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PubMed1997

The new politics of U.S. health policy.

Following the demise of comprehensive health care reform in 1994, some reformers are seeking comfort in the successful "incremental" strategy for enacting Medicare that emerged out of President Harry Truman's failed campaign for national health insurance in 1948-50. But despite similarities between the Truman and Clinton health security efforts, overall contexts of government and politics are much less hospitable to governmentally funded reforms today than they were after Truman's defeat. Back then, market transformations and political dynamics were both pushing toward expanded access to health services and insurance coverage. Today, by contrast, both push in the opposite direction. The private insurance market is fragmenting, federal budgetary constraints stymie new programs, and the deficit dominates debate over existing programs. Equally important, a stable pro-reform coalition like that of Truman's day has yet to emerge, while a new and fiercely conservative corps of Republicans is championing coherent programmatic alternatives based on antigovernment premises. Although passage of the Kassebaum-Kennedy health insurance reform bill in 1996 unleashed a wave of enthusiasm about incremental health care reform, formidable political, fiscal, and technical obstacles continue to stand in the way of even relatively modest incremental solutions.

Economic Competition↗
PubMed2002

The politics of discretionary Medicaid spending, 1980-1993.

Why do some states choose to spend more than four times as much as others to provide health care to the disadvantaged? Political scientists who have traditionally explored this question by analyzing trends in overall Medicaid expenditures lumped states' discretionary spending in with other money that states are mandated to spend. Analyses of total expenditures found that socioeconomic factors drove spending but that party control of state legislatures made no difference in health policy making. By isolating discretionary state Medicaid expenditures from total spending figures, I reexamine the influences of political as well as economic and demographic factors. The often-doubted importance of party control becomes clear. This study investigates spending patterns in the discretionary portions of state Medicaid programs in forty-six states from 1980 to 1993 and analyzes both incremental program changes and absolute differences in state spending. To discover how greatly the researcher's choice of dependent variables can affect results, optional spending is separated from total spending levels and the variation is modeled in both. Focusing not on the spending that the federal government requires of state officials but on the policies that state officials actually choose allows a balanced exploration of both political and economic effects on welfare expenditures. This research also provides new insights about which forces will shape policy decisions if more and more control of the public health care system is devolved to the states.

Aid to Families with Dependent Children↗
PubMed2004

The paradoxical politics of provider reempowerment.

The recent decline, indeed perhaps dismantling, of managed care is sometimes treated as both consequence and cause of the political reempowerment of medical providers, whose professional dominance managed care had challenged. Drawing evidence from Round III of the Community Tracking Study of the Center for Studying Health System Change, this article reviews the politics of four "arenas" of managed care regulation--prompt payment, mandated benefits, external appeals, and financial solvency--and concludes that the power of providers is contingent on patterns of coalition and conflict that differ across the discrete arenas. The zero-sum connotations of the "de" and "re" empowerment of providers under managed care fail to capture the subtlety of providers' search for fresh cultural, economic, and political resources in shifting policy contexts.

Consumer Behavior↗
PubMed1979

Diagnosis and the dole: the function of illness in American distributive politics.

This article argues that the concept of illness has certain properties that make it a convenient administrative device for managing a need-based redistributive system in a society whose primary distributive system is based on work. These properties--cultural acceptance of illness as a legitimate excuse for not working, objective standards for identifying illness, and restrictiveness--have led to the widespread use of illness as an eligibility criterion for many social benefits, including cash transfers, services, privileges and exemptions. Paradoxically, the traditional rationales for using illness as one of the keystones of categorical welfare policy are eroding, yet welfare programs based on illness certification are growing rapidly. To explain this anomaly, the author suggests that medical certification as a distributive mechanisms serves certain latent political functions, such as allowing welfare programs to be responsive to political unrest, siphoning off opposition to controversial policies by the granting of medical exemptions to intense opponents, are reducing political conflict by using physicians as arbiters.

Attitude to Health↗
PubMed1984

Redressing the imbalanced political market for health policy: a role for the state attorney general?

