This study examines the impact of the European Court of Justice- the best case of powerful supranational justice- on the health services of Western Europe- the best cases of welfare states, politically salient and deeply wedded to their domestic order. Since 1998, the European Court of Justice (ECJ), the top court of the European Union (EU) and "the most effective supranational body in the history of the world" (Stone Sweet 2005:108), has begun to incorporate health and social security into the liberalizing EU single market. Existing studies have focused on explaining this case of European integration and on doing preliminary maps of power and responsibility in EU health care policy. This project goes beyond those studies and takes this development as a case of the impact of supranational justice on policy and implementation. It asks (1) what variance is there in the concrete policy responses of EU member states to the decisions of the ECJ on cross-border mobility of patients and labor regulation? And 2) what explains the variation in EU member state responses to the developing EU law? Answering the first question requires research to identify what "compliance" means to governments in different states and how much of it there has been. This involves governments' interpretation not just of EU law but of the likely actions of the domestic courts that interpret and apply most EU law. For the second question, there are two clear hypotheses derived from the literature on the impact of judicial decisions on society. One is a political hypothesis, that the success of judicial decisions is a function of the existing "support structure"- that decisions, without interest groups who will support and take advantage of implementation, will have very limited impact. The other is institutional, drawn from the literature on "Europeanization". It identifies the problem as a goodness-of-fit problem; states will comply faster and better with decisions that require less change to existing institutions. The study will be conducted with legal elite-level interviews and legal documentary analysis in Spain, France, Germany and the United Kingdom. The countries have been selected because they represent a range of relevant variables- legal systems, health systems, bureaucracies, and historic relations with EU law and policy. This plays to the strengths of qualitative case studies in a situation with many hypotheses and few reliable indicators. Policymakers' perceptions of their legal powers and constraints are crucial, and best accessed through interviews and research in the relevant law. The intellectual merit of the proposal lies in its approach to the issue of judicialization in the EU and beyond. For the EU, it contributes to the analysis both of the rising power of the ECJ and of its actual impact- an impact that includes both extended EU powers over the welfare state, and the potential legitimation or delegitimation of the European project. More broadly, it should contribute to the small literature on the important relationship between courts and bureaucracies, identifying the effects of courts on implementers. The broader impact will come in two ways. First, European Union law and the welfare state is an important topic with ample potential to engage in contemporary European debates. Second, the project incorporates student research from the undergraduate to doctoral level, exposing students to sociolegal research and European politics.
