Comparative Health Systems: A New Framework

Abstract

Americanization of the Italian welfare state, amid the timid protests of part of the labour movement. The distributive effects of fiscal welfare in Italy are studied by Figari and Matsaganis (chapter X) through EUROMOD simulations. The overall verdict is merciless: with regard to all tax expenditures, the poorest households (1 decile) receive 3% of the total, the wealthiest ones (10 decile) as much as 15%; that is, five times as much. Regressivity is not, however, equally distributed by social policy. The biggest offender is housing policy, where the ratio of benefits received by the wealthy vis-à-vis the poor is 10 to 1. Family benefits are instead mildly progressive and income support for workers mainly benefits the middle classes. The latter finding points to one of the major shortcomings of tax expenditures: those households, overwhelmingly poor, that pay no personal income taxes due to insufficient earnings are by default excluded from the majority of fiscal welfare measures. As for the volume’s final aim, Natili and Jessoula (chapter VI) provide a summary of the ‘quiet’ politics underpinning the expansion of fiscal welfare. Changes in tax expenditures are first and foremost difficult to trace, due to their technical nature and the need for only marginal legislative interventions, such as modifying obscure articles within yearly budget laws. This implies that the salience of such measures is low, as opposed to the fierce public debates that erupt around pensions or healthcare, and that the fora where fiscal welfare is debated are dominated by the technocrats of the finance ministry rather than by officials dealing with labour and social affairs. In sum, the impressive array of contributions assembled by Jessoula and Pavolini may become a key reference for Italian welfare state studies. Conceiving the volume as a point of departure for further research, I see three main avenues for improvement. First, more effort should be directed towards defining where fiscal welfare’s external boundaries lie and why. At times, the reader has the impression that the concept is excessively stretched. Second, tax expenditures should be studied within a European multilevel governance context. How has the expansion of tax allowances interacted with the rules set by the (now suspended) Stability and Growth Pact? Was it a deliberate strategy to shake off the shackles of externally-imposed austerity? Third, and related to the previous point, shedding social for fiscal welfare may be conceptualized as a novel type of obfuscation tactic, one aimed not at retrenching welfare, but paradoxically at expanding it.