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.     

Reviews

Dark Age: The Political Odyssey of Emperor Bokassa by Brian Titley. McGill‐Queen's University Press, Québec (Canada) and Liverpool University Press, Liverpool, (UK), 1997. xii. plus 5pp. of illustrations (photographs and a map of the Central African Republic) plus 257pp. including notes, bibliography and index. £22.95 hardback.

The Making of a Periphery: Economic Development and Cultural Encounters in Southern Tanzania edited by Pekka Seppala and Bertha Koda. Nordiska Afrikainstitutet, Uppsala (Sweden), 1998. 344 pp. including figures, tables, maps, notes, bibliography and index. Paperback.

Farewell to Farms: De‐agrarianization and Employment in Africa edited by D.F. Bryceson and V. Jamal. Ashgate Publishing Ltd., Aldershot, 1997. iv plus 265pp. including figures, tables, notes and index.

The World Bank and Nigeria: Cornucopia or Pandora's Box? by Rufai Ahmed Alkali. Kaduna, Baraka Press, 1997. 205pp. including selected references.

Sustaining the Future: Economic, Social and Environmental Change in Sub‐Saharan Africa edited by George Benneh, William B.Morgan and Juha I.Uitto. The United Nations University Press, Tokyo, New York and Paris, 1996.     

Maternal Child-Rearing Attitudes and Role Satisfaction and Children's Temperament as Antecedents of Adolescent Depressive Tendencies: Follow-up Study of 6- to 15-Year-Olds

Development of depressive tendencies was assessed over a 9-year period in a random sample of 389 Finnish children. Predictors of maternal role satisfaction and hostile child-rearing attitudes, assessed when the children were ages 6 and 9 years, respectively, and a temperament predictor of perceived child difficultness, assessed when the children were age 6 years, were measured using questionnaires designed for this study. Depressive tendencies were assessed by a self-report at age 15 (modification of Beck's Depression Inventory). Using structural equation modeling, we tested a hypothesized model comprising direct as well as mediated effects between the childhood predictor variables and adolescent depressive tendencies. The results indicated support for a similar mediational model in girls and boys. Low maternal role satisfaction and maternal perceptions of child difficultness, measured when children were age 6 years, predicted hostile maternal child-rearing attitudes measured when children were age 9 years, which in turn had a significant direct effect on depressive tendencies among these children during adolescence. The only other direct effect was found solely in girls: Low maternal role satisfaction predicted adolescent depressive tendencies. These results underline the close interplay of child temperament and mothering factors in the development of depressive tendencies in girls and boys.     

Studying British government: reconstructing the research agenda

This article seeks to place the study of British government in a broader context by exploring the potential contribution of an anti-foundational epistemology. We seek to 'reinvent' a self-conscious, sceptical and tentative approach rooted in philosophy and history. The first section defines the Westminster model and the family of linked narratives: traditional sceptics, social science, radical theory, new public management. The second section outlines an anti-foundational epistemology, focusing on the notions of traditions, narratives, decentering and dilemmas. The third section applies this approach to one prominent school of thought about British government: policy networks. We argue that an anti-foundational approach will decenter networks, shifting the locus of analysis from the institutions to individuals, and focus on dilemmas to explain how networks change. Finally, we conclude there is no essentialist account of British government, only complex and diverse narratives, and no tool kit for solving problems, only lessons drawn from many stories.     

The psychological impact of stalking on female undergraduates.

This study examined the psychological impact of stalking upon female undergraduates, a population previously determined to experience a surprising stalking prevalence rate. Despite common understanding that stalking has deleterious effects, there have been no previous efforts to systematically assess them with standardized measures. Thirty-six female stalking victims were compared with 43 females who had been harassed and 48 controls. Psychological impact was assessed with the Posttraumatic Stress Disorder Scale, the Symptom Checklist-90-R, and the Self-Report Interpersonal Trust Scale. Stalked subjects endorsed significantly more PTSD symptoms and with greater severity than the harassed or control subjects. Stalked subjects also had significantly higher scores on several subscales of the SCL-90, and had significantly higher positive symptom totals and distress indices.     

Electrospray and MALDI mass spectrometry in the identification of spermicides in criminal investigations.

Electrospray ionization (ESI) and matrix-assisted laser desorption/ionization (MALDI) mass spectrometry have been used to examine evidence in a sexual assault investigation. Because condoms are being used increasingly by sexual assailants and some condom brands include the spermicide nonoxynol-9 (nonylphenoxy polyethoxyethanol) in the lubricant formulation, the recovery, and identification of nonoxynol-9 from evidence items may assist in proving corpus delicti. A method was developed for the recovery of nonoxynol-9 from internal vaginal swabs and for its identification by reverse phase liquid chromatography/electrospray ionization mass spectrometry (LC ESI-MS), nanoelectrospray ionization (nanoESI) mass spectrometry, and high resolution MALDI Fourier transform mass spectrometry (MALDI-FTMS). The method was tested on extracts from precoitus, immediate postcoitus, and four-hours postcoitus vaginal swabs provided by a volunteer whose partner does not normally use condoms, but for this trial used a condom having a water-soluble gel-type lubricant that includes 5% nonoxynol-9 in its formulation. Subsequently, LC ESI-MS was used to identify traces of nonoxynol-9 from the internal vaginal swab of a victim of a sexual assault.