Cross-national discourse in public policy is marked by an ongoing tension between the common and the particular. At one extreme, we identify common trends and challenges in a given policy arena, and view national systems as laboratories in which responses to these challenges can be tested and, if successful, emulated. At the other extreme, we see national systems as so idiosyncratic that only "home-grown" solutions are possible.
In the health care arena of the 1990s, this tension was clearly apparent. On the one hand, cross-national attention was drawn to the alleged potential of market mechanisms to squeeze greater efficiency from health care delivery systems, as both public and private payers became more cost- and price-conscious. Experiments in Britain, the Netherlands, New Zealand, Sweden, and elsewhere, themselves influenced by developments in the United States, were closely watched for their lessons for other nations. At the same time, national debates about health care reform, particularly in the United States but also in other nations, were marked as well by skepticism about the applicability of foreign models to domestic circumstances.
Like policy makers, students of comparative public policy also debate the relative importance of common or distinctive features of national policy arenas. Countless conferences and symposia have been devoted to the question of whether advanced capitalism is driving toward a common model in economic . . .