Health Risks and Health Care Reform in Western Europe and North America

This article addresses the question whether new social risks have superseded the classic risks to family incomes addressed by welfare states in Western and North America – unemployment, the costs of illness and employment income foregone, industrial accidents, retirement poverty, and costs of raising a large family. While the risks at the time of a mature welfare state differ to some extent from those of its earlier formative days, the ‘old’ risks to family incomes did not disappear. There is no evidence to support the position that healthcare costs have become fiscally ‘unaffordable’ or politically ‘unsustainable’. If anything, there has been expansion of the risks covered by (public) health insurance by expanding entitlements and categories of beneficiaries, or adding long-term care insurance to the public schemes.