"Using engaging descriptions of individual situations ... and careful analysis of data, Katherine Swartz draws attention to the problematic and growing prevalence of the uninsured in the middle class. The centerpiece of her book is a promising response to this important problem."
-The New England Journal of Medicine

"Katherine Swartz has written an unusual and valuable book, one that will serve well both in the classroom and in the world of politics. Students and their instructors should welcome perhaps the clearest exposition available of how the various markets for health insurance work-or don't work. Policymakers should be challenged-and, I hope will be persuaded-by her reasoned argument that government-financed reinsurance is a promising way to extend insurance coverage by making it affordable."
-HENRY J. AARON, senior fellow, The Brookings Institution

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.

This work is the fifth in a series of bulletins on the applications of sociology to various fields of professional practice prepared under the joint sponsorship of the American Sociological Association and the Russell Sage Foundation. Previous bulletins have dealt with applications of sociology in the fields of corrections, mental health, education, and military organization.

Dr. Suchman has performed an important service in his clear delineation of the great potential sociology and related disciplines have for sharpening our understanding of the social factors in health and disease, for intelligent planning and mounting of appropriate action programs, and for improving the organizational structure and institutional mechanisms of the health professions themselves.

EDWARD A. SUCHMAN is professor of sociology at the University of Pittsburgh.

One of the most detailed reports ever made on an effort to establish a therapeutic community within a California prison. This work describes how the program was launched, gives a number of examples of its operation, and outlines the new problems and prospects created for inmates, staff, and the broader prison administration by this attempt to redefine the roles within the prison.

ELLIOT STUDT, a social worker, is a member of the senior research staff of the Center for the Study of Law and Society at the University of California, Berkeley.

SHELDON L. MESSINGER is Vice Chairman of the Center and is a sociologist.

THOMAS P. WILSON is assistant professor of sociology at the University of California, Santa Barbara.

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.

In recent years the decisions of the United States Supreme Court in the area of juvenile law and the growing public awareness of the delinquency problem have brought about drastic changes in American juvenile courts.

This book represents a major research effort to determine the effect of defense counsel’s performance on the conduct and outcome of delinquency cases. After a brief historical analysis of the factors leading to changes in juvenile law, the authors explore in detail the impact of the lawyer’s presence and performance on the outcomes of cases in two juvenile courts.

The analysis further explores the various factors influencing a lawyer’s defense posture and develops the thesis that the effectiveness of counsel is determined largely by the structure of the delinquency hearing and the willingness and ability of court personnel and procedures to adapt to the introduction of an adversarial role of defense counsel. What makes this study unique is the large-scale effort to combine legal analysis and sociological methodology to the study of an action-oriented program. The use of the classical experimental design, the selection of control and experimental groups by random assignment, and the extent to which the use of this methodology increases the validity of the results, will be of interest to both lawyers and social scientists. The book is a major contribution to the growing literature in the field of the sociology of law.

W. VAUGHAN STAPLETON is assistant professor of sociology at the State University College at Buffalo, New York.

LEE E. TEITELBAUM is associate professor of law at the State University of New York at Buffalo, faculty of law and jurisprudence.

"A wonderful compendium of everything you always wanted to know about trends in women's roles—both in and out of the home. It is a balanced and data-rich assessment of how far women have come and how far they still have to go." —Isabelle Sawhill, Urban Institute

"Based primarily on the 1990 population census, Balancing Act reports on the current situation of American women and temporal and cross-national comparisons. Meticulously and clearly presented, the information in this book highlights changing behaviors, such as the growing incidence of childbearing to older women, and unmarried women in general, and a higher ratio of women's earnings to men's. The authors' thoughtful analysis of these and other factors involved in women's fin de siècle 'balancing act' make this an indispensable reference book and valuable classroom resource."—Louise A. Tilly, Michael E. Gellert Professor of History and Sociology, The New School for Social Research

