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OVERVIEW: Ten years after the failure of President Clinton?s ambitious attempt to overhaul the U.S. health care system, a growing number of policymakers, clinicians, employers, insurers, and patients are renewing the age-old argument that comprehensive reform is urgently needed. My paper examines how events over the last decade have led to the new health care crisis in America. DATA SOURCES: The paper illustrates how health inequalities in the U.S. are exacerbated by our nation?s beleaguered, patchwork system of health care: (1) Based on data from the Census Bureau, the paper shows how lack of health insurance has become as much a ?working class? and ?middle class? phenomenon as it is a ?poor? one; (2) Based on data from the Kaiser Family Foundation, the paper shows how the costs for employers and employees who have health insurance are increasing at their fastest rate since the early 1990s; (3) Based on data from the American Bankruptcy Institute, the paper shows how health care problems?lack of health insurance, insufficient health insurance, and/or substantial medical problems?have become the single leading cause of personal bankruptcy in the United States; (4) Based on data from the Centers for Medicare & Medicaid Services (CMS), the paper shows how the government?s primary health insurance programs?Medicare for the elderly and disabled, SCHIP for children, and Medicaid for the poor?are experiencing considerable financial strain; (5) Based on my personal interviews with key policymakers and senior staff (many of whom have only recently gone on record), the paper includes a reexamination of Clinton?s failure at health care reform. Interviewees include: Clinton?s Health Care Communications Director, Bob Boorstin; Chief of Staff to former Senate Majority Leader Bob Dole, Sheila Burke; Director of Clinton?s Health Care Transition Team, Judy Feder; former White House Chief of Staff and Director of OMB for President Clinton, Leon Panetta; Senior Economist for the Clinton Health Care Task Force, Sherry Glied; former Senator from Nebraska, Bob Kerrey; former CBO Director, Robert Reischauer; former Chair of Ways and Means, Dan Rostenkowski; former Treasury Secretary, Robert Rubin; current CMS Administrator, Tom Scully; former CEA Chair, Laura D?Andrea Tyson; and former Chairman of Prudential Insurance and Chair of the Business Roundtable?s Health Subcommittee, Robert Winters. CONCLUSION: The paper concludes with a brief overview of the leading proposals for solving the problem of the uninsured that have recently emerged. [ABSTRACT FROM AUTHOR]

There is no question that Bosnia and Herczegovina is a dysfunctional state, reflecting its post-conflict institutional design. However, it must use these structures to tackle the problems of a postcommunist transition. After outlining issues of weak governance and institutional development in Bosnia, this paper will use three attempts at health care reform in Bosnia to illustrate the enormous challenges for creating and implementing policy. The first example, health insurance reform, shows how the problems of institutional design are mirrored in other areas. The problems plaguing the community mental health centers demonstrate how behaviors by various elements of society can doom a project that appears perfectly reasonable on paper. Finally, a long-term program to strengthen family doctors includes elements that make it comparatively promising, but it also faces some real dangers ahead. The paper will conclude with some recent reasons to hope that the oversight and accountability of the social sector can be increased, thereby alleviating some of Bosnia’s structural problems. [ABSTRACT FROM AUTHOR]

A conference paper about heath care reform in the U.S. and Great Britain is presented which is prepared for presentation at the American Political Science association annual conference, from September 1-4, 2011, in Seattle, Washington. The paper discusses topics including divergence in the governance of health care regimes, and the ongoing round of health care reform in the two countries.

Political maneuvering over health care reform continues and will likely persist. The reality, however, is that health reform is now proceeding in Washington and in states across the country after the Supreme Court's affirmation of the Affordable Care Act of 2010 (ACA) and President Barack Obama's reelection. The pace and scope of health reform is, however, varying across states. This paper investigates four potential explanations for the variation in state decisions to implement the Medicaid expansion -- state party control, economic affluence, the trajectory of established policy, and the process of learning about intergovernmental bargaining. Our analysis of 50 states finds that party control is a dominating influence on state decisions; but economic affluence and process learning impacted states with Democratic governors. The findings suggest that while party casts a long shadow over states, states that extensively interact with federal agencies develop skills and expectations to treat new programs from Washington as an opening bid subject to negotiation rather than as a fixed "take-it-or-leave-it" proposition. The paper concludes by underscoring the value of moving beyond partisanship to explore additional influences including the lasting effects of state interaction with federal policy making. [ABSTRACT FROM AUTHOR]

