America's current system of health insurance, which relies almost exclusively on employer-sponsored coverage, is in danger of collapse, and this problem is not limited to the poor and working class. An increasing number of middle class Americans do not have employer-provided insurance and—due to skyrocketing premiums—cannot afford to purchase coverage for themselves. Reinsuring Health, by economist Katherine Swartz, examines this growing national crisis and outlines a concrete plan to make health insurance accessible and affordable for all Americans.

Reinsuring Health documents why the number of uninsured Americans—now 45.5 million people—has grown in the last twenty-five years. Swartz focuses on how labor market changes—such as the decline of domestic manufacturing, decreased unionization, and the growth of non-standard work arrangements—have led U.S. employers to retreat from providing health insurance for their workers. These trends, combined with the increasing costs of medical care, have led to an explosion in health insurance premiums and a decline in coverage, particularly among the middle-class. Since those who seek insurance as individuals are generally most likely to need health care, private insurers charge higher premiums in the individual (non-group) markets than to people who obtain group insurance. This makes individual health insurance less attractive to the young and increasingly unaffordable for middle-class Americans. Similarly, insurers charge higher per person (or per family) premiums to small firms than to large companies, so many small firms do not sponsor coverage for their employees. Reinsuring Health shows how these problems can be overcome if the federal government provides a new reinsurance program which would protect insurance companies that provide small group and individual health insurance against the possibility that their policy-holders will incur very high medical expenses. By assuming some of the risk that people will face extremely costly medical bills, the government will make insurers less hesitant to offer coverage to high-risk individuals, and will help drive down premiums for others. Reinsuring Health demonstrates that this form of government reinsurance has worked in the past, helping to establish smooth running private markets for catastrophe insurance and secondary mortgages.

Today, growing numbers of middle class Americans lack health insurance. Protection against the possibility of falling ill or getting hurt and having to pay extraordinary health care bills should not be a luxury available only to the very rich and the very poor. Reinsuring Health proposes a straightforward solution that would bring health insurance back within the reach of the increasing ranks of the uninsured, particularly those who are in the middle class.

KATHERINE SWARTZ is professor of health policy and management at the School of Public Health, Harvard University

Two sociologists and a lawyer examine here the attitudes of both survivors and attorney on various problems surrounding inheritance—from will-making through estate settlement. Within a legal frame of reference, this book is a study of what happens within a family at death—and why. The authors use the "inheritance unit" as the basis for looking at the functions of inheritance in intergenerational family continuity and the general patterns of family relationship.

MARVIN B. SUSSMAN is professor and chairman of the Department of Sociology at Case Western Reserve University.

JUDITH N. CATES is research associate of the American Psychological Association.

DAVID T. SMITH is professor of law at the University of Florida.

Provides a directory of the rapidly expanding philanthropic foundations in Latin America, identifying over 750 foundations and presenting detailed information on 364 of them. In addition, the directory contains an introduction that analyzes historical data on Latin American foundations, a country-by-country summary of legal processes regarding foundations and pertinent tax laws, two essays by North and South American foundation presidents discussing the organization and management of private foundations, and an appendix with models of bylaws and financial statements of Latin American foundations.

ANN STROMBERG has participated in various community development projects in Latin America, taught in Latin American schools, and engaged in other sociological research projects. She is at the Pan American Development Foundation.

Over the past three decades, the contours of American social, economic, and political life have changed dramatically. The post-war patterns of broadly distributed economic growth have given way to stark inequalities of income and wealth, the GOP and its allies have gained power and shifted U.S. politics rightward, and the role of government in the lives of Americans has changed fundamentally. Remaking America explores how these trends are related, investigating the complex interactions of economics, politics, and public policy.

Remaking America explains how the broad restructuring of government policy has both reflected and propelled major shifts in the character of inequality and democracy in the United States. The contributors explore how recent political and policy changes affect not just the social standing of Americans but also the character of democratic citizenship in the United States today. Lawrence Jacobs shows how partisan politics, public opinion, and interest groups have shaped the evolution of Medicare, but also how Medicare itself restructured health politics in America. Kimberly Morgan explains how highly visible tax policies created an opportunity for conservatives to lead a grassroots tax revolt that ultimately eroded of the revenues needed for social-welfare programs. Deborah Stone explores how new policies have redefined participation in the labor force—as opposed to fulfilling family or civic obligations—as the central criterion of citizenship. Frances Fox Piven explains how low-income women remain creative and vital political actors in an era in which welfare programs increasingly subject them to stringent behavioral requirements and monitoring. Joshua Guetzkow and Bruce Western document the rise of mass incarceration in America and illuminate its unhealthy effects on state social-policy efforts and the civic status of African-American men.

