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 reviews

Turkey in the Middle East By Philip Robins. Pinter for the Royal Institute of international Affairs. 1991.130 pp. £22.50. ISBNO 86187 198 7. PBk £8.95. ISBN 0 86187 1995.

Hitler Slept Late and other blunders that cost him the war By James P. Duffy. London: Praeger. 1991.176pp. £17.50.

Alliance within the alliance: Franco‐German Military Cooperation and the European Pillar of Defense By David G. Haglund. Boulder: Westview Press, 1991. 213 pp.

Homeward Bound? Allied Forces in the New Germany Edited by David G. Haglund and Olaf Mager. Boulder: Westview Press, 1992. 299 pp. £24.95

Avoiding War: Problems of crisis management By Alexander L. George (ed.), Westview Press, 1991. 590 pp. £16.95.

The Future of NATO: Facing an Unreliable Enemy in an Uncertain Environment By S.N. Drew et al. Praeger Publishers, New York, 1991. pp. 206.

Parliament and international relations Edited by Charles Carstairs and Richard Ware. Milton Keynes: Open University Press, 1991. 195 pp. £12.99 (paperback)     

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.