The possibilities and limitations of insurgent technocratic reform

This dissertation presents three papers which analyze the politics of social policy, with a decided focus on health policy, in Mexico. The core of the dissertation is the first independent assessment of the politics surrounding the internationally acclaimed Popular Health Insurance program, known as Seguro Popular (SP). In the first paper, I take up the issue of whether and how democratization can contribute to equity-enhancing health reform. Although democratization is generally believed to lead to more equitable social policies, the mechanisms by which this may occur are poorly specified. I argue that, in Mexico, the process of democratization led to a combination of change and continuity in the executive branch and the policymaking process that allowed for the creation of SP by a group of "insurgent technocrats." The second paper looks at the process of SP implementation, with a focus on three states: Chiapas, Guerrero and Oaxaca. While recent work on social policy in Mexico has emphasized the degree to which policy implementation is biased by partisan distributional effects, I argue that this misses equally important distributional factors. I emphasize two: the politics of federalism, and the "Politics of the South." I demonstrate that federal politics have systematically undermined the financing aspects of the reform. Second, I show that political behavior in the Mexican South is dominated by weak institutions and that policy implementation is driven less by partisan bias than by factionalism, clientelism and extra-electoral competition. Finally, using a quantitative approach, I do find some partisan, electoral bias as well, indicating that the emphasis on partisanship in other literature is not wrong, but simply incomplete. The final paper compares SP to prior reforms in Mexico (PRONASOL and PROGRESA). I provide a new set of dimensions of variation for analyzing the increasingly important phenomenon of targeted social policy. Previous attempts to explain the type and degree of social policy targeting have both missed these key dimensions of variation, and failed to provide adequate explanations for them. Using the Mexican case, I argue that the politics of democratization and party-building can explain key design features in targeted social policy.