The dilemmas of incrementalism: logical and political constraints in the design of health insurance reforms.

Health care reform became a premier issue on the U.S. policy agenda in the 1990s. While the comprehensive proposal put forth by President Clinton failed, states and the federal government successfully pursued a variety of lesser initiatives. This article focuses on a set of reforms intended to make private health insurance more accessible and affordable to individuals and workers in small firms. It outlines the key arguments made by experts to justify stronger regulation of health insurance and the options and difficult tradeoffs that must be considered in policy design. It then examines the scope and strength of legislation adopted by 45 states and the federal government from 1990 to 1996. The substantial variation in state policies demonstrates that even though insurance market reform was the one issue that commanded nearly universal support in the health care debate, few design features were universally accepted by those who crafted the reforms. The article concludes by assessing the pattern of state and federal action. The reforms represent some progress on nominal access to insurance but little progress on the affordability of insurance for individuals and small groups. Few of the reforms present a serious challenge to existing practices and interests of the insurance industry. This pattern of policy design reflects the logical and political constraints of incrementalism. In a system where insurance coverage is voluntary, changes to increase access for one group tend to increase costs and thereby decrease access for another segment of the population. In addition, because incremental reforms will not attract sustained attention and support from the general public, it is politically difficult to impose substantial new regulation on a powerful industry.     

Attachment as an Organizational Construct for Affect,Appraisals, and Coping of Late Adolescent Females

The purpose of this study was to 1) compare general affective dispositions (depression and anxiety) and negative affect during interpersonal conflict as a function of attachment security, 2) examine appraisals as a function of attachment style and as predictors of coping, 3) compare strategies of coping with interpersonal conflict as a function of attachment style, and 4) investigate the roles of attachment style, affect, and appraisals in predicting coping in the context of interpersonal conflict. Seventy-three late adolescent females participated. Insecure participants reported higher levels of depression, anxiety, and negative affect during interpersonal conflicts. Insecure participants were more likely to cope with interpersonal conflicts through support seeking or avoidance. Hierarchical regression analysis indicated that general and specific attachment style, affect, and appraisals significantly predict coping strategies. Implications for general and specific models of attachment as organizational constructs and attachment as a predictor of coping with interpersonal and non-interpersonal stressors are discussed.