagree with them. The dissolution of the AWBZ was thus stooled on broad social consensus, which makes this a perfect illustration of corporatist political culture. 

From this perspective, the restructuring of the Dutch LTC scheme does not seem controversial at all. It’s all the more surprising that LTC was a hot topic in the Dutch national election of March 2017. Current controversies focused on the execution of this decentralized policy by the municipalities. Relatives of State Secretary for Health, Welfare and Sport, Martin van Rijn, even publicly complained about the elderly care they were receiving!9 Blame avoidance thus re-entered the policy process after the LTC reform was implemented: the new Rutte government was forced to promise to big investments in elderly care, at the sum of €2,1 billion to “meet the new norms of quality care”10.

We need a good turnout on March 21: while the Minister or State Secretary of Health are being addressed for problems in elderly care, little emphasis is put on holding the responsible alderman within the municipalities similarly accountable. If you do care, go vote in these municipal elections.
















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