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RSF Review

RSF Review

Public Health in New York City: A Review of "Epidemic City"

November 14, 2012

A review in the latest issue of Contemporary Sociology praises RSF's book Epidemic City, an engaging historical account of public health issues in New York City in the 20th century:

Epidemic City clearly documents in detail how the New York public heath system has in the last fifty years dealt with outpatient care for the poor, lead paint poisoning, abortion, heroin addiction, childhood immunizations, infant mortality, AIDS, homelessness, drug-resistant tuberculosis, West Nile Virus, bioterrorism, tobacco use, diabetes, and cardiovascular disease. Each issue brought to the fore different players and a different set of issues for the department. From the story told, no issues were easy to resolve and with all the contests, most of the issues were at least partially resolved, even those problems related to poverty and costly in human lives.

[...]This book should be of great interest to anyone interested in public health and health care, but also should be read by those concerned with local politics and how we make decisions that work to balance individual rights and the public good.

Medicaid and Long-Term Care: An Interview with Leonard E. Burman

Rohan Mascarenhas, Russell Sage Foundation
November 6, 2012

long-term careLeonard E. Burman is Professor of Practice in Public Administration and International Affairs at Syracuse University. An expert in public finance and modeling the effects of government policies on individuals' and firms' decisions, Burman contributed a chapter to RSF's free e-book, Universal Coverage in Long-Term Care in the United States.

Q: First, we should establish some facts. How do Americans pay for long-term care? Is it mostly informal, unpaid work – assistance from families and friends – or do private insurance and Medicaid pay most of the bill?

A: Family and friends provide a lot of informal care and most people with long-term care needs live in the community, not in nursing homes. Medicaid pays for about 40 percent of the cash costs and Medicare pays for 23 percent. The rest is paid for by private insurance or out-of-pocket.

Q: You write that if current trends persist, we could face a fiscal “catastrophe.” How big of a burden is long-term care on the Medicaid budget, and why do you think it will increase “dramatically” in the coming decades?

A: Medicaid is a large and growing share of the federal and state budgets and almost one-third of Medicaid goes to cover long-term care expenses—a share that will rise over time. In 2009, federal and state spending on Medicaid was about 2.7 percent of GDP. That is more than half of spending on defense, which is less than 5 percent of GDP. In 2008, 30 percent of Medicaid spending paid for long-term care, but that percentage will increase dramatically over time as baby boomers age and their long-term care needs rise. Assuming a continuation of current policy, demographic and health cost trends, federal and state spending on Medicaid will exceed spending on defense by 2040.

Two factors drive this rapid growth. First, the proportion of the population aged 85 and over will almost double between now and 2040. More than one-fifth of this group was in nursing homes in 1995. Second, health care costs continue to grow faster than the economy—by more than two percent per year on average. Assuming nursing home costs track health care spending, this translates into steadily increasing Medicaid spending relative to GDP.

Q: A major argument in your chapter is that “the incentives in our long-term care system are all wrong.” I wanted to focus on this point – are you saying that if Medicaid didn’t exist, more Americans would save more for long-term care insurance? Isn’t it also possible that Americans simply underestimate their future need for long-term care, or that the private insurance market isn’t a viable option for many?

A: There’s a lot of evidence that people underestimate the cost of long-term care and the private insurance market certainly has a lot of problems, but public policy should aim to address those problems. Instead, it exacerbates them. Medicaid amounts to a 100-percent tax on assets above the threshold for eligibility for assistance (typically, $2,000 for a single person), which provides a powerful disincentive to save. Medicaid also strongly discourages purchasing long-term care insurance because much of what is covered under private insurance simply replaces services provided for free under Medicaid.

Economic Hardship, Political Attitudes, and the 2012 Election

Lindsay Owens and David S. Pedulla, Stanford University and Princeton University
November 5, 2012

election-2012As part of our Election 2012 series, Lindsay Owens and David S. Pedulla examine the effects of the economic downturn on political attitudes. Owens, a graduate student at Stanford University, contributed to the RSF volume The Great Recession. Pedulla is a graduate student in sociology at Princeton University.