In current discussions of "procompetitive" approaches to health policy, the enforcement of antitrust laws in health care markets is a strategy that has attracted increasing attention: the filing of consumer-oriented health suits provides a means to "redress" the typically imbalanced "political market" in health policy. This study examines an important aspect of the antitrust enforcement process, the decision by a state attorney general to undertake an aggressive antitrust enforcement program in the health area. Three variables were found to explain this decision: the political needs of a "politician-supplier," the organizational resources of a strategic institutional position, and the availability of a relatively favorable policy arena. An assessment of the future role of state attorneys general in this area suggests that their health antitrust initiatives will increase, but that various political and resource constraints are likely to inhibit their aggressiveness in pursuing these actions.

Economic Competition↗
PubMedDate not supplied

Should nurses be politically aware?

In the present atmosphere of change, nurses need to develop political awareness. This article reviews the many factors that have mitigated against such a development and examines how these have adversely affected the profession. It proposes that nurses must develop political awareness as only by becoming politically knowledgeable can they can control and shape their own destiny, and effectively contribute to the decisions that affect their patients.

Education, Nursing↗
PubMed1992

Deconstruction, lesbian and gay studies, and interdisciplinary work: theoretical, political, and institutional strategies.

The problematic of cultural self-representation is examined in light of the development of lesbian and gay studies. The issues are examined through the lens of deconstruction as theoretical and political strategy. This examination suggests the value of interventionist work, and seeks to articulate an understanding of interdisciplinary work as exemplary of such an interventionist practice and politic. Relevant theoretical and political implications are explored, most especially in terms of the future developments of lesbian and gay studies.

Curriculum↗
PubMed1999

Integration within a transgender social network and its effect upon members' social and political activity.

The purpose of this study is to examine the male to female transgender social networks and how they influence social and political activity. Four Transgender organizations within Northeast Ohio were contacted for this study. Members were asked to complete a questionnaire and to mail it back. Few of the network elements were useful in predicting social and political activity. Network size has a positive effect upon a person's social and political activity, as did meeting attendance. This study suggests the importance of social networks for Trans-people.

Adult↗
PubMed1999

Political opportunism and the harassment of homosexuals in Florida, 1952-1965.

This paper examines activities by the state against homosexuals in Florida between 1952 and 1965. At the beginning of this period most of this activity took the form of police raids on gay bars, beaches and other gathering places. By the mid-1950s, however, the state government had established an investigations committee which concentrated on what the legislature saw as the "homosexual problem." The committee was particularly concerned with homosexual school teachers and faculty members in land grant universities in Florida, and attempted to purge state institutions of homosexual employees. This activity followed a similar campaign against homosexuals by the federal government and the article examines this in order to provide background for the Florida campaign. The ideology about homosexuals which was propagated by these campaigns is examined, as are the effects of the campaigns on homosexuals, and their response. Concern about the "homosexual menace" gradually abated and these discriminatory campaigns subsided. The article examines the social and political context of these campaigns and speculates on causes for the rise and demise of these campaigns. Principal among these appear to be political expediency by leaders of campaigns to extend political power by attacking a weak and defenseless target group, and a desire by conservatives to re-establish traditional values.

Faculty↗
PubMedDate not supplied

Poor program's progress: the unanticipated politics of Medicaid policy.

Advocates of U.S. national health insurance tend to share an image that highlights universal standards of coverage, social insurance financing, and national administration--in short, the basic features of Medicare. Such an approach is said to be good (equitable and efficient) policy and equally good politics. Medicaid, by contrast, is often taken to exemplify poor policy and poorer politics: means-tested eligibility, general revenue financing, and federal/state administration, which encourage inequities and disparities of care. This stark juxtaposition fails, however, to address important counterintuitive elements in the political evolution of these programs. Medicare's benefits and beneficiaries have stayed disturbingly stable, but Medicaid's relatively broad benefits have held firm, and its categories of beneficiaries have expanded. Repeated alarms about "bankruptcy" have undermined confidence in Medicare's trust funding, while Medicaid's claims on the taxpayer's dollar have worn well. Medicare's national administration has avoided disparities, but at the price of sacrificing state and local flexibility that can ease such "reforms" as the introduction of managed care. That Medicaid has fared better than a "poor people's program" supposedly could has provocative implications for health reform debates.

Eligibility Determination↗
PubMed1995

[Hospital infections in Brazil. Government activities for their control as an expression of socio-politics in the health field].

