How Bureaucracies Listen to Courts: Bureaucratized Calculations and European Law

The European Court of Justice, and courts in general, were key actors in the creation of the European Union (EU). However, they cannot change major policy without political supporters to lobby and litigate for implementation. We argue that part of the resolution of this apparent paradox comes from complementing existing work on the activities of EU courts and litigants with a focus on a third actor: implementing bureaucracies, whose effect on law and politics has not been a focus of studies of EU legal development. Their calculations about whether to pay attention, lobby, and comply shape the impact of the law. Those calculations are variable and patterned; when and how bureaucracies listen to courts varies in predictable ways. We find evidence for this proposition in the case of EU health care services law, both in the secondary literature and in empirical studies of France and Spain.     

Alaska public health law reform

The Turning Point Model State Public Health Act (Turning Point Act), published in September 2003, provides a comprehensive template for states seeking public health law modernization. This case study examines the political and policy efforts undertaken in Alaska following the development of the Turning Point Act. It is the first in a series of case studies to assess states' consideration of the Turning Point Act for the purpose of public health law reform. Through a comparative analysis of these case studies and ongoing legislative tracking in all fifty states, researchers can assess (1) how states codify the Turning Point Act into state law and (2) how these modernized state laws influence or change public health practice, leading to improved health outcomes.     

Contesting anticompetitive actions taken in the name of the state: state action immunity and health care markets

The so-called state action doctrine is a judicially created formula for resolving conflicts between federal antitrust policy and state policies that seem to authorize conduct that antitrust law would prohibit. Against the background of recent commentaries by the federal antitrust agencies, this article reviews the doctrine and discusses its application in the health care sector, focusing on the ability of states to immunize anticompetitive actions by state licensing and regulatory boards, hospital medical staffs, and public hospitals, as well as anticompetitive mergers and agreements. Although states are free, as sovereign governments, to restrict competition, the state action doctrine requires that "the state itself" make the decision to do so. Partly on the basis of problems in the political environment, the article criticizes courts for using a mere "foreseeability" test to decide whether a state legislature sufficiently authorized competitors to act in contravention of clear federal policy: "Few things are more foreseeable than that a trade or profession empowered to regulate itself will produce anticompetitive regulations."     

Food Fraud and the Partnership for a ‘Healthier’ America: A Case Study in State-Corporate Crime

At a moment of heightened public concern over food-related health issues, major corporations in the food industry have found their products and practices under scrutiny. Needing to be understood as socially responsible, these corporations have established partnerships with the state to construct a positive, proactive, and cooperative public image. One major public–private partnership that evolved from former First Lady Michelle Obama’s Let’s Move initiative—the Partnership for a Healthier America—serves as a case study in this paper, which analyzes the consequences and social harms perpetuated by a public health campaign bound by the imperative to maximize profit. By using trusted state actors to deliver accurate but deceptive claims about food companies’ commitment to public health, this public–private partnership actively misleads the public and potentially exacerbates public health challenges, warranting a skeptical revision of how we understand corporate social responsibility and neoliberal governance on issues of health and nutrition. As a form of fraud, these attempts to mislead the public go beyond the actions of public sector individuals or members of corporate boards, but are structurally incentivized by the legal rights, regulatory privileges, and profit-related incentives central to the modern corporate form. While conventional criminological research tends to underemphasize state and corporate harms, we make use of a critical criminological perspective to analyze state-corporate partnerships in the space between food industry practices and public health policy.     

Courts and health policy: judicial policy making and publicly funded health care in Canada

The 1982 Canadian Charter of Rights and Freedoms provided political actors with the opportunity to make rights-based challenges to public policy decisions. Two challenges launched by providers and consumers of health care illuminate the impact of judicial review on health care policy and the institutional capacity of courts to formulate policy in this field. The significant impact of rights-based claims on cross-jurisdictional policy differences in a federal regime is noted.     

