Political Territoriality in the European Union The changing boundaries of security and health care Hans Vollaard
Political territoriality in the European Union The changing boundaries of security and health care Proefschrift ter verkrijging van de graad van Doctor aan de Universiteit Leiden, op gezag van Rector Magnificus prof. mr. P.F. van der Heijden, volgens besluit van het College voor Promoties te verdedigen op donderdag 11 juni 2009 klokke 16.15 uur door Johannes Paul Vollaard geboren te Amersfoort in 1977
Promotiecommissie Promotores: Prof. Dr. P. Mair Prof. Dr. A. van Staden Co-promotor: Dr. R.B. Soetendorp Referent: Prof. Dr. J. Zielonka (Oxford University) Overige leden van de promotiecommissie: Prof. Dr. M.G.W. den Boer (Vrije Universiteit van Amsterdam) Prof. Dr. R.T. Griffiths Prof. Dr. K. Koch Printed by Drukkerij Groen, Leiden Cover design: Johan Selier
Contents List of tables x Acknowledgements xiii Chapter 1 Making political territoriality variable 1 1.1 Political territoriality beyond Westphalia 1 1.2 The golden age of territoriality theory? 5 1.2.1 Research on politics and territory until the 1980s 5 1.2.2 Politics and territory in International Relations: neo-realism and globalisation 10 1.2.3 Politics and territory in other research fields 16 1.3 An empirical impression of changing political territoriality 20 Chapter 2 Conceptualising political territoriality 25 2.1 A political strategy, not an instinct 25 2.1.1 The social construction of (non-)territorial boundaries and space 27 2.1.2 Sack s understanding of political territoriality and its implications 31 2.2 The logic of political territoriality 33 2.2.1 Geographical fixity 34 2.2.2 Impersonality 36 2.2.3 Geographical exclusivity/ inclusion 39 2.2.4 Geographical centrality 43 2.2.5 Anarchy, functional differentiation, and (geographical) distance 46 2.3 Tracing changing political territoriality 49 2.4 Time and territory 56 2.5 Conclusion 64 Chapter 3 Comparative territorialities 65 3.1 Mapping unit variation 65 3.2 The ideal type state: the logic of territoriality in extremis 66 3.3 (Con)federation: conflicting territorialities or consociationalism 71 3.4 Network governance: spatial functionality 79 3.5 Political territoriality and a (neo-mediaeval) empire 81 3.6 What is the European Union? 86 Chapter 4 Explaining changing political territoriality in the European Union 87 4.1 The improbability of France 87
Contents 4.2 French history of territorial integration 89 4.3 Theoretical lessons learned from French polity-formation and boundarymaking 97 4.4 The territorial trap in EU studies 99 4.5 Rokkan, Hirschman, and Bartolini 104 4.6 Exit, voice and loyalty 110 4.7 No functionalist determinism 114 4.8 Political territoriality and polity-formation 117 Chapter 5 Political Territoriality and European (dis)integration 119 5.1 Will the European Union survive until 2014? 119 5.2 The territorial bias in theories of European integration 122 5.2.1 Realism 122 5.2.2 Federalism 124 5.2.3 (Neo-)functionalism 125 5.2.4 Transactionalism 128 5.2.5 Communitarianism 129 5.3 Theories of decline and fall of empires 131 5.4 European (dis)integration and political territoriality until the 1980s 136 5.4.1 From the 1940s until the 1960s: Establishing a Euro-polity 138 5.4.2 1969-1975: the first wave of external de-consolidation 144 5.4.31979-1986: the second wave of external de-consolidation 147 5.4.4 Political territoriality in Europe in the 1980s 149 5.5 European (dis)integration and political territoriality until the 1980s 151 5.5.1 A third wave of external de-consolidation 151 5.5.2 Propositions 155 5.6 Europe s morphology 167 Chapter 6 Territoriality and the geography of threats 169 6.1 Introduction 169 6.2 Avoiding the territorial trap in security studies 172 6.3 Political territoriality and organising security in history 180 6.3.1 Territorialisation of security 180 6.3.2 Controlling masterless men 188 6.3.3 Territorial defence after the Second World War: an illusion? 197 6.4 A European security system in the making? 204 6.4.1 West-European exits from the US security empire? 204 6.4.2 Breaking through the logic of territoriality of local and national security systems? 211 6.5 Security before 1989: multi-layered, territorial and non-territorial strategies 219 Chapter 7 Political territoriality and security in the European Union and the Netherlands 223 vi
Contents 7.1 Introduction 223 7.2 The redefinition of security threats in the European Union and the Netherlands 225 7.3 Keeping security threats out of the European Union 239 7.3.1 The creation of European boundary control 239 7.3.2 Outward-looking and value-based security policies of the EU 247 7.3.3 Dutch security policies in European perspective I 263 7.4 Keeping security threats down in the European Union 270 7.4.1 Dutch security policies in European perspective II 270 7.4.2 The creation of a Area of Security, Freedom and Justice at European level 272 7.4.3 Security and territoriality in the Netherlands since the 1980s 283 7.4.3.1 Conflicting territorialities: national/european 284 7.4.3.2 Personalisation of boundary control 289 7.4.3.3 Partial exit by interface regions 291 7.4.3.4 European integration and conflicting territorialities: national/local 295 7.4.3.5 Terrorism: centralisation and nationalism 299 7.5 