Social Context and Personal Expenditures for Health Care: Federal Policy and the Experience of Older Adults in the 1970s

The relationship between the intent and the outcome of legislated social policy is discussed. Specifically, this study documents some effects of federal health reimbursement and income policy in the late 1960s and early 1970s on health care behavior and expenditures in the decade 1970-1980. The Longitudinal Retirement History Study (LRHS), containing information on a panel of 6,270 men and unmarried women aged 58 to 63 in 1969, was used to provide information on the personal health expenditures in this decade. Medicare and Medicaid and the indexing of Social Security became operational at the beginning of the study, which permitted the exploration of intended and observed effects of legislation designed to make health care more accessible and affordable for older adults. As policy intended, utilization increased over the decade as indicated by both increases in the number of panelists with health care bills and increases in the size of total bills (constant dollars). Consistent with federal policy to reduce personal costs, out-of-pocket expenditures and the proportion of total bills paid out of pocket decreased. However, the effects of these federal policy initiatives were constrained by reimbursement rules and the social location of users. For instance, even at the end of the 1970s, out-of-pocket health care expenditures across subpopulations persisted. The 1980s and early 1990s have brought increased concern over the cost of health care and renewed concern over access. Data suggest that future proposals aimed at providing universal coverage along with high out-of-pocket costs may not result in equitable programs, and are likely to have a limited impact on constraining health care costs. The LRHS data indicate that utilization increased despite continued high out-of-pocket costs for all except the lower-income groups, who may be limited in their ability to purchase increasingly costly care.     

Social context and personal expenditures for health care: federal policy and the experience of older adults in the 1970s

The relationship between the intent and the outcome of legislated social policy is discussed. Specifically, this study documents some effects of federal health reimbursement and income policy in the late 1960s and early 1970s on health care behavior and expenditures in the decade 1970-1980. The Longitudinal Retirement History Study (LRHS), containing information on a panel of 6,270 men and unmarried women aged 58 to 63 in 1969, was used to provide information on the personal health expenditures in this decade. Medicare and Medicaid and the indexing of Social Security became operational at the beginning of the study, which permitted the exploration of intended and observed effects of legislation designed to make health care more accessible and affordable for older adults. As policy intended, utilization increased over the decade as indicated by both increases in the number of panelists with health care bills and increases in the size of total bills (constant dollars). Consistent with federal policy to reduce personal costs, out-of-pocket expenditures and the proportion of total bills paid out of pocket decreased. However, the effects of these federal policy initiatives were constrained by reimbursement rules and the social location of users. For instance, even at the end of the 1970s, out-of-pocket health care expenditures across subpopulations persisted. The 1980s and early 1990s have brought increased concern over the cost of health care and renewed concern over access. Data suggest that future proposals aimed at providing universal coverage along with high out-of-pocket costs may not result in equitable programs, and are likely to have a limited impact on constraining health care costs. The LRHS data indicate that utilization increased despite continued high out-of-pocket costs for all except the lower-income groups, who may be limited in their ability to purchase increasingly costly care.     

Women's and men's subjective class identification from the 1970s to the 1990s

This study examines the subjective class identification of employed married women and men during the 1970s, 1980s, and 1990s. Using data from the General Social Survey, we test three competing models of subjective class identification: status borrowing, independent status, and status sharing. The findings indicate that the predictors of class identification for both women and men have changed considerably over the past three decades. The model for men has shifted from an independent model in the 1970s to a sharing model that depends on their gender‐role attitudes in the 1980s, and, further, to a sharing model irrespective of gender‐role attitudes in the 1990s. The model for women has moved away from a complex borrowing model of the 1970s toward a sharing model in the 1980s and 1990s, with women's gender‐role attitudes shaping their class identification process in the 1970s and 1980s, but not in the 1990s.     

Public policy implications of elderly interstate migration to Oregon, 1985-1990

Several Oregon counties received a noticeable influx of elderly migrants from other states during the 1980s. Oregon policy regarding taxes, land use, and long-term care is examined for possible influence on migration. Models of elderly migration are examined for insight into how public policy influences migration, and previous research regarding the effects of elderly migration on public policy is reviewed. Data regarding disability and financial vulnerability among elderly by migration status are analyzed for possible influence upon public policy. Change in the population aged 65 and older mirrored state and national patterns for 1980 to 1990 and 1990 to 1999. Interstate elderly arriving in attractive counties reported a low prevalence of disability and financial vulnerability, indicating a low risk of demanding public assistance. Interstate elderly arriving in population centers reported a relatively high prevalence of disability but a low prevalence of financial vulnerability. This may suggest that Oregon's long-term care policy influenced elderly migration.     

