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Shortly before the Loma Prieta earthquake devastated areas of Northern California in 1989, Risa Palm and her associates had surveyed 2,500 homeowners in the area about their perception of risk from earthquakes. After the quake they surveyed the homeowners again and found that their perception of risk had increased but that most respondents were fatalistic and continued to ignore self-protective measures; those who personally experienced damage were more likely to buy insurance. A rare opportunity to analyze behavior change directly before and after a natural disaster, this survey has implications for policy makers, insurance officials, and those concerned with risk management.

At the turn of the century, the North Carolina Mutual Life Insurance Company became the "world's largest Negro business." Located in Durham, North Carolina, which was known as the "Black Wall Street of America," this business came to symbolize the ideas of racial progress, self-help, and solidarity in America. Walter B. Weare's social and intellectual history, originally published in 1973 (University of Illinois Press) and updated here to include a new introduction, still stands as the definitive history of black business in the New South. Drawing on a wide range of sources—including personal papers of the company's leaders and oral history interviews—Weare traces the company's story from its ideological roots in the eighteenth century to its economic success in the twentieth century.

Over the past century, tort law and insurance have developed deeply intertwined legal and economic roots. Insurance usually determines whether tort cases are brought to trial, whom plaintiffs sue, how much they claim, who provides the defense, how the case gets litigated, the dynamics of the settlement, and how much plaintiffs ultimately recover. But to what extent should liability rules be influenced by insurance? In this study, Mark Rahdert identifies the leading arguments both in favor of and against what he terms the "insurance rationale"—the idea that tort law should be structured to facilitate victim access to assured compensation.

The insurance rationale has been a leading force in the development of product liability law and, as a component of accident compensation, has significantly influenced pro-plaintiff advances in principal areas of tort law. However, the insurance rationale is also the source of great controversy. Critics charge that liability rules deliberately set to maximize plaintiffs' access to insurance funds have corrupted the system, causing insurance costs to spiral upward uncontrollably. Considering the strengths and weaknesses of both sides of the current debate, Rahdert develops a modified version of the insurance rationale that can become a tool for evaluating future tort reform proposals.

Personalized and precision medicine (PPM)—the targeting of therapies according to an individual’s genetic, environmental, or lifestyle characteristics—is becoming an increasingly important approach in health care treatment and prevention. The advancement of PPM is a challenge in traditional clinical, reimbursement, and regulatory landscapes because it is costly to develop and introduces a wide range of scientific, clinical, ethical, and socioeconomic issues. PPM raises a multitude of economic issues, including how information on accurate diagnosis and treatment success will be disseminated and who will bear the cost; changes to physician training to incorporate genetics, probability and statistics, and economic considerations; questions about whether the benefits of PPM will be confined to developed countries or will diffuse to emerging economies with less developed health care systems; the effects of patient heterogeneity on cost-effectiveness analysis; and opportunities for PPM’s growth beyond treatment of acute illness, such as prevention and reversal of chronic conditions.
 
This volume explores the intersection of the scientific, clinical, and economic factors affecting the development of PPM, including its effects on the drug pipeline, on reimbursement of PPM diagnostics and treatments, and on funding of the requisite underlying research; and it examines recent empirical applications of PPM.   
 

For much of the twentieth century, industrialized nations addressed social problems, such as workers' compensation benefits and social welfare programs, in terms of spreading risk. But in recent years a new approach has emerged: using risk both as a way to conceive of and address social problems and as an incentive to reduce individual claims on collective resources.

Embracing Risk explores this new approach from a variety of perspectives. The first part of the book focuses on the interplay between risk and insurance in various historical and social contexts. The second part examines how risk is used to govern fields outside the realm of insurance, from extreme sports to policing, mental health institutions, and international law. Offering an original approach to risk, insurance, and responsibility, the provocative and wide-ranging essays in Embracing Risk demonstrate that risk has moved well beyond its origins in the insurance trade to become a central organizing principle of social and cultural life.

Long before the age of "Big Data" or the rise of today's "self-quantifiers," American capitalism embraced "risk"--and proceeded to number our days. Life insurers led the way, developing numerical practices for measuring individuals and groups, predicting their fates, and intervening in their futures. Emanating from the gilded boardrooms of Lower Manhattan and making their way into drawing rooms and tenement apartments across the nation, these practices soon came to change the futures they purported to divine.