Why do states decide to provide better services for their citizens? When and how do normative requirement about service provision become concrete policy actions? What role do donors play in this process? The paper poses these questions in the context of health and education policy and seeks to address them by looking at one specific policy issue in one developing region: the abolition of user fees for primary health and education services in Sub Saharan Africa. Although basic health and education are both human rights of equivalent value, 18 African countries have responded to pressure to abolish fees in primary education, but some form of 'cost sharing' persist for health services in all but 5 countries, despite popular pressure and evidence that fees exclude the poor (Deininger & Mpuga 2004, Fafchamps & Minten 2004). The paper uses a multi-method approach combining quantitative analysis, a qualitative inter-sectoral case study of Tanzania and a 'least likely' case of healthcare reform in Lesotho, to untangle the causal processes at play. It argues that, when considering policy changes such as abolishing fees, developing states engage in rational cost-benefit analyses that consider the likely political returns for any change against the amount of material effort required. Although democracy has increased the returns for pro-poor policies with mass appeal, the material constraints on most African countries have remained high. As the qualitative cases reveal it has been by strategically focusing resources on tasks requiring less capacity (like education) and by opportunistically forging alliances with forces outside the state - such as donors and civil society - that capacity constraints have been overcome and free services introduced. [ABSTRACT FROM AUTHOR]

Having established the significance of young voters in the election of President Obama, this paper focuses on how they using micro-blogging social network site Twitter have affected the political discourse of the Obama administration centering on two of the most controversial political agendas of the Obama administration's first 100 days - the legislation battle on health care reform and the nomination and confirmation of the first Hispanic female Supreme Court Justice, Sonia Sotomayor. This paper attempts to measure how this Obama followers react to these two politically important agendas as evidenced by their tweeting, replying, re-tweeting, and searching for further information. Despite a big difference between the total number of tweets and the amount of followers on both health care and Sotomayor nomination issues, an average of more than 1.5 million followers of President Obama's account and around 450,000 followers of the White House account clearly shows a strong sign of engagement in the Twitter network. [ABSTRACT FROM AUTHOR]

A conference paper about the relative contribution of informal communications, formal coalitions, and political parties to the capacity of interest groups to broker changes in health policy. It discusses a theory developed that integrates coalitions and parties into traditional understandings of interest group brokerage through informal communication networks. It also examines the structure of the contemporary health policy domain and presents a case study of how interest groups helped transform Medicare in 2003.

This paper analyzes the puzzle of deteriorating public support for health care reform. Using a unique series of tracking polls, we argue that declining support for health care reform was a function of three distinct trends in public opinion. First, we find that trust in government fell precipitously during 2009, leading many Americans to question whether government was up to the challenge of implementing a national health plan. Second, more Americans came to believe that health care reform would require them to make material sacrifices. Third, we observe that conservatism became a significantly more attractive ideological label for Americans, which increased the percentage of people who perceived that health care would require an ideological sacrifice of them. Collectively, our analysis demonstrates, these trends contributed to the erosion of public support for health care reform and made the idea of a national health plan unpalatable to a larger segment of the American public. [ABSTRACT FROM AUTHOR]