The morphology of Europe s organisation of security 304 7.6 The territorial trap avoided 305 Chapter 8 The territorial closure and the European opening of the Dutch healthcare state 307 8.1 Introduction 307 8.2 The territorial underpinnings of healthcare states 309 8.2.1 Territorial closure 309 8.2.2 Two families of healthcare states 311 8.2.3 Centralisation in the Dutch healthcare state 313 8.3 European exit options from European healthcare states 319 8.3.1 Regulation 1408/71 320 8.3.2 The Single European Act 323 8.3.3 INTERREG: exit options in border regions 327 8.3.3.1 Euregion Meuse-Rhine 329 8.3.3.2 Other border regions 333 8.3.4 The European Court of Justice creates another hole in the fence 335 8.3.5 The European Health Insurance Card 339 8.4 propositions 343 Chapter 9 Cross-border patient mobility in the European Union and the Netherlands 347 9.1 Introduction 347 9.2 Attempts to keep the healthcare states closed at EU level 347 9.2.1 After Kohll and Decker: a deafening silence 347 9.2.2 Patient mobility officially on the European agenda 351 9.2.3 DG Internal Market vs. DG SANCO 353 vii
Contents 9.3 The Dutch healthcare state after the Kohll and Decker rulings 360 9.3.1 The Euro-compatibility of the contracting system 360 9.3.2 Dutch waiting lists and cross-border healthcare 367 9.3.3 Cross-border healthcare: more than a temporary safety valve? 373 9.4 Moves and motives of patients 377 9.4.1 (Voicing) dissatisfaction about waiting lists 378 9.4.2 Patients exit? 381 9.4.3 Patterns of cross-border patient mobility 390 9.5 Competing territorialities in the EU 395 9.5.1 A European healthcare territory in the making 396 9.5.2 Unfreezing state territoriality 398 9.5.3 Voice vs. choice 401 Chapter 10 Conclusion 409 10.1 Essential and variable 409 10.2 The EU is not going beyond territoriality 411 10.3 Mobile vs. immobile citizens 413 10.4 Imperialism and disintegration 417 Annex I: Samenvatting (summary in Dutch) 419 Annex II: List of Interviewees 443 Annex III: Primary sources 445 Bibliography 457 Curriculum Vitae 477 viii
Contents ix
List of tables Table 1: Public satisfaction with the Dutch healthcare system, p. 378. Table 2: Attention to healthcare waiting lists in Dutch newspapers, p. 379.
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Acknowledgements Writing a PhD dissertation on political territoriality in the European Union is like learning to play the trombone well. Exploring relatively new conceptual ground requires at least as much discipline and time as practicing this instrument. Fortunately, the Department of Political Science at Leiden University offered me the opportunity to chart the world of territoriality, even though it was initially unclear what this would eventually bring about. Friends and colleagues, among others Joop van Holsteyn, Koen Koch, Willem-Jan Lammers, Hans Oversloot, Huib Pellikaan, and Niels van Willigen have been sources of inspiration and reflection for helping me compose the dissertation. I would like to express my deep gratitude to Maarten Vink for years of good company, for showing me how to become a good political scientist, and for sharing interest in tiny political entities across the world. A great variety of academics have written on certain aspects of political territoriality, from post-structuralists to health policy experts, and from political geographers to historians. It has been quite a challenge to create harmonic melodies from this cacophony of voices. The participants from the Public Administration/ Political Science PhD seminar at Leiden University, the courses of the Netherlands Institute of Governance (NIG), and the NIG colloquium on Europeanisation led by Markus Haverland and Ronald Holzacker have been very helpful for staying in tune with the methodological and theoretical requirements of the discipline. Richard Griffiths placed his trust in me as a beginning academic to organize conferences and publish books on political territoriality and related issues in the EU studies programme at the Leiden Faculty of Arts, for which I am deeply thankful. Furthermore, I am indebted to all participants of those conferences, and in particular Michael Burgess, for discussing some of the fundamental aspects of European politics. I would also like to thank all my students, particularly those attending my MA course on political territoriality, who have been a responsive audience for testing my ideas. The interviewees have been willing to share their comments and ideas without hesitation on several occasions. They have been indispensable to me for gaining better insight
into the daily practices of healthcare and security policies. I would also like to express my gratitude to those others I failed to mention who have helped me create a more harmonious symphony on political territoriality in the European Union. No program is available for the concert of life, as a well known Dutch cliché says. I have enjoyed the program so far, including the PhD symphony, also because I could always count on the love and support of my parents. The accompaniment of my brothers, the Matthew Locke Brass Ensemble, Evert-Jan, Filip and other friends has made my life as a PhD candidate light and bearable. I am looking forward to the next piece on the program! Hans Vollaard Leiden, spring 2009 xiv