Between welfare medicine and mainstream entitlement: Medicaid at the political crossroads

As the new century begins, the Medicaid program is arguably at a political crossroads. Over the 1980s and 1990s, policy makers enacted major expansions in Medicaid coverage, offering significant new health benefits to poor women and children and other constituencies. In elite rhetoric and political framing, Medicaid was increasingly cast as a broad-based social welfare entitlement of value to all Americans, including middle-class citizens. Some health care advocates began viewing Medicaid expansions as a potential path to achieving universal coverage in the United States. Yet Medicaid remains a means-tested program that has been repeatedly threatened with policy retrenchment. In this essay, we scrutinize Medicaid's current status and future possibilities from a historical-institutional perspective by tracing its complex evolution since its enactment in the Social Security Amendments of 1965. Our core claim is that decisions made at the time of Medicaid's original adoption have fundamentally set the matrix for struggles over the program's unfolding development. We demonstrate that key ambiguities embedded in the 1965 act created largely unintended opportunities for policy entrepreneurs to broaden Medicaid's scale and scope as well as foreseeable vulnerabilities that must be overcome if Medicaid is to realize its full potential.     

Technology Policy and Programs at a crossroads

Following a period of tinkering with various approaches to designing technology programs, and in the wake of recent elections, it appears that government interventions in technology development and transfer must be carefully crafted and mindful of political minefields and economic limits. In this article, the Director of the Southern Technology Council comes down from the mountain with Ten Commandments of Wise Technology Programs and Policy Making.     

Men's attitudes toward affirmative action: Justice and intergroup relations at the crossroads

Two studies were conducted to examine some factors that may motivate support of or opposition to affirmative action programs for women. In the first study, a sample of 96 French-speaking male managers and professionals were presented with one of three versions of an affirmative action program to benefit women in blue-collar jobs. The men were asked about their endorsements and beliefs about the program described to them and (using a neosexism scale) about sex equity. Results indicate that neosexist attitudes influence support of the program presented, and articulating adherence to a merit principle in affirmative action influences perceptions of fairness. The second study evaluated reactions to an affirmative action program targeting jobs similar to those of the participants. Four conditions were designed to determine which element or combinations of elements of information presented in the first merit condition might have a stronger impact on fairness evaluations. A total of 131 francophone male managers and professionals participated in this study. Results reveal that neosexist attitudes influence level of support for the program. Both neosexism and the four conditions had an impact on evaluations of fairness.     

The first amendment at the crossroads: Free expression and new media technology

A century and a half after it became part of the Constitution, the First Amendment finally began to fulfill its promise of protecting freedom of speech and press. Only in recent decades have courts extended that protection to a broad range of expressive activity. In an era of emerging media technology, courts will be called on to establish new constitutional principles to deal with the changing communications landscape. Once unleashed, the “new”; First Amendment standards will be available to change the legacy of landmark cases that some consider to be overly‐solicitous of freedom of speech and press. Protecting the First Amendment in the cyberspace era is best accomplished not by creating new standards, but by applying and thus preserving established First Amendment principles.     

Creating clones, kids & chimera: liberal democratic compromise at the crossroads

The objective of this article is to find middle ground between the supporters and opponents of biotechnology by perpetuating the existing legal compromise pertaining to the complete range of health and welfare doctrines relevant to the biotechnological industry. The author aspires neither to add to nor detract from this liberal democratic consensus, but to preserve its constitutive balance between positivism and natural law and over-regulation and under-regulation in the hopes of stabilizing new political fault lines developing around the few biotechnological innovations already grabbing headlines. The most feasible solution is to extend the existing liberal democratic compromise with respect to equal protection, reproductive rights, the First Amendment, human subject experimentation, patent law, and parental rights. This includes banning or monopolizing certain biotechnologies and extending substantive special respect to the ex vivo living human embryo. Biotechnology must not be left to regulate itself.     

Medical restrictive covenants in Illinois: at the crossroads of Carter-Shields and Prairie Eye Center

This article examines the history, development and treatment by Illinois courts of medical restrictive covenants. The authors highlight two recent cases from Illinois, one from the Supreme Court and the other authored by an appellate court panel. The article concludes by providing not only a forecast of how such covenants should be treated by Illinois state courts in the future, but also a pathway for the expectations of health care practitioners who wish to use restrictive covenants in their employment relationships with their colleagues.     

Presidential address: Juvenile justice at the crossroads: Presidential address to the academy of criminal justice sciences

Three interacting factors appear to significantly affect our treatment of youths and thus our juvenile justice policy: ideology, the media, and politics. As a result of these factors, although juvenile violent crime is decreasing, legislatures still advocate a harsh, punitive stance toward youthful offenders. Legislative initiatives have resulted in determinate sentencing for juveniles, more youths handled by the adult criminal court, and more youths sentenced to adult institutions. Recent evidence suggests that the public supports more prevention and early intervention strategies for youths and favors rehabilitation rather than punishment. These conflicting trends suggest that we are at a crossroads: the juvenile justice system can continue its harsh, reactive stance, or it can choose a more proactive approach. The members of the Academy of Criminal Justice Sciences have an opportunity to play an active role in the development of criminal justice policy.     

Streetwork at the crossroads: An evaluation of a street gang outreach intervention and holistic appraisal of the research evidence

Spurred by the success of public health violence interventions, and accelerated by policy pressure to reduce violence without exacerbating overpolicing and mass incarceration, streetwork programs—those that provide anti-violence services by neighborhood-based workers who perform their work beyond the walls of parochial institutions—have positioned themselves as the most important non–law-enforcement violence prevention option available to urban policy makers. Yet despite their importance, the state of the field seems difficult to interpret for academics and practitioners alike. In this article, we make several contributions that bring forth new findings and deliver new perspectives on streetwork as a violence reduction strategy. First, we offer an extended analytic review of the streetwork evaluation literature that connects the study of contemporary public health violence interventions to a preceding tradition of criminologically inspired streetwork studies. Second, we present the results of an impact evaluation of StreetSafe Boston (SSB)—a multiyear streetwork intervention that served 20 Boston gangs. We find that the SSB intervention had no detectable effect on violence among the gangs that it served. We conclude by offering a framework for understanding a field at multiple crossroads: past and present, proclaimed successes and failures, help and harm.