The United States is undertaking a major investment in "comparative effectiveness research" (CER) to learn more about what medical treatments work best for different patients. CER has the potential to reduce wasteful health care spending and promote the quality of care, but its political sustainability remains uncertain. During the health reform debate, conservative elites argued that CER would lead to "death panels" and "one-size-fits-all" medicine. Previous public opinion surveys have shown that the public generally supports funding of CER but remains anxious about the use of study results to restrict treatment options. An unresolved question is what factors might boost public support for CER. In this paper, we investigate one potential source of support: the public's trust in physicians as faithful agents of patient interests. We conducted two national surveys on Americans' confidence in doctors relative to other groups, beliefs about the motivation of medical societies when such organizations make public policy recommendations, and willingness to support a generic health reform proposal when told that it is endorsed by a physician association. The study features a survey experiment that permits examination of how much cues from doctors' groups affect public opinion relative to cues from partisan and bipartisan political groups. Our results demonstrate that the medical profession has a significant influence over public opinion in this area, and suggests that advocates of CER should recognize that the medical profession's support may be the strongest available weapon to combat claims that CER is simply a pretext for health care rationing. [ABSTRACT FROM AUTHOR]

The health care system of the People's Republic of China has undergone significant change over the last decades. Much of the literature has focused on the internal dynamics of change. In this paper we week to understand Chinese health care reforms since the 1980s in a global context. We first examine the health care system in China from the Maoist era to the reform period. We find that the health care system in China - a self-proclaimed socialist country - has become one of the least socialist in the world. We then attempt to explain the evolution of China's health care system in the last three decades, paying special attention to the impact of external factors on China's policy choices. We argue that international norms and China's development strategy vis-à-vis the global economy have profoundly shaped the its health care system. [ABSTRACT FROM AUTHOR]

The current literature on affect often treats audience response to emotional cues as homogeneous. In other words, individual differences between participants are of little import in the examination of the effects of affect. I set forth a theoretical framework which posits the effects of emotion on attitudes towards policy issues are moderated by individual characteristics. I argue that individual predispositions govern the type of deliberative processes invoked following an affective cue. As the primary goal of this deliberative process is to mitigate uncertainty, I expect different types of people will evaluate policies differently even when the same emotion is invoked. For this research, I focus on the moderating influence of partisanship, sophistication, and prior attitudes on the experience of anger and fear with regard to the issue of health care reform. I find that sophistication is an important moderator in both anger and fear conditions, and that strength of partisanship changes this relationship in the anger condition. This paper presents a promising first step in understanding under what circumstances and for whom anger and fear are influential. [ABSTRACT FROM AUTHOR]

Access to health care is considered a public right in European countries. The transition to democracy in Central and Eastern Europe has introduced new medical technology, equipment, and medication, while at the same time exposing and even deepening the shortcomings inherited from the old Semashko systems. The "tradition" of informal payments is one of the features passed from the old regime and which has continued to expand after 1989. Reforming health care systems in post-communist Europe has proven to be very difficult. The lack of a unified European health care policy meant that the European Union could exercise little pressure on candidate countries to reform and combat corruption in their health care systems. This paper examines the extent and use of informal payments in health care systems of Central and Eastern European countries and assesses the institutional strategies designed to reform the system. The results show that informal payments are common practice in most countries with important consequences for people's health. Additionally, the analysis shows that reforms were impeded by the lack of a clear vision, high turnover of Ministers of Health, insufficient funding, and lack of political will. [ABSTRACT FROM AUTHOR]

Public healthcare systems can provide crucial protection for the poorest and most vulnerable groups in society, but not all systems are created equally. Indeed, while some countries have carried out healthcare reforms that increase coverage among low-income groups and respond to the risks faced by these sectors, other states have built exclusionary systems that fail to provide protection for the most vulnerable members of society. This underscores an interesting puzzle: what explains variation in the ability of Latin American states to universalize access to health services? This paper, which is part of a larger book manuscript, seeks to address this question in the context of Chile and Uruguay. I find that the organizational structure of political parties and the design of previous policies are important determinants of the ability of Latin America's advanced social protection states to pursue universalizing healthcare reform. [ABSTRACT FROM AUTHOR]

In the paper, we use an experimental design to assess the effect that partisan framing of a policy problem has on individuals' preferences for a policy solution. We combine key elements from work on prospect theory, framing effects, and attitude formation to develop a theory of policy evaluation by citizens faced with alternatives involving risk. We test the predictions derived from our theory using a hypothetical, but timely, health care reform proposal. As a first cut at this question, the results of this preliminary test of our theory support two of our three hypotheses, suggesting additional implications for the application of prospect theory to the study of opinion formation surrounding domestic policy issues. [ABSTRACT FROM AUTHOR]

