Social insurance financing for long-term care: creative public policy to halt pauperization of the elderly and disabled in nursing homes

Long-term care (LTC) in institutions is one of the last major remaining gaps in the social insurance safety net provided to beneficiaries of Social Security.⁽¹⁾ However, Medicaid pays almost half of the costs of nursing home care after institutionalized elderly or disabled persons become impoverished. Structural reasons make it impossible for private insurance to cover institutional LTC for the bulk of the elderly and disabled. The paper demonstrates that there is an efficient, equitable and feasible social insurance solution to this serious social problem.

The second section details a plan for a Medicare Part C Trust Fund to cover extended stays in nursing homes by Social Security beneficiaries (virtually the entire elderly population and most of the long-term disabled). It involves: (1) maintenance of current government funding indexed to inflation; (2) a premium taken from the cost-of-living allowances (COLAs) due to beneficiaries in the years immediately after they qualify for Social Security; (3) a substantial copayment; (4) a deductible consisting of the first three months of nursing home care; (5) a two-year waiting period between qualification for Social Security and full LTC coverage. The three revenue streams will all increase automatically with inflation. The plan is designed to cover only institutional LTC costs in order to reduce complexity, minimize the price tag and maximize its political chances. However, it could be expanded to cover home and community-based care.

The second half of the analysis explores the policy justifications supporting such a plan and considers the political reasons why this carefully crafted proposal might appeal to moderate conservatives as well as to progressives.     

Presidential Leadership on Foreign Policy,Opinion Polling,and the Possible Limits of “Crafted Talk”

The strategy of “crafted talk” (or framing) suggests that a politician uses public opinion to anticipate the most alluring, language to convince the public to follow a politician's own preferred policy (Jacobs & Shapiro, 2000 Jacobs, L. R. and Shaprio, R. Y. 2000. Politicians don't pander: Political manipulation and the loss of democratic responsiveness, Chicago: University of Chicago Press.  [Google Scholar]). This manipulatory behavior by presidents has important consequences in the realm of constructing foreign policy, especially if the policy involves military service personnel, international prestige, or foreign conflict. However, no scholar has investigated White House archival data to examine the theoretical nuances of presidential “crafting” talk when constructing arguments for foreign policy. This article examines three case studies using internal polling memoranda and focus group results concerning the Vietnam War under President Johnson, the signing of the INF Treaty with the Soviet Union under President Reagan, and the Gulf War under President Bush. In each of the three cases, public opinion places serious constraints on presidential framing of foreign policy. Implications for the effectiveness of political framing and the limits of presidential persuasion are discussed.     

Jail Officers’ Perceptions of the Work Environment in Traditional Versus New Generation Facilities

New Generation jails have emerged as an important innovation in local incarceration. The results of existing research suggest that new generation jail design and operation can positively impact inmates and staff, but the literature is far from unequivocal. The current study utilized data collected from a single jail complex to provide a unique test of how the type of facility influences jail staff perceptions of the work environment along several dimensions. Our results revealed few differences between correctional officers working in traditional units and those posted in new generation units. We discuss the implications of these findings, including the use of direct supervision inmate management in traditional as well as new generation jails.     

The Nature of Legal Change on the U.S. Supreme Court: Jurisprudential Regimes Theory and Its Alternatives

Jurisprudential regimes theory (JRT) posits that legal change on the U.S. Supreme Court occurs in a drastic, structural‐break‐like manner. Methodological debates present conflicting evidence for JRT, which has implications for the important law versus ideology debate. We confront this debate by first elaborating two alternative theoretical perspectives to JRT—evolutionary change and legal stability. Our analytical framework focuses on two key substantive effects of jurisprudential categories on the Court's case outcomes—relative differences between categories over multiple time periods and longitudinal differences across time periods. Importantly, different pieces of empirical evidence can provide support for different dynamic processes. The extent to which “law matters” is not necessarily tied to one particular model of legal change. Empirical analysis of updated and backdated free expression data generates key findings consistent with JRT, legal stability, and evolutionary change. We discuss the implications of the results for understanding legal change and legal influence.     

Saving Children from a Life of Crime: Toward a National Strategy for Early Prevention

A great deal has been learned about childhood risk factors for offending and about effective interventions targeting these risk factors that reduce later delinquency and criminal offending. The time is right to implement a risk-focused, evidence-based national strategy for early prevention in the United States. A National Council on Early Prevention could provide technical assistance, skills, and knowledge to state and local agencies in implementing prevention programs; could provide funding, continuity, coordination, and monitoring of local programs; could provide training in prevention science for local people; could commission systematic reviews of the effectiveness of interventions; and could maintain high standards for evaluation research. The main aim of this article is to outline a national strategy for the prevention of delinquency and later offending. It identifies and discusses critical lessons learned from Western countries, such as Canada and Sweden, about the development of national crime prevention agencies.