The social roles of Medicare: assessing Medicare's collateral benefits

The Medicare program incorporates a number of functions that go beyond providing health insurance to its beneficiaries. These activities, which we refer to as "collateral" functions, may have important health consequences but are also an increasing source of controversy. In this essay we develop a conceptual framework for categorizing these involvements, introduce some additional options that might complement Medicare's current collateral functions, assess the reaction of policy elites and Medicare's current beneficiaries to these alternatives, and evaluate the role that collateral activities play for Medicare's core mission. A case can be made for expanding some collateral involvements, but only if the Health Care Financing Administration has the strategic direction and administrative capacity to effectively implement these activities.     

Is health care different? Popular support of federal health and social policies

Over the past several years there has been a striking increase in policy-makers' attention to health care reform. This paper explores whether there has been a corresponding shift in popular attitudes and identifies factors that may have changed these attitudes. The first part of the analysis relies on survey data collected between 1975 and 1989 to estimate a set of regression models, relating support for federal involvement in health care, antipoverty programs, and general domestic policies to a set of sociodemographic characteristics.... The second part of this study explores motivations that might account for these patterns. We identify a half dozen ways in which health care may be viewed as "different," that is, more or less appropriate for federal action. Analysis of survey data from 1987 suggests that there are relatively small differences in the attitudes and perceptions that motivate support for federal health initiatives, relative to federal domestic policies in general. However, there are more striking differences between health programs and more overtly redistributive policies.... We suggest that the growing support for federal intervention in health care, relative to other social policies, is in part an inadvertent by-product of ideological positions popularized during the Reagan and Bush administrations. We draw from these results some predictions about the course of the ongoing debate over federal health policies.     

A critique of the research literature concerning pregnant adolescents, 1960–1970

A perspective on the research literature from 1960 to 1970 concerning pregnant adolescents (this literature was abstracted and reviewed in a previous publication) is presented. Research methodology and potential content for research are examined and suggestions made that would contribute to a stronger empirical base for the research. Several assumptions (of difference, of homogeneity, and of special need) regarding pregnant adolescents that seem to be implicit in the research are brought to light. Finally, an analysis of the risk concept is presented.Has degrees in social work (M.S. and Ph.D.) and public health (M.S.), with research interests in adolescent health status, human service for youth, and the process of (research) consultation.Has M.A. in sociology.Has degrees in theology (B.D.) and medical sociology (Ph.D.). He teaches the latter, while focusing his research interests on the mental health consequences on women as a result of their labor force participation and the evaluation of accelerated medical education programs.M.D. degree and a degree also in public health. Before his academic career, he was a high public official in the New York State Department of Health. His publications include studies of the medical aspects of water fluoridation and high-risk groups receiving maternity care. Current research interests include studies of patterns of provision of maternal and child health services in the United States, the incidence and prevalence of long-term diseases of childhood, and followup studies of low birth weight and other vulnerable infants.     

Navigating Limited and Uncertain Access to Subsidized Housing After Prison

An emerging literature has documented the challenges that formerly incarcerated individuals face in securing stable housing. Given the increasingly unaffordable rental market, rental subsidies represent an important and understudied source of stable housing for this population. The existing literature has described substantial discretion and a varied policy landscape that determine former prisoners’ access to housing subsidies, or subsidized housing spaces that are leased to members of their social and family networks. Less is known about how former prisoners themselves interpret and navigate this limited and uncertain access to subsidized housing. Drawing on data from repeated qualitative interviews with 44 former prisoners, we describe the creative and often labor-intensive strategies that participants employed to navigate discretion and better position themselves for subsidized housing that was in high demand, but also largely out of reach. Our findings also illustrate the potential costs associated with these strategies for both participants and members of their social and family networks.