How do Americans connect their economic interests to their policy preferences? This paper analyzes conversations from multiple visits with 31 preexisting informal groups meeting in 23 communities sampled across a Midwestern state. The analyses focus on conversations about health care reform. They reveal that attitudes toward government are a central part of the way people structure their policy preferences. However, how this works varies by both individual and community economic background and perceptions of these backgrounds. In groups composed of people from more working-class backgrounds, people commonly express skepticism toward government as part of a general perspective of skepticism toward institutions of authority in general. In groups of professionals, people question and criticize government, but not authority in general. These perspectives are commonly intertwined with references to geography that operate as metaphors for resource inequalities, identification with sets of values and social classes, and perceptions of the exercise of authority. Recognizing these patterns is key to understanding the connections between economic interests and policy preferences and the possibilities for social policy reform. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The health care reform of 2003 in Mexico does not conform to the expectations of influential theories of social welfare reform, such as power resources or veto players theory. In this paper, the origins and nature of the Seguro Popular reform are analyzed, as well as the political process culminating in legislative approval by the Mexican Congress. I argue that the reform is more consistent with modified versions of both the Heclo-Hall approach to policy change, and David Rueda's theory of "insider-outsider politics." ..PAT.-Conference Proceeding [ABSTRACT FROM AUTHOR]

Research has shown that priming can be an effective strategy in election campaigns and policy debates. But because the goal of priming is to structure the terms of political debate, it is a largely offensive strategy. For a political actor who seeks to make a change to the status quo, such as the passage of new policy, it often is necessary to engage the opponent and defend oneself from attack. Borrowing from the sports adage that ?the best offense is a good defense,? this study contends that engaging one?s opponent in a dialogue is a wise strategy, and that political elites are better off employing some combination of priming and engagement than pursuing either alone. Using over two dozen public opinion polls and a detailed content analysis of media reports, I examine the use and effectiveness of priming and engagement strategies during the 1993-1994 debate over the Clinton health care reform plan. A time series analysis reveals that the failure of the plan was not due to the Clinton team?s inability to engage in priming; had they engaged their opponents more vigorously, proponents of reform might have mounted a more adequate defense of their plan and stemmed the loss of public support. [ABSTRACT FROM AUTHOR]

Market-oriented reforms in the first half of the 1990s in New Zealand explicitly sought to de-politicize the health sector by ending a long tradition of elected local health boards and were promoted as offering greater consumer power. Instead, Government fostered a strong reaction among voters towards more public control of the health sector. A new reform law enacted in 2000 has assertively returned local voter control of the hospital sector. Five factors are considered important for understanding the shift between market and democratic policy models, and the rejection of market models in health care more generally: (1) the difficulty of reforming health care after reforming the economy (2) public support for the notion of health care as a social rather than marketable commodity (3) signaling effects from the range and vehemence of market reform opponents and sympathy with professional groups; (4) negative understandings of the effects of competition-oriented health care reform, and (5) no favorable models for market-based health care able to justify reforms. [ABSTRACT FROM AUTHOR]

On March 17, 2010, former Alaska Governor Sarah Palin described President Obama's health care reform plan as "undemocratic" and "un-American" to a Fox News audience. Previous research has established that attitudes toward the 2010 health care reform law were affected by a variety of factors, including socioeconomic status (Brady and Kessler 2010; Gelman, Lee, and Ghitza 2010) and even racial prejudice (Knowles, Lowery, and Schaumberg 2010; Tesler 2012). This study investigates the relationship between support for health care reform and nativism, the perception that a traditional American culture and way of life is being threatened by foreign influence. In other words, this study describes and analyzes the extent to which the health care reform bill was perceived by the American public as somehow "un-American", or a threat to traditional American values. Data for this study are drawn from two distinct national public opinion samples fielded in 2010 and 2011. Results demonstrate that nativism was an independent and significant predictor of opposition to health care reform, and that this effect held for both Republicans as well as Democrats (although the relationship is stronger among Republicans). This is substantively important for two reasons. First, it demonstrates that certain sub-groups of the American public evaluate public policy proposals on the basis of their perceived "foreignness". Second, it demonstrates that while nativism is traditionally associated with immigration and other race/ethnic-based policy preferences, it also affects attitudes toward other seemingly non-racial policies in the United States. [ABSTRACT FROM AUTHOR]