As Americans head to the ballot box, they will no doubt consider whether Obama or Romney will be better able to stimulate our sluggish economy. People were hit hard by the Great Recession and the aftershocks of economic distress are still forceful in the lives of individuals, families, and communities across the country. How will these economic hardships influence the choices that voters make at the ballot box in the upcoming election? While only time will be able to answer this question definitively, below we present findings from some of our research that hints at some possibilities for how economic hardship may (or may not) influence the political attitudes and voting behavior of the American electorate.

In research for the Russell Sage Foundation’s edited volume The Great Recession (2011), Owens (with her co-author, Lane Kenworthy) examined whether a variety of political and social attitudes change during and after economic recessions. On the whole, the findings from this study suggest that recessions do not seem to produce lasting shifts in Americans’ attitudes in the aggregate (Kenworthy and Owens 2011). They found little evidence of a “recession effect” on perceptions of fairness and opportunity in the economy, interests in helping the poor, confidence in government, or beliefs about the proper role of the government in regulating the economy. And, the changes that do occur tend to be temporary, reversing when the economy begins to recover. Given these macro-level findings, we might expect that the current economic situation will not affect political attitudes in any significant ways.

Attitudes Toward The Financial Sector

Although we have not seen wholesale shifts in political attitudes due to the recent recession, there are a few areas where attitudes have changed. Americans’ favorability toward banks and financial institutions has reached at least a forty year low. And, drawing on data from the The Gallup Poll and Pew Research Center for the People and the Press, Owens (2012) finds that Americans’ attitudes toward the ethical practices of bankers and Wall Street stockbrokers are at historic lows. Social scientists don’t usually think these types of political attitudes matters in elections. But there is reason to think this election might be different. Republican Presidential candidate Mitt Romney has strong ties to the financial sector. In particular, he was a founding partner of Bain Capital, a large private equity investment firm. The Obama campaign has certainly seized upon Romney’s connection with such an unpopular industry, running a variety of ads linking Romney to Bain Capital and in particular highlighting Bain Capital’s role in outsourcing jobs overseas. Although there is little evidence that these ads have had a lasting negative impact on Romney’s favorability, his ties to Bain Capital are certainly not an asset given the shift in Americans’ attitudes towards the financial sector. The upshot is that Americans’ overwhelming negativity toward financial institutions and those individuals who work in them may pose a problem for the Romney campaign.

The Impact of School Desegregation

October 26, 2012

Court-ordered school desegregation, perhaps most famously highlighted by Brown v. Board of Education, has been described as among the most ambitious and controversial social experiments of the past fifty years. But what do we know about the long-run impact of school desegregation on students' lives?

In an engaging TEDx talk, former RSF Visiting Scholar Rucker Johnson, argues that desegregation had a major effect on school quality and yielded substantial increases in educational attainment and adult earnings among black students. Johnson argues that two key non-racial aspects of integration -- an increase in per-pupil spending and a reduction in class sizes among blacks -- played a substantial role in helping black students. Watch below for more:

The "Obama Effect" on White Racial Prejudice

Seth K. Goldman, University of Pennsylvania
October 24, 2012

election-2012As part of our Election 2012 series, Seth K. Goldman examines the impact of President Barack Obama's campaign on levels of white prejudice. A Russell Sage grantee, Goldman is a post-doctoral fellow at the Annenberg School for Communication.

In the wake of the presidential and vice-presidential debates, pundits and political scientists alike have dissected the performance and rhetoric of the candidates, hoping to answer one question: Who will win the election? Obviously, this is an important question, but given the historic nature of Barack Obama’s candidacy, we need to also address another issue: Will the campaign to reelect the first African-American president influence white Americans’ racial attitudes? If the 2008 campaign is any indication, it may very well do so. My research demonstrates that during the 2008 campaign, long before Obama's election, levels of white racial prejudice declined significantly.