For many disadvantaged Americans who used to look to government as a source of opportunity and security, the state has become increasingly paternalistic and punitive. Far from standing alone, their experience reflects a broader set of political victories and policy revolutions that have fundamentally altered American democracy and society. Empirically grounded and theoretically informed, Remaking America connects the dots to provide insight into the remarkable social and political changes of the last three decades.

JOE SOSS is the Cowles Professor for the Study of Public Service at the Hubert H. Humphrey Institute of Public Affairs, University of Minnesota.

JACOB S. HACKER is professor of political science at Yale University and resident fellow of the Institution for Social and Policy Studies.

SUZANNE METTLER is Clinton Rossiter Professor of American Institutions in the Government Department at Cornell University.

CONTRIBUTORS:  Andrea Louise Campbell, Richard B. Freeman, Joshua Guetzkow, Jennifer Hochschild,  Helen Ingram,  Lawrence R. Jacobs,  R. Shep Melnick,  Kimberly J. Morgan,  Frances Fox Pivens,  Paul Pierson,  Joel Rogers,  Sanford F. Schram,  Deborah Stone,  Vasla Weaver,  Bruce Western.  

Despite the rapid creation of jobs in the greater Atlanta region, poverty in the city itself remains surprisingly high, and Atlanta's economic boom has yet to play a significant role in narrowing the gap between the suburban rich and the city poor. This book investigates the key factors underlying this paradox.

The authors show that the legacy of past residential segregation as well as the more recent phenomenon of urban sprawl both work against inner city blacks. Many remain concentrated near traditional black neighborhoods south of the city center and face prohibitive commuting distances now that jobs have migrated to outlying northern suburbs.

The book also presents some promising signs. Few whites still hold overt negative stereotypes of blacks, and both whites and blacks would prefer to live in more integrated neighborhoods. The emergence of a dynamic, black middle class and the success of many black-owned businesses in the area also give the authors reason to hope that racial inequality will not remain entrenched in a city where so much else has changed.

DAVID L. SJOQUIST is professor of economics in the Andrew Young School of Policy Studies at Georgia State University.

CONTRIBUTORS: Ronald H. Bayor, Irene Browne, Obie Clayton Jr., Nikki McIntyre Finlay, Christopher R. Geller, Gary Paul Green, Roger B. Hammer, Truman A. Hartshorn, Cynthia Lucas Hewitt, Keith R. Ihlanfeldt, Sahadeo Patram, Travis Patton, David L. Sjoquist, Mark A. Thompson, and Leann M. Tigges

A Volume in the Multi-City Study of Urban Inequality

Capital of the American Century investigates the remarkable influence that New York City has exercised over the economy, politics, and culture of the nation throughout much of the twentieth century. New York's power base of corporations, banks, law firms, labor unions, artists and intellectuals has played a critical role in shaping areas as varied as American popular culture, the nation's political doctrines, and the international capitalist economy. If the city has lost its unique prominence in recent decades, the decline has been largely—and ironically—a result of the successful dispersion of its cosmopolitan values.

The original essays in Capital of the American Century offer objective and intriguing analyses of New York City as a source of innovation in many domains of American life. Postwar liberalism and modernism were advanced by a Jewish and WASP coalition centered in New York's charitable foundations, communications media, and political organizations, while Wall Street lawyers and bankers played a central role in fashioning national security policies. New York's preeminence as a cultural capital was embodied in literary and social criticism by the "New York intellectuals," in the fine arts by the school of Abstract Expressionism, and in popular culture by Broadway musicals. American business was dominated by New York, where the nation's major banks and financial markets and its largest corporations were headquartered.

In exploring New York's influence, the contributors also assess the larger social and economic conditions that made it possible for a single city to exert such power. New York's decline in recent decades stems not only from its own fiscal crisis, but also from the increased diffusion of industrial, cultural, and political hubs throughout the nation. Yet the city has taken on vital new roles that, on the eve of the twenty-first century, reflect an increasingly global era: it is the center of U.S. foreign trade and the international art market: The New York Times and The Wall Street Journal have emerged as international newspapers; and the city retains a crucial influence in information-intensive sectors such as corporate law, accounting, management consulting, and advertising.

