Instrumental or procedural democrats? The evolution of procedural preferences after democratization

This paper addresses instrumentalist attitudes to democracy – attitudes according to which democracy is not valued for itself, but accepted only as a means to specific policy goals. Pippa Norris ha...

Five types of OECD healthcare systems: Empirical results of a deductive classification

This article classifies 30 OECD healthcare systems according to a deductively generated typology by Rothgang and Wendt [1]. This typology distinguishes three core dimensions of the healthcare system: regulation, financing, and service provision, and three types of actors: state, societal, and private actors. We argue that there is a hierarchical relationship between the three dimensions, led by regulation, followed by financing and finally service provision, where the superior dimension restricts the nature of the subordinate dimensions. This hierarchy rule limits the number of theoretically plausible types to ten. To test our argument, we classify 30 OECD healthcare systems, mainly using O…

Demokratisches Institutionendesign in der Priorisierung und Rationierung von Gesundheitsleistungen

Decisions on priority setting and rationing in health care have both informational and distributional aspects, which is why they require expert knowledge and specialised bodies on the one hand and democratic consent on the other hand. The paper presents normative criteria for the evaluation and empirical categories for the description and comparison of respective bodies. As procedural decisions always have implications for resulting distributional decisions, the bodies charged with priority setting and rationing decisions must be subject to democratic institutional design. (As supplied by publisher).

Reconciling credibility and accountability: how expert bodies achieve credibility through accountability processes

Arguments about the legitimate role of expert bodies in Europe often centre on the following question: Does their independence help to make policies credible or should they be made democratically accountable to principals and stakeholders? This article claims this is a false dichotomy. It does so by arguing theoretically that credibility can be achieved through accountability processes. Then, drawing on exemplary case studies, this article identifies distinctive accountability processes for ensuring credibility: revisable competencies, deliberation over institutional design, and engagement in public justification. Credibility and accountability are thus not conflicting, but co-constitutive …

Legitime Expertokratie? Zur Stellung nicht-majoritärer Expertengremien in einem deliberativ-demokratischen System

Die zunehmende Komplexitat von Entscheidungsgegenstanden und die Vielzahl von Entscheidungen, mit denen Regierungen und Verwaltungsapparate konfrontiert sind, stellen diese vor erhebliche Herausforderungen. Ob in der Hoffnung auf sachkundigere, glaubwurdige Politikstrategien oder aus Angst, an der Wahlurne fur Fehlentscheidungen verantwortlich gemacht zu werden, haben Regierungen in den vergangenen Jahrzehnten zunehmend Entscheidungskompetenzen an spezialisierte, nicht-majoritare Gremien delegiert, welche in der Regel mit Experten besetzt sind.

Is money where the fun ends? Material interests and individuals’ preference for direct democracy

Abstract Are people’s attitudes towards referendums as a decision-making procedure predominantly driven by their material self-interest, or do individuals also value direct democracy as such, regardless of the material payoffs associated with anticipated policy outcomes? To answer this question, we use a survey data set that offers information on respondents’ support for referendums as a procedure to decide on tax policy, their income levels, socio-economic characteristics, and, most importantly, their expectation about the majority’s support for higher taxes. We find that the support of low-income individuals for referendums increases substantially if they expect a clear population majorit…

Me the people. How populism transforms democracy. ByNadia Urbinati. Cambridge, MA: Harvard University Press2019.

Thinking about Brexit with Cristina Lafont

In this comment on Cristina Lafont’s new book Democracy without Shortcuts, I apply some of her ideas to the Brexit case in order to show that her identification of problematic shortcuts has significant analytical potential when it comes to understanding contemporary challenges to democracy. I argue that the push for Brexit can be viewed as a response to ‘expertocratic’ shortcuts in European Union decision-making, while David Cameron’s attempt to resolve the conflict once and for all by referendum constituted a ‘proceduralist’ shortcut. I conclude by asking whether Lafont’s suggestion to ‘constitutionalize’ discourses and decisions could also imply seeking a meta-deliberative assessment of …