Changing Definitions of Risk and Responsibility in French Political Scandals

In the 1990s in France, a large number of political scandals developed and many political actors were prosecuted. This process of making politicians responsible related, in particular, to the rise of 'new risks' regarding public health and security. In this paper, I analyse the diffusion and the crystallization of discourses linking public risk and political responsibility. First, I point to some of the social and cognitive bases in which the recent uses of the notions of risk and responsibility are rooted. Second, I focus on the mechanisms through which the notions were mobilized and invested with new definitions in the course of the scandal hearings. Third, I explore some of the effects of the changes which occurred during the 1990s: new perception frames in terms of risk and responsibility are consolidated and are progressively appropriated by social actors located in various professional spheres.     

The law and the public's health: a study of infectious disease law in the United States

Law plays crucial roles in the field of public health, from defining the power and jurisdiction of health agencies, to influencing the social norms that shape individual behavior. Despite its importance, public health law has been neglected. Over a decade ago, the Institute of Medicine issued a report lamenting the state of public health administration, generally, and calling, in particular, for a revision of public health statutes. The Article examines the current state of public health law. To help create the conditions in which people can be healthy, public health law must reflect an understanding of how public health agencies work to promote health, as well as the political and social contexts in which these agencies operate. The authors first discuss three prevailing ways in which the determinants of health are conceptualized, and the political and social problems each model tends to create for public health efforts. The analysis then turns to the core functions of public health, emphasizing how law furthers public health work. The Article reports the results of a fifty-state survey of communicable disease control law, revealing that few states have systematically reformed their laws to reflect contemporary medical and legal developments. The Article concludes with specific guidelines for law reform.     

Contesting Legality in Authoritarian Contexts: Food Safety,Rule of Law and China's Networked Public Sphere

Since the introduction of the Internet, China's networked public sphere has become a critical site in which various actors compete to shape public opinion and promote or forestall legal and political change. This paper examines how members of an online public, the Tianya Forum, conceptualized and discussed law in relation to a specific event, the 2008 Sanlu milk scandal. Whereas previous studies suggest the Chinese state effectively controls citizens' legal consciousness via propaganda, this analysis shows that the construction of legality by the Tianya public was not a top‐down process, but a complex negotiation involving multiple parties. The Chinese state had to compete with lawyers and outspoken media to frame and interpret the scandal for the Tianya public and it was not always successful in doing so. Data show further how the online public framed the food safety incident as indicative of fundamental problems rooted in China's political regime and critiqued the state's instrumental use of law.     

Some Questions Pertaining to the Study of Government in the System of Legal Education

Courses in government represent different proportions of the curriculum in the system of legal education in various countries. In bourgeois states, it is usually only the public (constitutional) law of their own country and so-called "political science," often amounting to several years in the curriculum (as in Canada, Ethiopia, etc.), that are studied as general disciplines. The object of political science includes, specifically, a comparative study of the political and legal systems of the world (sometimes a number of subdisciplines are combined with constitutional law to comprise a general discipline — constitutional law and political institutions, as is the case in France, for example); but, basically, "political science" goes far beyond the confines of the study of government. In the bourgeois countries, the other subjects in the field of government are handled as special or elective courses, but their scope is very limited. Legal education as such, in the system of training personnel for the administration of justice, is limited essentially to the study of legal institutions. Higher educational institutions and departments of political science are used in the USA, England, France, the Federal Republic of Germany, Italy, India, etc., to train higher and middle-rank officials.     

