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.     

Diplomacy in isolation

Isolated States: A Comparative Analysis by Deon Geldenhuys. Jonathan Ball, Johannesburg, 1990.764 pp. including notes and index.

South Africa's Foreign Policy: The Search for Status and Security 1945 ‐ 1988 by James Barber and John Barratt. Cambridge University Press, Cambridge and Southern Book Publishers, Johannesburg, 1990. ix plus 398 pp. including appendix, notes and index.     

Reviews

Orlando Figes, Peasant Russia, Civil War: The Volga Countryside in Revolution, 1917–1921. Oxford: Clarendon Press, 1989, xx + 401 pp., £40.00.

Hugh Macdonald, The Soviet Challenge and the Structure of European Security. Aldershot: Edward Elgar, 1990, ix + 318 pp., £38.50.

Jonathan Eyal, ed. The Warsaw Pact and the Balkans: Moscow's Southern Flank. London: Macmillan Press, 1989, xvi + 246 pp., £35.00.

Kurt M. Campbell & S. Neil MacFarlane, eds., Gorbachev's Third World Dilemmas. London & New York: Routledge, 1989, xvi + 270 pp., £35.00.

Terry L. Thompson, Ideology and Policy: The Political Uses of Doctrine in the Soviet Union. London: Westview Press, Westview Special Studies on the Soviet Union and Eastern Europe, 1989, viii + 220 pp., $28.95 p/b.

Mary Buckley, Women and Ideology in the Soviet Union. London: Harvester Wheatsheaf, 1989, 266 pp., £9.95 p/b.

Maria Lo?, ed., The Second Economy in Marxist States. London: Macmillan, 1990, xiv + 240 pp., £37.50.

Harley D. Balzer, Soviet Science on the Edge of Reform. Boulder, CO: Westview, 1989, xxi + 290 pp., $32.50.

Michael Ryan, Doctors and the State in the Soviet Union. Basingstoke and London: Macmillan, 1989, ix + 205 pp., £37.50.

Jerzy Tomaszewski, The Socialist Regimes of East Central Europe: Their Establishment and Consolidation 1944–67, Trans. Jolanta Krauze. London: Routledge, 1989, 305 pp., £40.00.

Paul G. Lewis, Political Authority and Party Secretaries in Poland 1975–1986. Cambridge: Cambridge University Press, 1989, xix + 340 pp., £35.00.

Leonard J. Cohen, The Socialist Pyramid: Elites and Power in Yugoslavia. Oakville, TX: Mosaic Press, 1989, 499 pp., $29.95 h/b, $19.95 p/b.

Diane P. Koenker & William G. Rosenberg, Strikes and Revolution in Russia, 1917. Princeton, NJ: Princeton University Press, 1989, xix + 393 pp., $39.50.     

Federalism and the Safety Net: Delinkage and Participation Rates

Since the enactment of welfare reform legislation in 1996, thefederal government and the states have emphasized putting theneedy to work and reducing caseloads. Simultaneously, however,national policymakers delinked eligibility for cash assistancefrom eligibility for other safety-net benefits. Contrary tostated policy, though, this delinkage has led to declining participationin the case of Food Stamps and health-insurance programs forlow-income children. We highlight four factors that states mustshape if they are to narrow this gap between policy promiseand program performance by fostering higher participation. Weshow how our focus intersects with enduring questions of Americanfederalism—the level of state commitment to redistributiveprograms, their capacity to implement these programs effectively,and the degree to which states can augment governing capacityby becoming more genuine laboratories of democracy.     

Mapping Patterns of Support for Privatization in the Mass Public: The Case of Michigan

This article examines public attitudes about using for-profit firms or nonprofit organizations to deliver public services in Michigan. Using survey data, it shows how the public reacts to the privatization of various state and local government services. It then considers some dimensions of attitudes toward privatization. Finally, it estimates models that predict support for privatization based upon a range of characteristics of respondents to our survey.     

Caught in the Act: The Smoking Gun View of Ministerial Responsibility

While any discussion of ministerial responsibility must in part focus on ministerial resignations, finding out when ministers resign is only the tip of the iceberg. A full assessment of ministerial responsibility would look at the relations between ministers and their senior bureaucrats, as discussed in Bill Blick’s article. It would look at the impact of managerialism on ministerial accountability, especially in the light of privatisation and contracting out. It would assess the impact of other mechanisms of accountability, including the senate. The subject of this article must always be put into a broader context. This article concentrates on ministerial resignations drawing on evidence from Britain, Canada, the federal government in Australia and the government of New South Wales. When do ministers resign?