The article focuses on the women's right and health reform issue in the U.S. President election in 2012. The Republican presidential candidates argued against the right to contraception. The Republican platform committee has reiterated its no exceptions pro-life plank. The Republican-controlled House and numerous Republican governors and/or state legislators have taken extraordinary steps to defund Planned Parenthood.

The article presents public opinion towards health care reforms and public policies of the U.S. government. It discusses the concept of structural framing which deals with the long-term public opinion towards health care policy and effects of response in particular situation. It also discusses situational framing approach that presents public's views on Affordable Care Act (ACA).

We capture the policy agendas of governors in the areas of health, education and economic from 1991 through 2013 using their State of the State addresses. We analyze if and how policy diffusion occurs between governors' policy agendas in these areas and Congress and the president. Our research considers how federalism and the nature of gubernatorial policy agendas shape the state-federal relationship. We find that in economic policy the federal policy agenda influences the priorities found in State of the State addresses while in health policy the agendas of governors' influence federal level priorities. Overall, we find a more dynamic relationship between the levels of government than initially anticipated. [ABSTRACT FROM AUTHOR]

The population is aging, increasing the number of people who need to access long term services and supports (LTSS). And yet, the political conversation avoids this looming reality, which poses a daunting challenge to our healthcare system. The purpose of this analysis is to evaluate the sufficiency of the LTSS provisions contained within the Patient Protection and Affordable Care Act (ACA). Most importantly, the ACA introduced the ambitious but fatally flawed Community Living Assistance Services and Supports (CLASS) Act, a federally-administered voluntary long-term care insurance program that was recently repealed by Congress. Beyond CLASS the ACA's LTSS changes represent but marginal advances over the status quo. Thus, we see a continuation of existing strategies for improving LTSS, rather than the fundamental change so badly needed. Moreover, the impact of the ACA's strategies varies with the extent to which the federal and state governments opt to invest in them, through funding, implementing, and enforcing the modest changes enacted. The ACA has been criticized for being too radical. With respect to LTSS, however, its provisions, while welcome, are unlikely to result in the major changes necessary to meet both current and future demand. Thus policy making in long-term care continues along an incremental trajectory, a pace of change that pales in comparison to the substantial challenges facing the nation. [ABSTRACT FROM AUTHOR]

At least since Heclo (1978), political scientists have recognized the important role that lobbyists play in the issue networks that shape public policy. Most of that research has focused on the connections between lobbyists and legislators, but an important and related line of research investigates the networks that tie interest groups to each other. We contribute to this research by applying a relatively new methodology to a dataset that captures both the presence and magnitude of inter-lobbyist communications. A variant of the Exponential Random Graph Model (ERGM), this technology allows one to conduct a statistical regression on a network where edges between nodes in the network have non-dichotomous count values (so-called count ERGMs). We demonstrate that the common practice of thresholding one's valued network data to create an effectively binary network for ERGM estimation can bias the inferences one draws about two factors affecting lobbyists' ties: revolving door background and party homophily. [ABSTRACT FROM AUTHOR]

The partisan split in Congress over health reform may reflect a broader divide among the public in attitudes toward the uninsured. Despite expert consensus over the harms suffered by the uninsured as a group, Americans disagree over whether the uninsured get the care they need and whether reform legislation providing universal coverage is necessary. We examined public perceptions of health care access and quality for the uninsured over time, and we found that Democrats are far more likely than Republicans to believe that the uninsured have difficulty gaining access to care. Senior citizens are less aware than others of the problems faced by the uninsured. Even among those Americans who perceive that the uninsured have poor access to care, Republicans are significantly less likely than Democrats to support reform. Thus, our findings indicate that even if political obstacles are overcome and health reform is enacted, future political support for ongoing financing to cover the uninsured could be uncertain. [ABSTRACT FROM AUTHOR]

The article discusses the interim report which analysis the healthcare reform under the Japanese government in September 2009 in Japan. It examines the study of acute problems of the implementation of the healthcare system in the country. It analyzes the impacts of the government shift from the long-entrenched Liberal Democratic Party (LDP) affecting the healthcare reform. It also adds the delineate and pending issues in the country's healthcare reform.