Capital of the American Century provides a fresh link between the study of cities and the analysis of national and international affairs. It is a book that enriches our historical sense of contemporary urban issues and our understanding of modern culture, economy, and politics.

MARTIN SHEFTER is professor of government at Cornell University.

CONTRIBUTORS: James L. Baughman, Paul DiMaggio, Nathan Glazer, Miles Kahler, James R. Kurth, Martin Shefter, David Vogel, and Vera L. Zolberg.

Today, a college education is increasingly viewed as the gateway to the American Dream—a necessary prerequisite for social mobility. Yet recent policy reforms in the United States effectively steer former welfare recipients away from an education that could further their career prospects, forcing them directly into the workforce where they often find only low-paying jobs with little opportunity for growth. In Putting Poor People to Work, Kathleen Shaw, Sara Goldrick-Rab, Christopher Mazzeo, and Jerry A. Jacobs explore this troubling disconnect between the principles of “work-first” and “college for all.”

Using comprehensive interviews with government officials and sophisticated data from six states over a four year period, Putting Poor People to Work shows how recent changes in public policy have reduced the quantity and quality of education and training available to adults with low incomes. The authors analyze how two policies encouraging work—the federal welfare reform law of 1996 and the Workforce Investment Act of 1998—have made moving people off of public assistance as soon as possible, with little regard to their long-term career prospects, a government priority. Putting Poor People to Work shows that since the passage of these “work-first” laws, not only are fewer low-income individuals pursuing postsecondary education, but when they do, they are increasingly directed towards the most ineffective, short-term forms of training, rather than higher-quality college-level education. Moreover, the schools most able and ready to serve poor adults—the community colleges—are deterred by these policies from doing so.

Having a competitive, agile workforce that can compete with any in the world is a national priority. In a global economy where skills are paramount, that goal requires broad popular access to education and training. Putting Poor People to Work shows how current U.S. policy discourages poor Americans from seeking out a college education, stranding them in jobs with little potential for growth. This important new book makes a powerful argument for a shift in national priorities that would encourage the poor to embrace both work and education, rather than having to choose between the two.

KATHLEEN M. SHAW is chair of the Department of Educational Leadership and Policy Studies and associate professor of urban education at Temple University.

SARA GOLDRICK-RAB is assistant professor of educational policy studies and sociology at the University of Wisconsin-Madison, and faculty affiliate of the Wisconsin Center for the Advancement of Postsecondary Education.

CHRISTOPHER MAZZEO is a New York City–based independent consultant.

JERRY A. JACOBS is Merriam Term Professor of Sociology at the University of Pennsylvania and editor of the American Sociological Review.

An Institute for Research on Poverty Affiliated Book on Poverty and Public Policy

Over the past three decades, average household wealth in the United States has declined among all but the richest families, with a near 80 percent drop among the nation's poorest families. Although the national debate about inequality has focused on income, it is wealth—the private assets amassed and passed on within families—that provides the extra economic cushion needed to move beyond mere day-to-day survival. Assets for the Poor is the first full-scale investigation into the importance of family wealth and the need for policies to encourage asset-building among the poor.

Assets for the Poor shows how institutional mechanisms designed to encourage acquisition of capital and property favor middle-class and high-income families. For example, the aggregate value of home mortgage tax deductions far outweighs the dollar amount of the subsidies provided by Section 8 rental vouchers and public housing. Banking definitions of creditworthiness largely exclude minorities, and welfare rules have made it nearly impossible for single mothers to accumulate savings, let alone stocks or real estate. Due to persistent residential segregation, even those minority families who do own homes are often denied equal access to better schools and public services.

The research in this volume shows that the poor do make use of the assets they have. Cash gifts—although small in size—are frequent within families and often lead to such positive results as homebuying and debt reduction, while tangible assets such as tools and cars help increase employment prospects. Assets for the Poor examines policies such as Individual Development Account tax subsidies to reward financial savings among the poor, and more liberal credit rules to make borrowing easier and less costly. The contributors also offer thoughtful advice for bringing the poor into mainstream savings institutions and warn against developing asset building policies at the expense of existing safety net programs.

Asset-building for low-income families is a powerful idea that offers hope to families searching for a way out of poverty. Assets for the Poor challenges current thinking regarding poverty reduction policies and proposes a major shift in the way we think about families and how they make a better life.

THOMAS M. SHAPIRO is professor of sociology at Northeastern University.

EDWARD N. WOLFF is professor of economics at New York University.