Democratic Meta-Deliberation: Towards Reflective Institutional Design

Theories of deliberative democracy are popular for their promise that in a deliberative polity, democracy can realise both participatory politics and rational policies. However, they are also confronted with the allegation that by qualifying essentially non-democratic practices as deliberative, they inadvertently (or not) become accomplices in the trend towards post-democratic governance. A central example of such a development is the rise of non-majoritarian bodies to which governments delegate decision making, thereby de-politicising conflicts and turning democratic discourses into technocratic ones. This article adopts a systemic perspective on deliberative democracy, asking whether non-…

Deliberation, Aggregation und epistemischer Fortschritt

Der vorliegende Aufsatz stellt zwei unterschiedliche Versionen epistemischer Demokratietheorie heraus – eine aggregative und eine deliberative – welche in jungerer Zeit haufig miteinander kombiniert wurden. Hinter der Zusammenfuhrung der beiden Versionen steht die Idee, dass Deliberation und Aggregation substituierbar sein konnen. Die Grundlage der aggregativer epistemischer Demokratiekonzeptionen basiert auf der Anwendung von Condorcets Jury-Theorem auf den Prozess politischer Entscheidungsfindung. Diese Anwendbarkeit des Jury-Theorems auf demokratische Entscheidungen mochte ich mit einer genaueren Betrachtung der drei zentralen Pramissen des Theorems aus deliberativer Perspektive in Frage…

Value congruence in health care priority setting: social values, institutions and decisions in three countries

AbstractMost developed democracies have faced the challenge of priority setting in health care by setting up specialized agencies to take decisions on which medical services to include in public health baskets. Under the influence of Daniels and Sabin’s seminal work on the topic, agencies increasingly aim to fulfil criteria of procedural justice, such as accountability and transparency. We assume, however, that the institutional design of agencies also and necessarily reflects substantial value judgments on the respective weight of distributive principles such as efficiency, need and equality. The public acceptance of prioritization decisions, and eventually of the health care system at lar…

Preferences for Referenda: Intrinsic or Instrumental? Evidence from a Survey Experiment

The call for more direct democracy, and referenda in particular, is often heard and met with support from large numbers of citizens in many countries. This article explores the motives for supporting referenda: Do citizens support them for intrinsic reasons, because referenda allow them to exercise their democratic rights more directly? Or are preferences for referenda predominantly based on the expectation that they will produce desired policy outcomes and thus instrumentally motivated? Our survey experiment explores such instrumental preferences by assessing how substantial policy preferences affect individuals’ choice of referenda over alternative decision-making procedures. We show tha…

Demokratische Legitimation durch rationale Kommunikation

Die Kernaussage deliberativer Demokratietheorien klingt viel versprechend: Unter den Bedingungen tief greifender gesellschaftlicher Konflikte und groser Unsicherheit soll durch den Austausch von Argumenten in einem machtfreien Diskurs Verstandigung oder sogar ein Konsens erzielt werden, wobei zugleich erwartet wird, dass eine solche Losung unter sachlichen und moralischen Gesichtspunkten rational ist. Deliberation als eine Form der politischen Interaktion bildet damit das Zentrum einer Demokratietheorie, die auf Gedanken aus liberalen und republikanischen Theorien zuruckgreift und diese um kommunikations- und erkenntnistheoretische Uberlegungen erganzt.

Where Democrats Disagree: Citizens’ Normative Conceptions of Democracy

While support for the essential norms of liberal electoral democracy is high in almost all developed democracies, there is arguably also a gap between democratic aspirations and democratic practice, leading to dissatisfaction among citizens. We argue that citizens may hold very different normative conceptions of democracy which are equally compatible with support for liberal democracy, but lead to different expectations where institutional design and democratic practice are concerned. Satisfaction with democracy may thus depend on congruence between such normative conceptions and institutionally entrenched norms. Drawing on survey data from Germany with a comprehensive item battery on attit…

Delegation and Institutional Design in Health-Care Rationing

The delegation of decision-making powers to nonmajoritarian, independent agencies has become a significant phenomenon in more and more policy areas. One of these is the health-care sector, where decisions on the range of services covered within public systems have, in most developed countries, been delegated to specialized bodies. This article offers an analytical framework that seeks to grasp the empirical variety and complexity of delegative processes and appointed institutions. The framework is used to describe decision-making processes and institutions in six countries: Austria, Germany, Norway, Sweden, New Zealand, and the United Kingdom. We find that, although constrained by preexisti…