The article looks at the role and the management of criticisms produced by service users in an aim to examine the shift in public policy towards the citizen. It examines new reflexive devices inside welfare public administration such as mediators and ombudsmen. It explores the Belgian context in relation with the health care reform act of 2002 in order to understand what is at stake when patients are entitled to criticize professionals and welfare bureaucracies through the introduction of a complaint.

The article discusses the results of a Web-based survey of specialists, including consumer advocates, provider representatives, public officials and policy experts, to facilitate long-term care reform in the U.S. Varying degrees of consensus among stakeholder groups regarding the desirability and effectiveness of strategies for improving access, quality and oversight in the long-term care sector are indicated by the results.

Why is health care reform so difficult politically? One prominent explanation holds that "it's the institutions, stupid!" What then can the literature on institutional change tell us about health care reform? Drawing on the notion of belief cascades, we argue that various crises in the health care can challenge the beliefs that support and maintain a given institutional arrangement, and that the resulting quandary creates the possibility of triggering a belief cascade that results in institutional change. We demonstrate how the advent of long waiting lists within the British National Health Service (NHS) created just such a quandary about a system that was widely supported while at the same time widely criticized in regards to its provision of service. We further show how Thatcher was able to engage in a heresthetical maneuver that depicted the waitlists as resulting from inefficiencies within the NHS, and not a lack of resources (e.g., insufficient money, physicians, nurses, or hospitals). In doing so, she was able to trigger a belief cascade that supported the introduction of a previously unviable feature, namely an internal market within the NHS. We also show that the advent of the waitlists did not directly challenge the strongly held belief that the NHS should remain public, and therefore did not allow for the complete privatization of the Service as some had hoped. We generalize our findings by arguing that such crises and quandaries are likely to emerge in the near future as the baby-boomers age, putting increases pressure on already strained health care systems. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Our analysis identifies profound contrasts in politics, political strategy and programmatic details between the Clinton plan and the successful expansions. The Clinton plan was partisan, leadership and ownership of the plan was limited to the White House, it alteredDraft Not For Distribution, Citation or Attribution the way most people would receive health insurance, challenged entrenched interests,lacked grassroots support, and was susceptible to charges of "socialized medicine." In contrast, SCHIP and Massachusetts reform were and are bipartisan, leadership and ownership are broad-based, the way most people receive insurance remains the same,these programs build off the existing system, and administration is state-based. Further, while the Clinton plan provided detailed policy prescriptions, SCHIP allows for significant state flexibility and innovation, and the Massachusetts Legislature left many of the plan details to a Board with broad interest group and consumer representation. The process by which SCHIP and Massachusetts reform were developed helped consolidate support and forge the political compromises necessary to achieve legislative success. This was not the case with the Clinton plan. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

John Zaller's (1992) RAS model of public opinion has become one of the most influential in the contemporary study of American political behavior, yet its central tenets and hypotheses have been tested by a surprisingly small body of empirical research. We undertake such a test in a case study of the health care reform debate of the early 1990s, an issue that presents an ideal opportunity to apply Zaller's model to political reality due a clear shift in elite positions partway through the debate. We look at how that shift is reflected in public opinion, including how political sophistication mediates any effects, and compare our results to a similar analysis of welfare reform, a policy debate that exhibited different characteristics in terms of elite discourse. In addition, we test Zaller's theory against an alternative hypothesis that self-interest drives individuals' opinion formation processes. Our results provide support for Zaller's theory but also suggest areas for potential refinement and extension. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