The Conundrum of Low Saving Rates in Latin America

Despite extensive economic reforms during the late 1980s/early 1990s, Latin America's saving rates remain low. This article examines the saving behaviour of 18 Latin American countries in the 1976‐2000 period and compares it with that of 25 other developing countries. It finds that lower inflation, income growth and increased real interest rates on deposits have not had the expected effects on saving rates in Latin America. Instead, the determinants of saving behaviour appear to differ between the two groups of countries, and saving rates are affected by a degree of inertia. Although more research is needed, this indicates that the focus of the neoliberal economic reforms of the 1980s was misplaced.     

Decentralization, aging policy, and the age of Clinton

This article examines the recent trends in decentralization and their implications for aging policy in the Clinton presidency. It first discusses a decade-long trend toward decentralizing policy and then examines some recent federal enactments that promote more discretion by state and local policymakers, suggesting that these may set the framework for aging policy during most of Clinton's first term. A basic premise of the discussion is, however, that the degree of flexibility varies with the policy area being analyzed-housing, transportation, health and social services--and whether these are "old" (pre-1980s) or "new" (post-1980s) policies. It concludes with the suggestion that a dual-centered, shared federal-state solution may provide the best approach to the premier issue in aging policy today-long-term care.     

Public Policy Implications of Elderly Interstate Migration to Oregon, 1985-1990

Abstract

Several Oregon counties received a noticeable influx of elderly migrants from other states during the 1980s. Oregon policy regarding taxes, land use, and long-term care is examined for possible influence on migration. Models of elderly migration are examined for insight into how public policy influences migration, and previous research regarding the effects of elderly migration on public policy is reviewed. Data regarding disability and financial vulnerability among elderly by migration status are analyzed for possible influence upon public policy.

Change in the population aged 65 and older mirrored state and national patterns for 1980 to 1990 and 1990 to 1999. Interstate elderly arriving in attractive counties reported a low prevalence of disability and financial vulnerability, indicating a low risk of demanding public assistance. Interstate elderly arriving in population centers reported a relatively high prevalence of disability but a low prevalence of financial vulnerability. This may suggest that Oregon's long-term care policy influenced elderly migration.     

Families in the Middle and Later Years: A Review and Critique of Research in the 1990s

Research on families in the middle and later years came into its own during the 1990s, documenting the complexity, malleability, and variety of older family connections. We examined 908 articles on family gerontology topics, observing 4 trends: Conceptually, an appreciation for pluralism and resilience as individuals and families age is apparent. Theoretically, life course, feminist, socioemotional selectivity, and family solidarity theories are increasingly applied to intergenerational family relations. Methodologically, new interest in qualitative methods for studying diverse groups has improved the depth with which aging studies can account for variability in old age; new quantitative methodologies have allowed greater sophistication in dealing with longitudinal data. Substantively, there is greater understanding of family caregiving, social support, parent‐child relationships, marital transitions, and grandparenting relationships. The field is poised to take even greater risks in fulfilling the promise of studying linked lives over time.     

Aging,Health, and Social Policy:

Seven major turning points in the evolution of U.S. aging policy are identified and reviewed: (1) the Social Security Act (2) the Great Society (3) the federalization of Old Age Assistance (4) the enactment of comprehensive social services (5) Social Security improvements (6) New Federalism, and (7) medical cost-containment policies under Medicare and Medicaid. In the 1980s, significant and growing problems of uninsurance and underinsurance for health care have re-emerged. Simultaneously, state Medicaid programs are characterized by their increasing variation and inequities, while there has been a decline in access for the poor. The future of aging policy will be decided in the context of four socio-demographic realities: (1) population aging (2) trends in mortality and morbidity (3) the relationship between income and health, and (4) aging as a woman's issue. The article concludes with a call for a recommitment to the public interest and to public solutions which affirm that health care is an inalienable right.     

On U.S. Foreign Policy in the Balkans in the 1990s: Spotlight on Croatia

In the 1990s, despite a change of administrations, U.S. policy towards the Balkans remained consistent. Post-Gulf War, the United States urged Europe to take the lead, but ultimately humanitarian considerations forced the United States to take an active, military role. Within the U.S. government, a struggle between ``incrementalism' and a longer-term ``visionary approach' characterized internal debate. Incrementalism ultimately prevailed. The framework for U.S. policy decisions, especially in the early 1990s, led the United States to active involvement, including a lack of consensus in the United Nations on the use of force. Events, culminating in the ``Washington Agreement', led Croatia to seeing that its interests coincided with those of Bosnian Croats and Muslims. Only later did Croatian and U.S. interests diverge. Since Dayton, U.S. focus in Croatia has been on democratization, human rights, and the implementation of the accords. As U.S. Balkan policy evolved, seeing a stable European future for the region became a fundamental security interest of the United States. The Balkan Wars contributed significantly to changing perceptions of the transatlantic relationship and of the U.S. global role.     