Backlash against the procedural consensus

While the politics of backlash is typically described as a reaction to policy decisions in favour of minority rights, immigration or globalisation, this essay focuses on the fact that backlash typically also involves a reaction against the procedural consensus liberal democracy is based upon. This challenge to democratic procedures and institutions may be even more dangerous in its effects than the substantial objectives of backlash. I use the composite definition of backlash suggested by Alter and Zürn to assess in how far the attacks on the institutions of liberal democracy have retrograde objectives in themselves or in how far they are merely instrumental to the pursuit of other retrogr…

Procedural justice and democratic institutional design in health-care priority-setting

Health-care goods are goods with peculiar properties, and where they are scarce, societies face potentially explosive distributional conflicts. Animated public and academic debates on the necessity and possible justice of limit-setting in health care have taken place in the last decades and have recently taken a turn toward procedural rather than substantial criteria for justice. This article argues that the most influential account of procedural justice in health-care rationing, presented by Daniels and Sabin, is indeterminate where concrete properties of rationing institutions are concerned. Such properties inscribe substantial norms into institutions. These norms can derive validity only…

sj-pdf-1-psx-10.1177_0032321719879619 – Supplemental material for Preferences for Referenda: Intrinsic or Instrumental? Evidence from a Survey Experiment

Supplemental material, sj-pdf-1-psx-10.1177_0032321719879619 for Preferences for Referenda: Intrinsic or Instrumental? Evidence from a Survey Experiment by Claudia Landwehr and Philipp Harms in Political Studies

Defending democracy against technocracy and populism : deliberative democracy's strengths and challenges

Democracy and Depression: A Cross-National Study of Depressive Symptoms and Nonparticipation

Depression is the most common mental health disorder. It has consequences not only on individuals but also on social and political levels. We argue that depressive symptoms impair political participation by reducing the motivation and physical energy of sufferers. We test our hypotheses by conducting regression analyses of four nationally representative cross-sectional and longitudinal surveys that collectively span many democracies. Our results are threefold. First, we find that the severest depressive symptoms lower the probability of voting by 0.05–0.25 points, an effect that is exceeded only by education and age. Second, we show that depressive symptoms negatively affect political inter…

sj-pdf-1-psx-10.1177_0032321719879619 – Supplemental material for Preferences for Referenda: Intrinsic or Instrumental? Evidence from a Survey Experiment

Supplemental material, sj-pdf-1-psx-10.1177_0032321719879619 for Preferences for Referenda: Intrinsic or Instrumental? Evidence from a Survey Experiment by Claudia Landwehr and Philipp Harms in Political Studies

The Europeanization of Health Care Coverage Decisions: EU-Regulation, Policy Learning and Cooperation in Decision-Making

The paper presents two cases of Europeanization in health policy – an area that has so far been viewed as hardly affected by European integration. We show that even in the less likely case of coverage decision-making, some traces of Europeanization can be found. This is possible because the Commission has a strong interest in further integration in this field and all other relevant actors have motives to at least engage in cooperation. Our first case deals with the EU’s transparency directive and shows that this has forced member states to establish formal decision-making procedures, but did not result in a harmonization of decision-making processes and institutions, which is why the Commis…

What explains ‘generosity’ in the public financing of high-tech drugs? An empirical investigation of 25 OECD countries and 11 controversial drugs

In times of increasing cost pressures, public healthcare systems in Organisation for Economic Co-operation and Development (OECD) countries face the question of whether and to which extent new high-tech drugs are to be financed within their public healthcare systems. Systematic empirical research that explains across-country variation in these decisions is, however, almost non-existent. We analyse an original dataset that contains coverage decisions for 11 controversial drugs in 25 OECD countries using multilevel modelling. Our results indicate that the ‘generosity’ with which controversial new drugs are publicly financed is unrelated to a country’s wealth and general expenditure levels fo…