The invention of health law

By default, the courts are inventing health law. The law governing the American health system arises from an unruly mix of statutes, regulations, and judge-crafted doctrines conceived, in the main, without medical care in mind. Courts are ill-equipped to put order to this chaos, and until recently they have been disinclined to try. But political gridlock and popular ire over managed care have pushed them into the breach, and the Supreme Court has become a proactive health policy player. How might judges make sense of health law's disparate doctrinal standards? Scholars from diverse ideological starting points have converged toward a single answer: the law should look to deploy medical resources in a systematically rational manner, so as to maximize the benefits that every dollar buys. This answer bases the orderly development of health care law upon our ability to reach stable understandings, in myriad circumstances, of what welfare maximization requires. In this Article, I contend that this goal is not achievable. Scientific ignorance, cognitive limitations, and normative disagreements yield shifting, incomplete, and contradictory understandings of social welfare in the health sphere. The chaotic state of health care law today reflects this unruliness. In making systemic welfare maximization the lodestar for health law, we risk falling so far short of aspirations for reasoned decision making as to invite disillusion about the possibilities for any sort of rationality in this field. Accordingly, I urge that we define health law's aims more modestly, based on acknowledgement that its rationality is discontinuous across substantive contexts and changeable with time. This concession to human limits, I argue, opens the way to health policy that mediates wisely between our desire for public action to maximize the well being of the many and our intimate wishes to be treated noninstrumentally, as separate ends. I conclude with an effort to identify the goals of health law, so constructed, should pursue and to suggest how a strategy of accommodation among these goals might apply to a variety of legal controversies.     

A Tale of Two Debtors: Responding to the Shock of Over‐Indebtedness in France and England – a Story from the Trente Piteuses

England and France have developed distinct treatment systems to address the shock of a substantial increase in over‐indebted individuals since the mid‐1980s. In France, Over‐Indebtedness Commissions, with the Bank of France playing a central role in their management, now dominate the system. A more fragmented system of private and public providers of remedies developed in England, with innovation driven by private actors modifying existing commercial procedures and increased access to bankruptcy relief a side‐effect of government promotion of entrepreneurialism. This article explains the differences between these countries in terms of the influence of interest groups, including state actors, and ideologies. Historical contingency also plays a role. The distinct responses were not hard‐wired to legal origins and the article argues that analysis of the interaction of interest groups, state actors and ideology in shaping institutions, which in turn structure future change, provides a productive approach for future comparative research in this area.     

Challenging custom: rethinking national population surveillance policy in a global public health age

This article examines the current state of disease surveillance and reporting in the United States and seeks to answer two central questions: first, whether the increasing emphasis on the global importance of public health policies compels a fundamental reexamination of the long-standing deferential approach to state power where matters of population health surveillance are concerned and, second, how the nation's long-standing deferential legal customs might be modified to address the growing emphasis on global public health policy that is undergirded by technological advances. We examine the International Health Regulations, or IHR (2005), and suggest that these regulations offer a powerful impetus for reevaluating U.S. legal custom concerning the policy and practice of population health surveillance, not only as a matter of U.S. law but also as a core dimension of U.S. legal obligations to other nations, as embodied in international agreements and treaties. We find that if the political will exists to change the domestic disease surveillance and reporting system, the federal government has the power to act. Questions remain, however, about whether the public health and legislative communities are willing to challenge current customs or even if they desire to do so.     

Purchasing power: business and health policy change in Massachusetts

As in many states around the country, health care costs in Massachusetts had risen to an unprecedented proportion of the state budget by the early 1980s. State health policymakers realized that dramatic changes were needed in the political process to break provider control over health policy decisions. This paper presents a case study of policy change in Massachusetts between 1982 and 1988. State officials formulated a strategy to mobilize corporate interests, which were already awakening to the problems of high health care costs, as a countervailing power to the political monopoly of provider interests. Once mobilized, business interests became organized politically and even became dominant at times, controlling both the policy agenda and its process. Ultimately, business came to be viewed as a permanent part of the coalitions and commissions that helped formulate state health policy. Although initially allied with provider interests, business eventually forged a stronger alliance with the state, an alliance that has the potential to force structural change in health care politics in Massachusetts for years to come. The paper raises questions about the consequences of such alliances between public and private power for both the content and the process of health policymaking at the state level.     