CONTRIBUTORS: Richard V. Burkhauser, John Sibley Butler, Stacie Carney, Dalton Conley, Nancy A. Denton, Kathryn Edin, William G. Gale, Robert Haveman, Lelvin L. Oliver, Laurence S. Seidman, Thomas M. Shapiro, Michael Sherraden, Seymour Spilerman, Mark J. Stern, Robert Weathers, Mark O. Wilhelm, Edward N. Wolff

A Volume in the Ford Foundation Series on Asset Building

Classical economic theory assumes that people in risk situations follow a course of action based on a rational, consistent assessment of likely outcomes. But as Zur Shapira demonstrates in Risk Taking, corporate managers consistently stray from the prescribed path into far more subjective territory. Risk Taking offers a critical assessment of the relationship between theory and action in managerial decision making.

Shapira offers a definitive account of the classical conception of risky decision making, which derives behavioral prescriptions from a calculation of both the value and the likelihood of possible outcomes. He then demonstrates how theories in this vein have been historically at odds with empirical observations. Risk Taking reports the results of an extensive survey of seven hundred managers that probed their attitudes and beliefs about risk and examined how they had actually made decisions in the face of uncertainty. The picture that emerges is of a dynamic, flexible process in which each manager’s personal expertise and perceptions play profound roles.

Managerial strategies are continually modified to suit changing circumstances. Rather than formulating probability estimates, executives create potential scenarios based not only on the possible outcomes but also on the many arbitrary factors inherent in their own situations. As Shapira notes, risk taking propensities vary among managers, and the need to maintain control and avoid particularly dangerous results exercises a powerful influence. Shapira also examines the impact of organizational structure, long-term management objectives, and incentives on decision making.

With perceptive observations of the cognitive, emotional, and organizational dimensions of corporate decision making, Risk Taking propels the study of managerial risk behavior into new directions. This volume signals the way toward improving managerial decision making by revealing the need for more inclusive choice models that augment classical theory with vital behavioral observations.

ZUR SHAPIRA is research professor of management and organizational behavior at the Stern School of Business at New York University.

The United States spends billions of dollars annually on social and economic policies aimed at improving the lives of its citizens, but the health consequences associated with these policies are rarely considered. In Making Americans Healthier, a group of multidisciplinary experts shows how social and economic policies seemingly unrelated to medical well-being have dramatic consequences for the health of the American people.

Most previous research concerning problems with health and healthcare in the United States has focused narrowly on issues of medical care and insurance coverage, but Making Americans Healthier demonstrates the important health consequences that policymakers overlook in traditional cost-benefit evaluations of social policy. The contributors examine six critical policy areas: civil rights, education, income support, employment, welfare, and neighborhood and housing. Among the important findings in this book, David Cutler and Adriana Lleras-Muney document the robust relationship between educational attainment and health, and estimate that the health benefits of education may exceed even the well-documented financial returns of education. Pamela Herd, James House, and Robert Schoeni discover notable health benefits associated with the Supplemental Security Income Program, which provides financial support for elderly and disabled Americans. George Kaplan, Nalini Ranjit, and Sarah Burgard document a large and unanticipated improvement in the health of African-American women following the enactment of civil rights legislation in the 1960s.

Making Americans Healthier presents ground-breaking evidence that the health impact of many social policies is substantial. The important findings in this book pave the way for promising new avenues for intervention and convincingly demonstrate that ultimately social and economic policy is health policy.
 

ROBERT F. SCHOENI is professor of public policy and economics, the University of Michigan.

JAMES S. HOUSE is Angus Campbell Collegiate Professor of Sociology and Survey Research, the University of Michigan.

GEORGE A. KAPLAN is the Thomas Francis Collegiate Professor of Public Health, the University of Michigan.

HAROLD POLLACK is associate professor of social service administration, University of Chicago.

CONTRIBUTORS: Marianne P. Bitler, Jeanne Brooks-Gunn, Sarah A. Burgard, Janet Currie, David M. Cutler, Rebecca C. Fauth, Irv Garfinkel. Ben B. Hansen, Pamela Herd, Hilary Hoynes, Daniel Keating, Jean Knab, Adriana Lleras-Muney, Sara McLanahan, Jeffrey D. Morenoff, Enrico Moretti, Theresa L. Osypuk, Richard H. Price,  Nalini Ranjit, Ana V. Diez Roux, Christopher J. Ruhm, Sharon Z. Simonton.

A Volume in the National Poverty Center Series on Poverty and Public Policy