States and the politics of incrementalism: health policy in Wisconsin during the 1990s

Wisconsin officials during the 1990s seemed poised to enact innovative and comprehensive health care reform. During that era, an ambitious, popular, and reform-minded governor led the state. The state had an unusually professional legislature. The state's economy was strong. Even with these advantages, however, the report card on the state's efforts is mixed. The state enacted a fairly modest set of reforms that were financed largely by the federal government and subject to extensive federal oversight. The Wisconsin story thus seems to be about the politics of incrementalism. But while critics of incrementalist politics point out that the number of uninsured continues to grow, the catalytic federalism witnessed in Wisconsin in the 1990s may well be the best model for implementing health care reform.     

Risk,response, and mental health policy: learning from the experience of the United Kingdom

Policy makers in the United States and the United Kingdom recognize that mentally disordered offenders present special challenges to law enforcement, mental health, and social service systems, as well as the community. Although various policy initiatives have advanced over the past twenty years to improve the management of mentally disordered offenders, mental health policy has chronically failed in both countries. Because safety concerns have emerged as the mental health system has been "deinstitutionalized," debate is growing about whether the community-care approach works-for the community. This study argues that mental health policy fails because policy makers focus on the wrong risks and design policies that manage these risks in ways that increase the possibility of adverse clinical and economic outcomes. The argument made here uses the case of persons with severe mental illness in the United Kingdom as an example of the complex relationship between risk and policy making in democratic governance. Emphasis is on the nature of risk in mental health policy and how government responds to policy and political risks. Mental health policy in Britain is then analyzed in terms of its response to and management of risks. Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.     

Playing fair: fairness beliefs and health policy preferences in the United States

Conventional wisdom suggests that the best way to persuade Americans to support changes in health care policy is to appeal to their self-interest - particularly to concerns about their economic and health security. An alternative strategy, framing problems in the health care system to emphasize inequalities, could also, however, mobilize public support for policy change by activating underlying attitudes about the unfairness or injustice of these inequalities. In this article, we draw on original data from a nationally representative survey to describe Americans' beliefs about fairness in the health domain, including their perceptions of the fairness of particular inequalities in health and health care. We then assess the influence of these fairness considerations on opinions about the appropriate role of private actors versus government in providing health insurance. Respondents believe inequalities in access to and quality of health care are more unfair than unequal health outcomes. Even after taking into account self-interest considerations and the other usual suspects driving policy opinions, perceptions of the unfairness of inequalities in health care strongly influence respondents' preferences for government provision of health insurance.     

New federalism and health care policy: states and the old questions

The New Federalism that evolved under the Reagan administration tends to grant states more discretion in the implementation of health care programs. It thereby rekindles old concerns about the commitment, capacity, and progressivity of the states. This paper reviews recent policy developments and reconsiders state performance from the vantage point of the mid-1980s. While hard evidence remains elusive, a plausible case exists that any gap between the states and Washington on commitment, capacity, and progressivity has diminished. State administrative capacity in particular has probably increased. The continued presence of substantial variation among the states needs to be underscored, however. Moreover, the relentless imperative of economic development, or migration, theory sets severe limits on how far states can go in adopting redistributive measures to assure adequate medical care for the poor. Given current federal laws, the most optimistic, plausible scenario envisions the rise of a technical politics of efficiency in the states. In spite of state limitations, health policy reformers need to pay increased attention to their potential role.     

Mental health policy in the liberal state: the example of the United States

Mental health policy arises out of the interaction of many different variables. These include (but are not limited to) the composition of the population of persons with severe mental illnesses; the means of dealing with disease and dependency; concepts of the etiology and nature of mental disorders; the organization and ideology of psychiatry; funding mechanisms; and existing popular, political, cultural, and professional values. But an often neglected but crucial factor in shaping policy is the very structure of the American political system, which played a crucial role in shaping mental health policy. Rather than emphasizing the neo-liberal theory and its accompanying hostility toward "unsuccessful" people and disdain of welfare, this article suggests that an understanding of mental health policy in the latter half of the twentieth century is better served by an examination of what actually happened. Theory, however attractive, rarely can encompass the messy data of reality.     

Unconscionability of E-contracts: A Comparative Study of India,the United Kingdom,and the United States

Liverpool Law Review - Adhesion contracts have a strong likelihood of being unconscionable. The laws and principles are further complicated by the introduction of electronic contracts, specifically...     

Domestic food policy in the United States

In this paper we review the major outlines of domestic food programs, assess their adequacy, and recommend ways to improve the relationship between food programs and hunger relief. In the Food Stamp Program we treat problems of outreach, coverage and the adequacy of benefits, and rationing access through imposition of costs on recipients. For WIC and commodity distribution programs we also discuss problems associated with the fragmentation of authority and dependence on nonprofit distributors.     

Privatization in the United Kingdom and economic regulation in the United States: Lessons in administrative law

The author would like to recognise Prof. Laksham Guruswamy, Faculty of Law, University of Durham, currently Visiting Professor of Law, University of Iowa, for the suggestions he contributed to this article.     

发达国家灾难治理基本经验及其启示:以英国、美国、日本为例

发达国家,尤其是英美日在灾难治理方面起步较早,积累了丰富的经验,主要体现在:灾难治理的组织机构日渐完备;灾难治理的运作机制更加协同;灾难治理的法律体系日益完善;灾难治理的资金保障更加有力;灾难治理的信息披露更加透明;灾难治理的参与主体逐渐多元;灾难治理的端口逐渐前移;灾难治理的教训得以及时总结。深入分析并总结这些国家灾难治理举措,目的在于从中找出于我国可资借鉴之处,提升我国政府灾难治理的水平和能力。