How Our Days Became Numbered tells a story of corporate culture remaking American culture--a story of intellectuals and professionals in and around insurance companies who reimagined Americans' lives through numbers and taught ordinary Americans to do the same. Making individuals statistical did not happen easily. Legislative battles raged over the propriety of discriminating by race or of smoothing away the effects of capitalism's fluctuations on individuals. Meanwhile, debates within companies set doctors against actuaries and agents, resulting in elaborate, secretive systems of surveillance and calculation.

Dan Bouk reveals how, in a little over half a century, insurers laid the groundwork for the much-quantified, risk-infused world that we live in today. To understand how the financial world shapes modern bodies, how risk assessments can perpetuate inequalities of race or sex, and how the quantification and claims of risk on each of us continue to grow, we must take seriously the history of those who view our lives as a series of probabilities to be managed.

The election of Ronald Reagan in 1980 was said to herald a new mood of opposition to government regulation. But at the same time, large and vocal segments of the population have been demanding that corporations and regulatory agencies address public concerns about technological safety. What do we really know about people's perceptions of technological risk and their judgments about appropriate levels of technological regulation? Perceptions of Technological Risks and Benefits analyzes the results of a unique body of survey data—the only large-scale, representative survey of public attitudes about risk management in such technologies as nuclear power, handguns, auto travel, and industrial chemicals. The findings demonstrate that public judgments are not simply anti-technological or irrational, but rather the product of a complex set of factors that includes an awareness of benefits as well as a sensitivity to the "qualitative" aspects of risk (how catastrophic, dreaded, or poorly understood a hazard seems to be). This volume offers striking evidence that whatever Americans may think about government regulation in general, they are remarkably consistent in desiring stricter regulation of technological safety. These conclusions suggest that the current trend away from regulation of technology reflects a less than perfect reading of public sentiment.

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.

After acts of airline terrorism, air travel tends to drop dramatically—yet Americans routinely pursue the far riskier business of driving cards, where accidents resulting in death or injury are much more likely to occur. Reporting on Risk argues that this selective concern with danger is powerfully shaped by the media, whose coverage of potentially hazardous events is governed more by a need to excite the public than to inform it. Singer and Endreny survey a wide range of print and electronic media to provide an unprecedented look at how hundreds of different hazards are presented to the public—from toxic waste and food poisoning to cigarette smoking, from transportation accidents to famine, and from experimental surgery to communicable diseases. Their investigations raise thought-provoking questions about what the media tell us about modern risks, which hazards are covered and which ignored, and how the media determine when hazards should be considered risky. Are natural hazards reported differently than man-made hazards? Is greater emphasis placed on the potential benefits or the potential drawbacks of complex new technologies? Are journalists more concerned with reporting on unproven cures or informing the public about preventative measures? Do newspapers differ from magazines and television in their risk reporting practices? Reporting on Risk investigates how the media place blame for disasters, and looks at how the reporting of risks has changed in the past twenty-five years as such hazards as nuclear power, birth control methods, and industrial by-products have grown in national prominence. The authors demonstrate that the media often fail to report on risks until energized by the occurrence of some disastrous or dramatic event—the Union Carbide pesticide leak in Bhopal, the Challenger explosion, the outbreak of famine in Somalia, or the failed transplant of a baboon heart to "Baby Fae." Sustained attention to these hazards depends less on whether the underlying issues have been resolved than on whether they continue to unfold in newsworthy events. Reporting on Risk examines the accuracy and the amount of information we receive about our environment. It offers a critical perspective on how our perceptions of risk, as shaped by the media, may contribute to misguided individual and public choices for action and prevention in an increasingly complex world. The authors' probing assessment of how the media report a vast array of risks offers insights useful to journalists, policy analysts, risk specialists, legislators, and concerned citizens.