Using three waves of nationally representative panel data collected during the 2008 campaign, I found that in just a handful of months whites became less likely to rate whites more positively than blacks on three scales ranging from hardworking to lazy, trustworthy to untrustworthy, and intelligent to unintelligent. And although the size of the decline was modest statistically, it was big historically. Between July 2008 and January 2009, racial prejudice declined by a rate that was at least five times faster than the secular trend in prejudice occurring in the United States over the previous two decades.

A True Change of Heart?

These are dramatic changes, but could they be the result of a methodological artifact driven by social desirability bias—that is, did whites become increasingly concerned about looking racist without changing their personal beliefs? Based on a variety of reasons, however, this appears unlikely. As an illustration, consider that in the late summer of 2008 (during the first of the three waves of the panel survey) fully 56 percent of whites rated whites more positively than blacks on the three scales described above. This suggests little aversion to answering the questions in a way that indicates prejudice, probably due to the fact that the measure of prejudice did not require whites to directly compare whites and blacks. The items about the two groups appeared at different points in the survey (with the order randomized), separated by several minutes' worth of items about non-racial topics.

Moreover, although social desirability effects are common in face-to-face and telephone surveys, this study was conducted over the Internet, where such effects are much less common because the respondents do not interact with another person. Nonetheless, as another check, I took advantage of the random order in which whites were asked about whites and blacks. This allowed me to assess whether whites changed their ratings of the second group in an effort to rate the two groups equally. For instance, if fears of looking racist altered whites' ratings, then they should have rated blacks more positively when whites were asked about first (in order to shift closer to a presumably higher rating of whites). Similarly, whites should have rated whites less positively when blacks were asked about first (in order to shift closer to a presumably lower rating of blacks). Completely contradicting the possibility of social desirability effects, neither pattern appeared on any of the three waves of the panel survey.

White Male Managerial Representation by Sector, 1966-2005

October 18, 2012

The figure below, taken from the RSF book Documenting Desegregation, reports sector trends in white male managerial representation. A score of zero indicates that a group is represented on average at the same rate at which its members are employed in local labor markets. A score of 40 indicates that a group is over-represented by 40 percent.

In all sectors other than social services, white men were over-represented in managerial jobs. All sectors showed an increase in white males' access to managerial jobs after 1966, but there was considerable variability in trajectories after the early 1970s. In 2005, white males' representation in management was lowest in retail trade and the three service sectors, which comprise relatively low-wage industries. You can analyze each sector by clicking on the chart's legend below.


Source:Authors' calculations based on data from EEO-1 surveys (EEOC, various years)

Immigrants and Elections: Does a Lack of Citizenship Rights Translate into a Lack of Voice?

James A. McCann, Purdue University
October 18, 2012

election-2012As part of our Election 2012 series, James A. McCann evaluates the political voice of non-citizens during an election season. A political scientist at Purdue University, McCann is also a former RSF Visiting Scholar.

At present, some forty million residents of the United States – or about one-eighth of the total population – are foreign-born. The number of immigrants in the U.S. is now at an all-time high. To find a period in history when as large a proportion of the mass public was foreign-born, we must look back a century to the first great wave of migrant settlement. Immigrants today vary widely with respect to country of origin, language use, cultural practice, family structure, and job skills. There is also considerable variation in formal civic and migration status. According to the most recent Census estimates, 37 percent of the foreign-born are naturalized American citizens, 35 percent are permanent or temporary legal residents, and 28 percent are unauthorized to reside in the United States.

In this campaign season, much concern has been expressed about these latter two groups, and the possibility that immigrants without voting rights may gain access to the ballot box. Over a dozen states have sought to purge alleged non-citizens from electoral registration lists, and nine require voters to prove their identity by showing a government-issued document with a photograph at polling stations. To date, however, exceedingly little evidence of unlawful voting has emerged. Except in scattered municipalities around the country where non-citizens can vote in local elections, immigrants who have not completed naturalization cannot, and do not, cast ballots.