Elder abuse in the United Kingdom

In recent years there has been an increased emphasis on violence and abuse within society generally. Following a focus in the United Kingdom (UK) on child abuse in the 1970s and domestic violence in the 1980s, in the 1990s the abuse and neglect of older people began to elicit concern. The initial focus of interest was of situations arising in the domestic setting. More recently, however, much needed attention has shifted to situations involving institutional settings. This paper will discuss abuse and neglect occurring in the UK. It aims to provide a brief overview of the status of current knowledge concerning abuse of older people followed by a discussion of some of the issues relating to the prevention of abuse and neglect from a UK perspective. An exploration of some of the issues involved will contribute to our understanding of abuse and neglect of older people in the UK.     

Value-oriented parameters in migration policies in the 1990s: the Israeli experience

"This article focuses on value inputs at various junctures of the immigrant-absorption process in Israel and their possible implications for the future of the immigrants.... The model of value inputs of the 1990s suggests several directions in which absorption policy may head....One such direction is dominant in other immigration countries: the integration of the stronger immigrants--those whose ability to function in modern Western society is high--is left to market forces.... Another possible paradigm of absorption is one in which the government intervenes selectively to help especially disadvantaged groups....A third orientation depends on the immigration trend. If immigration tapers off, the government will intervene more intensively and extensively in the integration of the 1990s immigrants, particularly at the municipal level." (SUMMARY IN FRE AND SPA)     

THE TRANSFORMATION FROM MULTIDIVISIONAL FORM TO CORPORATE GROUPS OF SUBSIDIARIES IN THE 1980s:

In the 1980s, the corporate form shifted from multidivisional forms to corporate groups of subsidiaries. Although many aspects of corporate change during the 1980s have been examined, the magnitude and nature of changes in corporate form have received relatively little attention. Moreover, this transformation of corporate form has been inadequately explained by the dominant theoretical perspectives on corporate form—managerialism, institutionalism, and agency theory. A new theory that incorporates dimensions of the existing perspectives is presented. This perspective maintains that corporate change occurs as a dialectical process, which in the 1980s involved a shift of corporate control from managers to owners, resulting from a crisis in the accumulation of capital in the corporation. After gaining control through institutional investments, owners insisted on greater return on their investments. Mergers and acquisitions transferred corporate capital from corporations, controlled by managers, to shareholders. The relative utility of this perspective compared to existing perspectives for explaining the transformation of corporate form in the 1980s is demonstrated, and hypotheses for understanding changes in corporate form in the 1990s are proposed.     

The formation of a socioeconomic health disparity: the case of cocaine use during the 1980s and 1990s

Despite the substantial and prolonged sociological interest in health disparities, much remains unknown about the processes that initiate them. To investigate this topic, we focus on the case study of cocaine use, for which a socioeconomic disparity emerged across all age groups in a short period of time around 1990. We examine whether the newly-formed disparity represents a selective remnant of previous users or, instead, a selective recruitment of new users. To evaluate these two potential processes we use latent class regression on a nationally representative cohort with repeated measures of past-year cocaine use before and after 1990. Results support the "remnant" hypothesis and show that the newly-formed disparity resulted primarily because people in the lower social strata were less likely to have a trajectory of cocaine use with a sharp drop in use after 1990. These results point to the "remnant" concept as a way to bring together disparity analysis of very different and diverse health outcomes.     

Setting Priorities for Research: New Politics for the Social Sciences*

This paper examines the emergence of sociopolitics in the United States during the 1980s. The Reagan Administration's drastic budget cuts for social research prompted social scientists to engage in interest-group politics. The newest development in sociopolitics is setting priorities for research. This paper examines the intellectual and political risks of setting priorities. I conclude that sociologists must begin to discuss the objectives and strategies of funding social research, and seek ways of reducing our dependency upon federal funding.     

The socialogy of football: a research agenda for the 1990s

The paper emphasizes the need for an alternative sociology of football that goes beyond the issue of football hooliganism, which has dominated work in the field. In the light of the Taylor Report and the agenda of modernization of football in the 1990s, research into the football crowd as a whole is required. A positive view of the state of English football in 1990 is presented as a corrective to the negative image of the 1980s. The debate is set in the context of my previous work on the politics of football both in Britain and the new Europe – West and East. In the final section, several topics are placed on the research agenda for the sociology of football in the 1990s. These are the modernization of facilities, the study of fanzines, comparative research and a social demography of the football crowd.     

Working Longer May Be Good Public Policy,But It Is Not Necessarily Good for Older People

Older people are facing a changed set of expectations regarding work and retirement. Until quite recently early retirement was being encouraged. Today's older workers, however, are contemplating longer working lives amid policy concerns about the costs of social welfare associated with an aging population. While working longer is, almost universally, being promoted as a social and individual good this article argues that this policy shift is unlikely to change the situation of many older workers who would have needed to continue working anyway. It also argues that the emphasis on prolonged employment undervalues engagement in activities beyond employment. As well, it argues that the emphasis on prolonging employment neglects to account for the attendant risks for many of continuing to work or having to seek work and the potential health- and well-being-enhancing effects of retirement.