In Balancing Act, authors Daphne Spain and Suzanne Bianchi draw upon multiple census and survey sources to detail the shifting conditions under which women manage their roles as mothers, wives, and breadwinners. They chronicle the progress made in education—where female college enrollment now exceeds that of males—and the workforce, where women have entered a wider variety of occupations and are staying on the job longer, even after becoming wives and mothers. But despite progress, lower-paying service and clerical positions remain predominantly female, and although the salary gap between men and women has shrunk, women are still paid less. As women continue to establish a greater presence outside the home, many have delayed marriage and motherhood. Marked jumps in divorce and out-of-wedlock childbirth have given rise to significant numbers of female-headed households. Married women who work contribute more significantly than ever to the financial well-being of their families, yet evidence shows that they continue to perform most household chores.

Balancing Act focuses on how American women juggle the simultaneous demands of caregiving and wage earning, and compares their options to those of women in other countries. The United States is the only industrialized nation without policies to support working mothers and their families—most tellingly in the absence of subsidized childcare services. Many women are forced to work in less rewarding part-time or traditionally female jobs that allow easy exit and re-entry, and as a consequence poverty is the single greatest danger facing American women. As the authors show, the risk of poverty varies significantly by race and ethnicity, with African Americans—most of whose children live in mother-only families—the most adversely affected.

This volume contributes to the national dialogue about family policy, welfare reform, and responsibility for children by highlighting the pivotal roles women play at the intersection of family and work.

DAPHNE SPAIN is associate professor at the Department of Urban and Environmental Planning, University of Virginia.

SUZANNE M. BIANCHI is professor of sociology and faculty associate at the Center on Population, Gender, and Social Inequality, University of Maryland.

"A superb collection that paints a clear, if not especially bright, picture: Inequality is widening in America largely because our democracy isn't working as it should. Read Remaking America and commit yourself to doing something about it."
-ROBERT B. REICH, professor of public policy, University of California at Berkeley

"Remaking America is a remarkable collection featuring original contributions from many leading analysts of U.S. democracy and public policy. Far from the usual arid collection of prescriptions, this book gives us the big picture: how U.S. tax and social programs have been reconfigured over recent decades, and what difference the changes make for governance and participation. We learn that policies are not only the result of ongoing political struggles; they also reshape the capacities of government and the ideas and engagement of citizens and social groups. Unfolding policies and their political effects say much about the nation's capacity to react-or not-to the deleterious effects of rising socioeconomic inequality. Students, scholars, and members of the educated public have much to learn from this insightful volume."
-THEDA SKOCPOL, Victor S. Thomas Professor of Government and Sociology and dean, Graduate School of Arts and Sciences, Harvard University

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.  

"Smith's research updates a long line of work that tries to understand the pattern of social supports in communities of concentrated poverty. She expands our understanding of the process by which acute deficits of human capital are converted into enduring disadvantage."
-CONTEMPORARY SOCIOLOGY

"Lone Pursuit significantly advances our understanding of the employment woes of poor African Americans, This book provides new insights on the structural, cultural, and psychological factors that contribute to the high rate of joblessness among low-skilled blacks. I highly recommend it."
-WILLIAM JULIUS WILSON, Lewis P. and Linda L. Geyser University Professor, Harvard University

"Ever since the classic work by Granovetter, we have been aware of the powerful influence of social networks in labor market matching. But the question of what prompts a network tie to take the next step-to activate on behalf of a job seeker-has rarely been investigated. In this rich and engaging volume, Sandra Smith discovers the self-defeating rules of the game among poor African American job seekers who refrain from asking their network partners to help because they expect to be rejected. Hesitation by network partners combines with withdrawal on the part of the unemployed, leading to a devastating stalemate. Smith's work is sobering, insightful, and crucial in helping scholars under stand how the matching process breaks down for thousands of would be workers in the inner city."
-KATHERINE S. NEWMAN, Forbes '41 Professor of Sociology and Public Affairs, Princeton University

