Why do governments recognize rights? In this article, we rely on natural experiments and an innovative matching technique to identify a new causal mechanism of policy feedback, which we refer to as the “recognition” effect. We rely on the “hard case” of health care to demonstrate that attitudes towards the health system change in response to government policy change and, indeed, even to rights‐based initiatives. During the time when public opinion surveys on public satisfaction with the health system were in the field, governments in both Germany and Sweden introduced a new right: the right to a maximum waiting time for health services. This serendipity allowed us to compare respondents’ attitudes both before (control) and after the implementation of the waiting time guarantee (treatment), using coarsened exact matching to account for the imbalances in the treatment and control groups. We find that respondents interviewed after implementation of the new waiting time guarantees (in contrast to those interviewed before the introduction of the guarantees) express higher levels of satisfaction with the health system in general, but do not evaluate their specific medical treatment (including waiting times) more positively. We interpret this finding as evidence that citizens respond to governmental recognition of their rights as a good per se, independent of their personal experience with the particular public service at hand. Thus, we argue that theories of policy feedback need to move beyond their focus on direct material experience with the policies at hand, and to incorporate mechanisms of symbolic action and normative valuations into their causal models.
Although welfare state politics since the 1990s have often revolved around austerity and retrenchment, governments do not solely cut back social services, but instead also aim to improve them. In the health care area, improvements in patient rights are a growing trend in public policy‐making (Fountain, 2001; Segal, 1998; Winblad, Vrangbæk, & Östergren, 2010). Indeed, rights‐based policies are common in social policy, such as for example, the right to a day care place, the right to adopt a child, or the right to opt‐out of government health and pensions plans. But do citizens notice and give governments credit for these new rights? Or do they wait and see in order to develop judgements about whether these new rights have, indeed, brought about any material improvements in their direct experience with the public service at hand?
The ways in which citizens judge and react to government policies is of central importance not only for social policy and administration, but also for our understanding and appreciation of representative democracy, more generally (Bingham Powell, 2004; Stimson, MacKuen, & Erikson, 1995). Indeed, there is a great deal of scholarly debate on the impact of policies on public opinion. Dynamic representation scholars argue that public opinion reacts very quickly to changes in government policies, and, indeed, that politicians in turn change policies directly after swings in public opinion. Policy feedback scholars argue by contrast that citizens’ preferences are endogenous to past policies, and are shaped by long‐term policy patterns as well as short‐term policy shifts. Despite this division, however, both sides of this debate share a common assumption that citizens evaluate government policies based on their direct experiences with policies. Thus, both policy responsiveness and policy feedback scholars view citizens’ evaluation of government policies as a matter of rational calculation and self‐interest. By contrast, “deservingness” theory roots differences in support for government policies as resulting from normative, and possibly affective and primordial, processes that govern the development of political and societal attitudes. Consequently, health attitudes should remain relatively invariant.