John L. Palmer

The meaning of social policy : the comparative dimension in social welfare

This book carries both a title and a subtitle, each referring to a separate dimension, and may therefore have set itself too ambitious a task. The subtitle refers to most of the books content and consists of summary references to hundreds of international studies in the fields of social security, personal social services, and planning. The main title refers to the questioning by the author of values, theories, and the social context of the issues involved in cross-national research. Both subjects are problematic, and putting them together effectively requires highly skilled integration. The author makes the important point that cross-national research can be informative, illuminating, and can lead to new insights into causal links, but only when it takes account of the comparability of circumstances, ideologies, and value systems. Having strongly made the case for the difficulties involved in research methodology in a cross-cultural framework, the volume shifts to a jam-packed compendium of references, often paragraph length, and of reports, essays, and studies major and minor in the three areas noted. It can be disconcerting to jump from country to country on every page, and even more so when the material reported is of uneven origin. Some summaries may refer to original data, such as government reports, others to major research, others to chapters in a book which are essays by single authors reviewing a field. Each is useful in its context, but the handle for evaluation is hard to grasp. The many citations, however, should be useful for anyone seeking references on where information can be found.

The Hard Road to Fiscal Responsibility

The paper describes the current fiscal problems of the United States showing that without significant changes in revenue and spending policies, the country is headed for a sovereign debt crisis similar to that afflicting countries in Southern Europe. Numerous committees and commissions have offered policy options that would stabilize the debt–GDP ratio in the long run. The proposals of the Presidents National Commission on Fiscal Responsibility and Reform and the Bipartisan Policy Centers Deficit Reduction Task Force are described in detail. Elected politicians have not been enthusiastic about the work of these bodies. Only the House has passed a budget that would stabilize the debt and that proposal is analyzed as is the presidents response. The paper goes on to describe the Budget Control Act that was passed after the debt limit debate in the summer of 2011.

Entitlement Programs for the Aged The Long-Term Fiscal Context

This article examines the long-term fiscal context for Medicare, Medicaid, and Social Security. It first considers their current and projected fiscal status under current policies and explicates the causes and consequences of the serious financing problems faced by the Social Security and Medicare trust funds. It then documents the tremendous pressure that the three programs, especially Medicare, will begin placing on overall federal finances with the retirement of the baby boom generation and discusses why neither continued growth of the economy nor new sources of revenues and reductions in other federal program spending by themselves can easily accommodate the large projected increases in the costs of these entitlements, as they have done in the past. Thus, the new Medicare prescription drug benefit notwithstanding, policy changes that on balance restrain, not further increase, the projected growth of Medicare, Medicaid, and Social Security may soon be the order of the day.

Medicare's Fiscal Problems: An Imperative for Reform

Many observers have noted that Medicare expenditures will significantly outstrip projected revenues over the course of the next 25 years. This paper examines the economic and demographic assumptions behind forecasts of Medicare hospital insurance and supplementary medical insurance expenditures and revenues and analyzes various strategies for closing the impending gap. It is argued that the present forecasts already assume considerable success in controlling hospital costs and physician payments, making substantial further savings unlikely. Shifting more of the burden onto the elderly through increased cost sharing or higher premiums also will not solve the programs fiscal problems over the long term. The remaining alternative--imposing higher income or payroll taxes on the under-65 population--is also unlikely to be a welcome solution. The authors argue that, eventually, the nation must choose between some form of a two-tier system of benefits or a Canadian-style national health insurance system.