As elected lawmakers confront complex social problems, they inevitably make choices to single out certain populations for government-sanctioned benefits or burdens. Why some groups and not others are targeted is the central question explored in this analysis of the congressional response to two related public health crises.

Weaving case studies from the wars against AIDS and drugs with an empirical analysis of fifteen years of congressional action on these issues, Mark Donovan shows how members of Congress balance problem solving with re-election concerns, paying particular attention to their need to craft compelling rationales for their actions. His analysis shows that, counterintuitive as it may seem, most target populations with negative public images are selected to receive benefits rather than burdens.

Demonstrating that it is possible to analyze simultaneously both policy rhetoric and policy outputs, this book shows how problem frames and policy decisions evolve through the dynamic interplay of conflict participants.

While many states cut back on their Medicaid enrollments from 1993 to 2001, TennCare grew from 750,000 to 1.47 million enrollees. The state was less successful in controlling costs, however. Each major stakeholder group (the state, the managed care organizations, the providers, and the enrollees and their advocates) pushed back against parts of the state's strategy that adversely affected their interests, and they eventually dismantled the mechanisms of cost constraint.

The author lays out the four stakeholder perspectives for each period in the history of TennCare and provides a link to difficult-to-access primary documents.

Proposals to reform the health care system typically focus on either increasing private insurance or expanding government-sponsored plans. Guaranteeing that everyone is insured, however, does not create a system with the quality of care patients want, the flexibility clinicians need, and the internal dynamics to continually improve the value of health care.

In Total Cure, Hal Luft presents a comprehensive new proposal, SecureChoice, which does all that while providing affordable health insurance for every American. SecureChoice is a plan that restructures payment for medical care, harnessing the flexibility and responsiveness of the market by aligning the incentives of clinicians, hospitals, and insurers with those of the patient. It uses the accountability of government to ensure transparency, competition, and equity.

SecureChoice has two major components. A universal pool covers the major risks of hospitalization and chronic illness, which account for almost two-thirds of all costs. Everyone would be in the pool, irrespective of employment, income, or health status. The second component emphasizes choice, flexibility, and responsibility. People will be able to choose any physician to serve as their “medical home,” to keep track of their health records, provide much of their care, and suggest referrals. Clinicians will have the information and incentives to continually enhance quality. SecureChoice also facilitates improvements in areas ranging from malpractice to pharmaceuticals and establishes new roles for key stakeholders such as health insurers.

Originally introduced by Dow and other chemical companies as a herbicide in the United States and adopted by the military as a method of deforesting the war zone of Vietnam, in order to deny the enemy cover, Agent Orange also found its way into the systems of numerous active-duty soldiers. Sills argues that manufacturers understood the dangers of this compound and did nothing to protect American soldiers.

Toxic War takes the reader behind the scenes into the halls of political power and industry, where the debates about the use of Agent Orange and its potential side effects raged. In the end, the only way these veterans could seek justice was in the court of law and public opinion. Unprecedented in its access to legal, medical, and government documentation, as well as to the personal testimonies of veterans, Toxic War endeavors to explore all sides of this epic battle.