"Lone Pursuit is an elegantly written and substantively rich book about the many challenges faced by poor black job seekers. Deftly navigating between structural and cultural accounts of these disadvantages, the story that emerges from Professor Smith's careful fieldwork is a subtle tale of how moral judgments about the importance of work internal to the working class African American community reflect and reinforce the values of mainstream society, and how those judgments structure the job seeking of disad vantaged blacks. This work is required reading for any serious scholar of race and inequality."
-ROBERTO M. FERNANDEZ, William F. Pounds Professor of Management, MIT Sloan School of Management

"Lone Pursuit explains the seemingly inexplicable. Building on parallel arguments in Carol Stack's classic All Our Kin-that trust and distrust infuse relations among kin-Sandra Smith extends the interpersonal to the drama of the labor market as people search for jobs and try to find 'somebody' to trust. A deeply complex and original view of social capital that shows how family and friend networks fail to facilitate job search processes in poor black communities."
-MITCHELL DUNEIER, professor of sociology, Princeton University

Unemployment among black Americans is twice that of whites. Myriad theories have been put forward to explain the persistent employment gap between blacks and whites in the U.S. Structural theorists point to factors such as employer discrimination and the decline of urban manufacturing. Other researchers argue that African-American residents living in urban neighborhoods of concentrated poverty lack social networks that can connect them to employers. Still others believe that African-American culture fosters attitudes of defeatism and resistance to work. In Lone Pursuit, sociologist Sandra Susan Smith cuts through this thicket of competing explanations to examine the actual process of job searching in depth. Lone Pursuit reveals that unemployed African Americans living in the inner city are being let down by jobholding peers and government agencies who could help them find work, but choose not to.

Lone Pursuit is a pioneering ethnographic study of the experiences of low-skilled, black urban residents in Michigan as both jobseekers and jobholders. Smith surveyed 105 African-American men and women between the ages of 20 and 40, each of whom had no more than a high school diploma. She finds that mutual distrust thwarts cooperation between jobseekers and jobholders. Jobseekers do not lack social capital per se, but are often unable to make use of the network ties they have. Most jobholders express reluctance about referring their friends and relatives for jobs, fearful of jeopardizing their own reputations with employers. Rather than finding a culture of dependency, Smith discovered that her underprivileged subjects engage in a discourse of individualism. To justify denying assistance to their friends and relatives, jobholders characterize their unemployed peers as lacking in motivation and stress the importance of individual responsibility. As a result, many jobseekers, wary of being demeaned for their needy condition, hesitate to seek referrals from their peers. In a low-skill labor market where employers rely heavily on personal referrals, this go-it-alone approach is profoundly self-defeating. In her observations of a state job center, Smith finds similar distrust and non-cooperation between jobseekers and center staff members, who assume that young black men are unwilling to make an effort to find work. As private contractors hired by the state, the job center also seeks to meet performance quotas by screening out the riskiest prospects—black male and female jobseekers who face the biggest obstacles to employment and thus need the most help.

The problem of chronic black joblessness has resisted both the concerted efforts of policymakers and the proliferation of theories offered by researchers. By examining the roots of the African-American unemployment crisis from the vantage point of the everyday job-searching experiences of the urban poor, Lone Pursuit provides a novel answer to this decades-old puzzle.

SANDRA SUSAN SMITH is assistant professor of sociology at the University of California, Berkeley.

Examines the conditions under which motives to achieve are fostered in children. The papers included in this volume reflect the major traditions of research in the field and bring together a set of studies for achieving a better understanding of the ways in which achievement-related personality characteristics develop and function in evaluative or competitive situations.

CHARLES P. SMITH is associate professor of psychology at Brooklyn College of the City University of New York.

CONTRIBUTORS: John W. Atkinson, Virginia C. Crandall, Sheila C. Feld, Judith Lewis, Howard A. Moss, Seymour B. Sarason, Charles P. Smith, and Joseph Veroff