The author studies the hospital infections evolution in Brasil and the demands for its control until its establishment by governmental actions. For a better understanding and analysis of the social actors' dispute process, their needs and interests and the relation with the governmental sector to the establishment of a certain state politics, a theoretical reference that enabled to elaborate the whole of social structure elements was searched. This theoretical reference should also take the filled of the relation between Society, State, Actors and Social Politics as its main question. In order to allude to these specific actions and its intervention range, it was necessary to make a distinction between the state politics modalities and the implementation responsibility. Based on empirical material, it was possible to trace these demands, conforming on technological-assistancial models through the working process indicators. Other empirical categories levels was demanded to approach to the theoretical reference: specific conjectures, welfare medical assistance, the clinical intervention model and the quality movement.

Brazil↗
PubMed2003

The political economy of urban homicide: assessing the relative impact of gender inequality on sex-specific victimization.

This research examines the ways in which the changing political economy of urban areas has contributed differently to the homicide victimization rates of females and males across US cities. Recent research, while relatively limited, has presented disparate results regarding the effect of gender inequality on urban sex-specific victimization. Our work further explores this relationship by taking into account relative gender disparities in income, education, labor market opportunities, and politics in an examination of sex-specific homicide victimization in 1990. Key to this current investigation is the evaluation of feminist and lifestyle arguments that suggest that structural gender inequality has a unique effect on female victimization. Overall, our findings reveal gender inequality to be a significant predictor of both male and female urban homicide. While these findings suggest mixed support for theoretical arguments regarding gender inequality, further analyses reveal significant differences in specific types of gender inequality on victimization patterns across genders. These additional results highlight the need for greater attention toward both methodological and theoretical issues when examining the interconnections between gender, political economy, and violence in research.

Crime Victims↗
PubMed1988

The impact of political violence on health and health services in Cape Town, South Africa, 1986: methodological problems and preliminary results.

Cape Town, South Africa experienced an upsurge in the level of political violence from May to July of 1986. To determine the impact of the political violence on health and health services, selected routinely available information was analyzed, a community survey was conducted of 1,540 randomly selected households in high, medium, and low impact areas (defined using police and community reports), and a survey of 162 nurses (75 per cent response rate) working in clinic and maternity services in Cape Town's townships was undertaken. Methodological problems were encountered in relation to sampling, interviewer allocation to areas, and access to routinely available information. Nevertheless, a consistent picture emerged from the studies that: demonstrated the impact of political violence on attendance at routine health service facilities (for hypertension, tuberculosis, immunizations, antenatal and postnatal services); highlighted the disruptions caused to basic services in high impact areas (water, street lighting, sanitation and transport); documented the problems experienced by nurses in performing their usual services and by patients obtaining access to their services; showed that high impact areas had three times higher rates of gunshot wounds than low impact areas during the period.

Adolescent↗
PubMed1992

The influence of social and political violence on the risk of pregnancy complications.

BACKGROUND: Events in Chile provided an opportunity to evaluate health effects associated with exposure to high levels of social and political violence. METHODS: Neighborhoods in Santiago, Chile, were mapped for occurrences of sociopolitical violence during 1985-86, such as bomb threats, military presence, undercover surveillance, and political demonstrations. Six health centers providing prenatal care were then chosen at random: three from "high-violence" and three from "low-violence" neighborhoods. The 161 healthy, pregnant women due to deliver between August 1 and September 7, 1986, who attended these health centers were interviewed twice about their living conditions. Pregnancy complications and labor/delivery information were subsequently obtained from clinic and hospital records. RESULTS: Women living in the high-violence neighborhoods were significantly more likely to experience pregnancy complications than women living in lower violence neighborhoods (OR = 5.0; 95% CI = 1.9-12.6; p less than 0.01). Residence in a high-violence neighborhood was the strongest risk factor observed; results persisted after controlling for several sets of potential confounders. CONCLUSION: Living in areas of high social and political violence increased the risk of pregnancy complications among otherwise healthy women.

Adult↗
PubMed1992

The President's Committee on Health Education: a 20-year retrospective on its politics and policy impact.