But does the lack of citizenship rights necessarily translate into a lack of voice during major national election campaigns? Large-scale telephone surveys of Mexican immigrants that I conducted with Stacey Connaughton (Purdue University) and Katsuo Nishikawa (Trinity University) during the 2008 campaigns with the support of the Russell Sage Foundation demonstrate that the foreign-born are far from disengaged from electoral politics. This holds true even for immigrants without voting rights. Below I point to three features of political engagement that we discovered among the foreign-born.

Segregation Between White Women and Black Women by Sector, 1966 - 2005

October 17, 2012

This chart, taken from the RSF book Documenting Desegregation examines racial segregation among women in the private sector. Although there was a sharp drop in segregation after 1966, the economy-wide pattern beginning in the 1970s was one of resegregation as white women moved into male jobs and black women continued to be employed in more typically female and racialized positions. There were exceptions, such as retail trade, business services, social services, and personal services. You can analyze segregation in each sector by clicking on the industry in the chart's legend.

*Segregation is measured using the conventional index of dissimilarity (D). The index equals 100 when groups are completely segregated from each other. The level of the index suggests what percentage of a group would have to switch occupations in order to end segregation in a workplace.
Source:Authors' calculations based on data from EEO-1 surveys (EEOC, various years)

Welfare Reform Today

Lawrence Mead, New York University
October 16, 2012

election-2012As part of our Election 2012 series, Lawrence Mead evaluates the state of welfare reform. A professor of politics and public policy at NYU, Mead is the author of several books on poverty and welfare reform; he also co-edited the RSF volume Welfare Reform and Political Theory.

What is the status of welfare reform today? I will take "welfare reform" to mean primarily the changes in family aid made by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. The act replaced Aid to Families with Dependent Children (AFDC) with Temporary Assistance for Needy Children (TANF), in which eligibility for welfare was much more strongly conditioned on work by the adult recipients than it had been before.

Reform attained its chief goals, to raise work levels on welfare and to reduce dependency. Among poor mothers, work levels soared in the 1990s, although some of that gain was lost in ensuing recessions. Cash welfare rolls plummeted by over two-thirds and grew very little in the recent hard times. Reductions in poverty were less dramatic, but still sizable, again with the gains reversing in the 2000s.

Evaluating Welfare Reform

Reform did not, however, assure that poor mothers who left welfare for jobs would have enough to live on. The combination of earnings with food stamps and wage subsidies was usually enough to lift a family out of poverty, but only if the mother worked steadily and full-time. Nor did reform assure that a working mother would be able to move up to higher pay over time. Few former welfare mothers work steadily, and more needs to be done to help them do that.

The leading criticism of reform has been that some 40 percent of mothers leaving cash aid did not go to work and have been left with little apparent support. Some think these “disconnected” mothers are in trouble, but so far no systematic evidence has emerged to show this. More inquiry is needed to find out how these mothers are coping. Most likely, most of them have found other means of support, such as living with other adults who are working or on other government benefits.

Another criticism is that some states have placed so many conditions on TANF that they have effectively closed the door to aid. In these places, applicants for aid have to produce so much documentation and search for jobs so strenuously up front that few can ever get on the rolls, even if they meet the income rules. If the federal government pays states to run a welfare program, then they must do so and not effectively deny aid to eligible recipients. Congress should investigate this issue when TANF is next reauthorized.

Segregation Between White Men and White Women by Sector, 1966 to 2005

October 16, 2012

Yesterday, we published a chart that examined segregation between white and black men in the private sector. The figure below, also taken from our book Documenting Desegregation, shows gender segregation levels between white men and white women in the private sector between 1966 and 2005.

Each sector shows declines in employment segregation and most trajectories are roughly parallel. Retail trade, social services, and personal services had the lowest levels of gender segregation across the period. These sectors, with the exception of business services, also stand out for having fairly low wages. The mining sector shows considerable gender resegregation among whites after 1990. You can analyze each sector by clicking on the legend of the chart below.

*Segregation is measured using the conventional index of dissimilarity (D). The index equals 100 when groups are completely segregated from each other. The level of the index suggests what percentage of a group would have to switch occupations in order to end segregation in a workplace.
Source:Authors' calculations based on data from EEO-1 surveys (EEOC, various years)