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One Nation, Uninsured offers a vividly written history of America's failed efforts to address the health care needs of its citizens. Covering the entire twentieth century, Jill Quadagno shows how each attempt to enact national health insurance was met with fierce attacks by powerful stakeholders, who mobilized their considerable resources to keep the financing of health care out of the government's hands.

After President Barack Obama signed into law the Affordable Care Act (ACA) of 2010, 26 states filed lawsuits challenging key provisions. In 2012, the Supreme Court ruled in support of most provisions but held that the mandatory Medicaid expansion was unconstitutional, in effect making it optional for the states. Yet Medicaid expansion is critical if the ACA is to achieve its goal of substantially increasing coverage, especially for lower-income adults with health problems, many of whom are racial and ethnic minorities. This article examines the factors explaining state variation in Medicaid expansion from 2012 to 2014. Although partisan power in the states is a key predictor, other relevant factors include the state's Medicaid policy legacy, providers' influence, conservative ideology, and racial resentment. We demonstrate that the enactment of legislation is only a part of the policy formation process and that implementation is equally salient, with state dynamics playing a critical role.

A central sociological premise is that health care systems are organizations that are embedded within larger institutions, which have been shaped by historical precedents and operate within a specific cultural context. Although bound by policy legacies, embedded constituencies, and path dependent processes, health care systems are not rigid, static, and impervious to change. The success of health care reform in 2010 has shown that existing regimes do have the capacity to respond to new needs in ways that transcend their institutional and ideological limits. For the United States the question is how health care reform will reconfigure the existing network of public and private benefits and the power relationships between the numerous constituencies surrounding them. This article considers how institutions, interest groups, and ideology have affected the organization of the health care system in the United States as well as in other nations. It then discusses issues for future research in the aftermath of the 2009-10 health care reform debate.

This article uses the 1996 General Social Survey (GSS) and the 1992 National Study of the Changing Workforce (NSCW) to examine two issues: the relationship of work characteristics, family characteristics, and work-family spillover to perceptions of work-family balance; and models of “gender difference” versus “gender similarity.” The GSS analysis supports the gender similarity model. It demonstrates that work demands such as the number of hours worked per week and work spillover into family life are the most salient predictors of feelings of imbalance for both women and men. The NSCW includes subtler measures of family spillover into work as well as measures of specific job characteristics and child care. The NSCW results support a gender difference model. They indicate that when family demands reduce work quality, there is a decreased likelihood of perceived balance. However, men and women experience balance in gendered ways. Women report more balance when they give priority to family; men report less balance when they have no personal time for themselves due to work and more balance when they make scheduling changes due to family.

The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies. These arrangements leave one-sixth of the population uninsured at any given time, and they leave others at risk of losing insurance as a result of normal life course events. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development, but they ignore the distinctive character of the health care financing arrangements that do exist. Medical sociologists emphasize the way that physicians parlayed their professional expertise into legal, institutional, and economic power but not the way this power was asserted in the political arena. This paper proposes a theory of stakeholder mobilization as the primary obstacle to national health insurance. The evidence supports the argument that powerful stakeholder groups, first the American Medical Association, then organizations of insurance companies and employer groups, have been able to defeat every effort to enact national health insurance across an entire century because they had superior resources and an organizational structure that closely mirrored the federated arrangements of the American state. The exception occurred when the AFL-CIO, with its national leadership, state federations and union locals, mobilized on behalf of Medicare.

Thirty years after Lyndon Johnson declared a War on Poverty, the United States still lags behind most Western democracies in national welfare systems, lacking such basic programs as national health insurance and child care support. Some critics have explained the failure of social programs by citing our tradition of individual freedom and libertarian values, while others point to weaknesses within the working class. In The Color of Welfare, Jill Quadagno takes exception to these claims, placing race at the center of the \"American Dilemma.\" From Reconstruction to Lyndon Johnson and beyond, Quadagno reveals how American social policy has continually foundered on issues of race. Drawing on extensive primary research, Quadagno shows how the exclusion of African Americans from the core programs of the Social Security Act, white backlash due to the inextricable intertwining of anti-poverty programs (such as job training, community action, health care, housing, and education) with the civil rights movement of the 1960s under Lyndon Johnson's \"unconditional war on poverty,\" and other such inadequacies demonstrates a \"continual reconfiguration of racial inequality in the nation's social, political, and economic institutions.\" In the 1960s, the United States embarked on a journey to resolve the \"American Dilemma.\" Yet instead of finally instituting full democratic rights for all its citizens, the policies enacted in that turbulent decade failed dismally. The Color of Welfare reveals the root cause of this failure--the inability to address racial inequality.

A central sociological premise is that health care systems are organizations that are embedded within larger institutions, which have been shaped by historical precedents and operate within a specific cultural context. Although bound by policy legacies, embedded constituencies, and path dependent processes, health care systems are not rigid, static, and impervious to change. The success of health care reform in 2010 has shown that existing regimes do have the capacity to respond to new needs in ways that transcend their institutional and ideological limits. For the United States the question is how health care reform will reconfigure the existing network of public and private benefits and the power relationships between the numerous constituencies surrounding them. This article considers how institutions, interest groups, and ideology have affected the organization of the health care system in the United States as well as in other nations. It then discusses issues for future research in the aftermath of the 2009-10 health care reform debate. Adapted from the source document.

This paper investigates public attitudes toward welfare state policies as a result of both situational, i.e. unemployment, and ideological factors, i.e. egalitarian ideology, at both the individual and national level. The dependent variables are public support for the sick and the old as well as for the unemployed as target beneficiaries of welfare state policies. Data from the ISSP study 'Role of Government' are analysed using a multi-level regression technique. Findings indicate that the National level is important in shaping public attitudes toward welfare state policies in industrialized nations, and that both situational and ideological factors play a role. Apparently, various nations generate different public beliefs about national social problems and about the relationship between individuals, the state and other institutions. Eventually, these understandings and beliefs influence popular attitudes regarding what kind of policies the state should pursue, and who should benefit.

One Nation, Uninsured offers a vividly written history of America's failed efforts to address the health care needs of its citizens. Covering the entire twentieth century, Jill Quadagno shows how each attempt to enact national health insurance was met with fierce attacks by powerful stakeholders, who mobilized their considerable resources to keep the financing of health care out of the government's hands.

Purpose – According to convergence theory, over time societies form similar social structures, political processes and public policies. In 2001, Israel adopted a welfare reform plan that rejected the traditional strategy of passive income support and instead endorsed the concept of activation. The plan was modeled on the Wisconsin Welfare to Work program and was designed to put the long-term unemployed to work. The program began operating in four regions in 2004 but was abruptly terminated six years later. The purpose of this paper is to analyze why Israel’s welfare reform failed to follow the smooth path predicted by convergence theory and elucidates the factors in the Israeli environment that made the implementation of a program borrowed from the USA unsustainable. Design/methodology/approach – A multi-method approach including interviews with key informants, content analysis of media materials and government documents and a quantitative comparative values analysis of four nations. Findings – The failure of US-style welfare reform in Israel was due to four main factors: a more diverse recipient population, a lack of understanding of Israeli cultural values, a welfare population that included a substantial number of ethnic minorities whose customs conflicted with program regulations and a social movement against the program by non-profit organizations. Originality/value – This paper demonstrates the limitations of convergence theory and highlights the salience of cultural values in the transmission of activation policies across nations. Specifically, it shows that outcomes vary when policies that are superficially similar are implanted in nations with fundamentally different cultures.