The President's Committee on Health Education was created by Richard M. Nixon in September 1971 and submitted its final report in September 1973. The committee resulted from the convergence of (1) a perceived national domestic policy need in response to escalating medical costs, (2) Nixon's personal and political ambitions, and (3) the dynamic political context of the late 1960s and early 1970s. Its work led to both private and public initiatives designed to influence the public's health through education; its findings and recommendations also laid the foundation for the National Consumer Health Information and Health Promotion Act of 1976 and thus contributed significantly to the development of subsequent national policy in health promotion and disease prevention. This paper places the work and contributions of the committee into historical perspective by analyzing the committee's origins and methods and the underlying politics that shaped its work and final report. The impact of the President's Committee is traced from the emergence of health education in the early 1970s as a potentially cost-effective alternative to medical care to the pivotal role health education now plays in health promotion and disease prevention efforts.

Consumer Advocacy↗
PubMed1996

The pleasures and perils of prophetic advocacy: Henry E. Sigerist and the politics of medical reform.

Henry E. Sigerist, an internationally renowned medical historian, played a surprisingly important and visible role in American medical politics in the 1930s and 1940s. Born in Paris of Swiss parents, he was professor in Leipzig, Germany, before coming to the United States in 1932 as professor of the history of medicine at Johns Hopkins University. Once in America. Sigerist became deeply involved in medical politics and the campaign for national health insurance. He argued that individualized medical practice was outdated and should gradually be superseded by state-run and state-financed health services. National health insurance was but one step in this historical progression. Sigerist thus lent the weight of history itself to the cause of medical care reform. The charming and erudite Sigerist was welcomed by the leaders of academic medicine in America. Soon, he emerged as a spokesman of the left wing of the medical profession, an effective and popular speaker and an impassioned advocate of socialized medicine. This paper traces Sigerist's political ideas and activities, and his contributions toward medical care reform in the United States.

Germany↗
PubMed2003

Special report on the political and social contexts of health: Part I. Introduction: objectives and purposes of the study.

This article introduces a series of research projects (carried out by the International Network on Social Inequalities and Health) focused on the impact of politics on policy and the consequences for health and quality of life, an area that has been understudied in the social science literature. The introduction describes the conceptual model that guided the research, centered on the study of how political parties and social agents (such as trade unions) affect social inequalities and mortality indicators through labor market and welfare state policies. The major theme of this research is whether political and social interventions matter in health policy and health outcomes. The introduction also describes the different types of research projects carried out by the International Network at the national levels (among OECD countries) and at the regional and local levels (in the United Kingdom, Italy, Germany, Spain, and Sweden). This Journal issue presents the multinational study and the U.K. case study; the next issue will include the Italian, German, Spanish, and Swedish case studies and the summary and conclusions.

Developed Countries↗
PubMed1979

Introduction to the theme--state intervention and the social wage: the politics of social services expansion.

State intervention in the consumption process has become increasingly critical to economic growth on the one hand and to real family income on the other. The social wage thus tends to become a conflictual political issue. As a result, the articulation of state intervention with the changing requirements of economic growth is subject to continuous political challenge. This special issue examines the problematic relationship between state intervention in social services and the organization of the capitalist economy. Some contributors study the ways in which state inter ventions are structured so as to be consonant with the requirements of economic growth and profitability, as well as the difficulties such structures pose. Feshbach's analysis of the Hill-Burton Hospital Construction Program and Mollenkopf's study of San Francisco's public transit system both reflect this concern. Other contributors study the ways in which the organization of the economy constrains the development of democratically responsive social services. Sbragia's study of the capital market and public housing in Italy and Taylor's study of free medical clinics in the U.S. both reflect this concern. Finally, contributors study macroscopic transformations in the relationship between state intervention and the organization of the capitalist economy. Esping-Andersen's study of the political logic of increasing state intervention in production and Hirschhorn's analysis of the defunctionalization of social services attendent upon the disaccumulative tendencies in capitalism both reflect this concern. This introductory paper reviews four theories which attempt to explain how state intervention is insulated from democratic controls. For each theory, the mechanisms specified to perform this function are subject to weaknesses. An attempt is made to position the contributions to this volume with respect to these theoretical traditions.

Conflict, Psychological↗