Programmatic actors and the transformation of European health care States

In France, Germany, Spain, and the United Kingdom, the decades from the late 1980s to the present have witnessed significant change in health policy. Although this has included the spread of internal competition and growing autonomy for certain nonstate and parastate actors, it does not follow that the mechanism at work is a "neoliberal convergence." Rather, the translation into diverse national settings of quasi-market mechanisms is accompanied by a reassertion of regulatory authority and strengthening of statist, as opposed to corporatist, management of national insurance systems. Thus the use of quasi-market tools brings state-strengthening reform. The proximate and necessary cause of this dual transformation is found in the work of small, closely integrated groups of policy professionals, whom we label "programmatic actors." While their identity differs across cases, these actors are strikingly similar in functional role and motivation. Motivated by a desire to wield authority through the promotion of programmatic ideas, rather than by material or careerist interests, these elite groups act both as importers and translators of ideas and as architects of policy. The resulting elite-driven model of policy change integrates ideational and institutionalist elements to explain programmatically coherent change despite institutional resistance and partisan instability.     

Why public opinion changes: the implications for health and health policy

Research on stasis or change in public opinion toward health, health policy, and medical care tends to focus on short-term dynamics and to emphasize the impact of discrete messages communicated by individual speakers in particular situations. This focus on what we term "situational framing," though valuable in some respects, is poorly equipped to assess changes that may occur over the longer term. We focus, instead, on "structural framing" to understand how institutionalized public health and health care policies impact public opinion and behavior over time. Understanding the dynamics of public opinion over time is especially helpful in tracking the political effects of the Patient Protection and Affordable Care Act of 2010 as it moves from the debate over its passage to its implementation and operation.     

Redressing the imbalanced political market for health policy: a role for the state attorney general?

In current discussions of "procompetitive" approaches to health policy, the enforcement of antitrust laws in health care markets is a strategy that has attracted increasing attention: the filing of consumer-oriented health suits provides a means to "redress" the typically imbalanced "political market" in health policy. This study examines an important aspect of the antitrust enforcement process, the decision by a state attorney general to undertake an aggressive antitrust enforcement program in the health area. Three variables were found to explain this decision: the political needs of a "politician-supplier," the organizational resources of a strategic institutional position, and the availability of a relatively favorable policy arena. An assessment of the future role of state attorneys general in this area suggests that their health antitrust initiatives will increase, but that various political and resource constraints are likely to inhibit their aggressiveness in pursuing these actions.     

Confrontation, consent, and corporatism: state strategies and the medical profession in France, Great Britain, and West Germany

The economic disorders of the last decade have compelled European welfare states to seek more stringent controls over costly social policies such as health care, thus circumscribing professional sovereignty. However, several factors--institutional structure, cultural values, political/economic circumstances, patterns of state/professional relations--constrain the policy alternatives available to governments, and make fundamental reform very difficult to achieve. After analyzing these factors and the reform policies adopted in France, Great Britain, and West Germany, this article will examine and compare the strategies pursued to meet professional resistance to change.     

Veto Players Revisited: Internal and External Factors Influencing Policy Production

Veto player models generally rely on two assumptions: (1) collective actors like political parties behave as individual actors; and (2) all actors influencing policy production are domestic. Yet these are often violated by empirical reality. Under certain institutions, parties are less cohesive and may not behave as individuals, and international regimes can have considerable influence over legislation. Using data on labor‐law production in Europe, we find that the effects of veto players are conditional on both party cohesion and international regimes. Future conceptualizations of veto players should be more sensitive to both internal and external institutional configurations.     

The European Redistributive State and a European Law of Struggle

Its more central involvement in the government of economic and fiscal policy requires a new public law for the EU. This must be alive to the positive, negative and intractable qualities of conflicts associated with these fields. Such a law would internalise conflicts within the political process so that their irresolution and ongoing struggle become the dynamo endowing the Union with qualities of political engagement, imagination and justice. The recent reforms make mediation of conflicts a central mission of the Union but still use the public law structures of the regulatory state which lack these three qualities.