German health care is undergoing radical transformation today. During the postwar period, the statutory health insurance funds have bargained collectively with monopolistically organized physicians over terms of remuneration and how doctors' services are to be organized and delivered. That system, whose creation is explained here, is now being dismantled. The centralized system, first instituted during the Depression, gave organized medicine an enormous victory. Until then, big business and organized labor had stood on the same side in conflict over physician income and autonomy. But in 1931 organized labor broke with capital and sided with organized medicine, and handed doctors a long-sought victory. A resulting presidential emergency decree imposed collective bargaining on thousands of company health funds as well as the many local multi-employer funds dominated by organized labor. This internationally unique system did not survive the Nazi years, but it was restored in the postwar period. It was not until 2003 that capital and labor reunited in opposition to organized medicine, allowing critics of the system to turn the clock back to the 1920s. They say the old system tightly restricted how health care delivery could be organized and therefore obstructed quality improvements and rewarded waste. Decentralization of bargaining among competing networks of providers, they say, will improve cost effectiveness. Doctors fear a loss of income and professional autonomy. Comparative implications of this history suggest that the power of the medical profession lies less in a monopolization of prestigious scientific knowledge than in the configuration of outside economic and political forces easily able to challenge the quality of its application. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The trust fund financing mechanisms underlying Social Security and Medicare create policy feedback effects that increase support for privatization alternatives during times of declining assets. The first part of the study demonstrates how worries about whether these programs will pay benefits in the future track objective changes in trust fund status. When financial strength improves, confidence in Social Security and Medicare increases. Public confidence dips when trust fund reserves dwindle. The second part of the analysis uses insights from prospect theory, originally developed from hypothetical decision making experiments, to show how the same principles structure political support for two of the largest federal programs in America. Citizens prefer risky privatization reforms when they perceive financial losses looming on the horizon. Ironically, the financing arrangements of Social Security and Medicare originally intended to bolster political support may do the opposite. ..PAT.-Conference Proceeding [ABSTRACT FROM AUTHOR]

The article discusses findings of a study which examined the course of policy development leading to the enactment and abrupt repeal of California's Health Insurance Act of 2003. The law is considered the most significant state action to address the problems facing uninsured people since the early 1990s. Senate Bill 2 was signed by California Governor Gray Davis on October 5, 2003 and was repealed by a statewide referendum in November 2004.

The Bush administration's policy position on Medicaid reflects persistent policy tensions and popular discourse around the Medicaid program for the last decade. after summarizing the Bush's Medicaid policy position, I respond to these popular notions by offering a larger historical analysis of the program and present a list of Medicaid myths which are important to debunk. Based on this analysis, I conclude by showing how historical lessons point to unique opportunities for Medicaid reform. My goal is to provide a broader political understanding of this important program, and to make clear what is at stake from the choices we make. ..PAT.-Conference Proceeding [ABSTRACT FROM AUTHOR]

Despite successful adoption of health care reforms in a number of domains and a number of incremental policy events designed to expand insurance coverage, the states collectively have been no more successful than the federal government in achieving universal coverage. Do the same forces credited with impeding health care reform at the national level also restrict state efforts to promote universal coverage? Why have the states have been so successful in adopting health policy reforms in some areas, but not in enacting universal coverage? Are the incremental steps that states have taken to promote universal coverage likely to lead to real reform in the future? We investigate these issues by examining data on state policy activity on universal coverage from 1988 through 2002. We find considerable reason to be pessimistic about the long-term success of incremental efforts to promote universal coverage and outline the requirements for a more punctuated approach to rapid policy diffusion. ..PAT.-Conference Proceeding [ABSTRACT FROM AUTHOR]

The article presents information on how the U.S. achieved universal health coverage under President George W. Bush. His re-election opened a window of opportunity for universal coverage that will close at the end of 2006. During his second term, Bush had quietly put into place a team well-suited to achieving major health care reform. He also had ready access to advice from the Health Policy Consensus Group representing academic and policy experts favoring market-oriented health care reform, especially reform of the tax treatment of health insurance.