Medicaid in the 1990s: Trends, Innovations, and the Future of the "PAC-Man" of State Budgets

Rapidly escalating health-care inflation and congressionallymandated expansions have led to large increases in spendingfor Medicaid, the federal-state program of health care for thepoor. These increases came at a time when state budgets werealready under recession-induced stresses. In addition, 1991brought new pressures for Medicaid spending from the courtsand closer federal scrutiny and control over revenues used forthe program's state "match." Yet the Medicaid picture is farfrom bleak. Diversity, innovation, and an emerging stale policyrole also characterize the program in ways that epitomize thestrengths and weaknesses of the American intergovernmental system.     

Book Review

Radical myths and superpower relations in the 1980s

A review of Mark Kaldor, Gerard Holden, and Richard Falk (eds), The New Detente: Rethinking East‐West Relations, Verso, London, 1989.

Paul Taylor and A.J.R. Groom, Global Issues in the United Nations Framework, Basingstoke, Hampshire, The MacMillan Press Ltd., 1989.

Roger A. Coate, Unilateralism, Ideology, and US Foreign Policy: The United States in and out of UNESCO, Lynne Reinner Publishers, London, 1988.

Bary Buzan, Morten Kelstnip, Pierre Lemaitre, Elzbieta Tromer, and Ole Weaver, The European Security Order Recast: Scenarios for the Post‐Cold War Era, Pinter Publishers, London & New York, 1990, pp.x. 282, £8.95 pbk, £30 hbk.     

Danger: implants

The superheated debate over breast implants awakened a sleeping giant of an issue clouding "medical devices"--the government's clumsy nomenclature for any medical product that is not a drug, from breast implants and artificial hips to X-ray machines and surgical thread. Some 130 categories of high-risk devices are in use with little or no proof of safety, reliability or effectiveness. All appeared before 1976, the year that the Food and Drug Administration got the authority to regulate such products. Under activist chief David Kessler and with added clout from a 1990 law, the FDA plans to scrutinize the entire 130-item list. Five will get special attention starting early next year: saline-filled breast implants, inflatable penile implants, testicular implants, heart-bypass pumps and cranial stimulators. U.S. News has looked at all five devices, using FDA data obtained through the Freedom of Information Act. In-depth computer analysis suggested that penile implants deserve closer examination. Why is clear from the following report.     

Acallosal brain in sudden infant death syndrome (SIDS).

A definitive explanation of "crib" or "cot" death remains unknown. An unusual incidental autopsy finding of agenesis of the corpus callosum in a case presenting as "near miss" sudden infant death syndrome (SIDS) is discussed. Hitherto, only a single case associated with SIDS has been reported in the literature. The condition may be easily missed outside the interest in neuropathology.