Every day, it seems, we become aware of some new technological or chemical hazard. Yet it is also possible that this very awareness is new, or at least newly heightened. Why are certain kinds of risks suddenly so salient? Are public perceptions of risk simply the sum of individual reactions to individual events, or do social and cultural influences play a role in shaping our definitions of safety, acceptable risk, and danger? Prompted by public outcries and by the confusion and uncertainty surrounding risk management policy, social scientists have begun to address themselves to the issue of risk perception. But as anthropologist Mary Douglas points out, they have been singularly reluctant to examine the cultural bases of risk perception, preferring to concentrate on the individual perceiver making individual choices. This approach leaves unexamined a number of crucial social factors—our concepts of what is "natural" or "artificial," for example; our beliefs about fairness, and our moral judgements about the kind of society in which we want to live. This provocative and path-breaking report seeks to open a sociological approach to risk perception that has so far been systematically neglected. Describing first some exceptions to the general neglect of culture, Douglas builds on these clues and on her own broad anthropological perspective to make a compelling case for focusing on social factors in risk perception. She offers a challenge and a promising new agenda to all who study perceptions of risk and, by extension, to those who study human cognition and choice as well. "An altogether brilliant piece of writing—far-reaching and a joy to read." —Amartya Sen, Oxford University A Volume in the Russell Sage Foundation's Social Science Frontiers Series

This unique comparative study looks at efforts to regulate carcinogenic chemicals in several Western democracies, including the United States, and finds marked national differences in how conflicting scientific interpretations and competing political interests are resolved. Whether risk issues are referred to expert committees without public debate or debated openly in a variety of forums, patterns of interaction among experts, policy makers, and the public reflect fundamental features of each country's political culture. "A provocative argument....Poses interesting questions for the sociology of science, especially science produced for public debate."—Contemporary Sociology A Volume in the Russell Sage Foundation's Social Science Frontiers Series

Classical economic theory assumes that people in risk situations follow a course of action based on a rational, consistent assessment of likely outcomes. But as Zur Shapira demonstrates in Risk Taking, corporate managers consistently stray from the prescribed path into far more subjective territory. Risk Taking offers a critical assessment of the relationship between theory and action in managerial decision making. Shapira offers a definitive account of the classical conception of risky decision making, which derives behavioral prescriptions from a calculation of both the value and the likelihood of possible outcomes. He then demonstrates how theories in this vein have been historically at odds with empirical observations. Risk Taking reports the results of an extensive survey of seven hundred managers that probed their attitudes and beliefs about risk and examined how they had actually made decisions in the face of uncertainty. The picture that emerges is of a dynamic, flexible process in which each manager's personal expertise and perceptions play profound roles. Managerial strategies are continually modified to suit changing circumstances. Rather than formulating probability estimates, executives create potential scenarios based not only on the possible outcomes but also on the many arbitrary factors inherent in their own situations. As Shapira notes, risk taking propensities vary among managers, and the need to maintain control and avoid particularly dangerous results exercises a powerful influence. Shapira also examines the impact of organizational structure, long-term management objectives, and incentives on decision making. With perceptive observations of the cognitive, emotional, and organizational dimensions of corporate decision making, Risk Taking propels the study of managerial risk behavior into new directions. This volume signals the way toward improving managerial decision making by revealing the need for more inclusive choice models that augment classical theory with vital behavioral observations.

What accounts for the striking decline in labor force participation at increasingly younger ages? Social Security and Retirement around the World examines one explanation: social security programs actually provide incentives for early retirement. This volume houses a set of remarkable papers that present information on the social security systems, and labor force participation patterns, in Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Spain, Sweden, the United Kingdom, and the United States.

Is it possible that the insurance and reinsurance industries cannot handle a major catastrophe? Ten years ago, the notion that the overall cost of a single catastrophic event might exceed $10 billion was unthinkable. With ever increasing property-casualty risks and unabated growth in hazard-prone areas, insurers and reinsurers now envision the possibility of disaster losses of $50 to $100 billion in the United States.

Against this backdrop, the capitalization of the insurance and reinsurance industries has become a crucial concern. While it remains unlikely that a single event might entirely bankrupt these industries, a big catastrophe could place firms under severe stress, jeopardizing both policy holders and investors and causing profound ripple effects throughout the U.S. economy.

The Financing of Catastrophe Risk assembles an impressive roster of experts from academia and industry to explore the disturbing yet realistic assumption that a large catastrophic event is inevitable. The essays offer tangible means of both reassessing and raising the level of preparedness throughout the insurance and reinsurance industries.

American health care is in crisis because of exploding medical malpractice litigation. Insurance premiums for doctors and malpractice lawsuits are skyrocketing, rendering doctors both afraid and unable to afford to continue to practice medicine. Undeserving victims sue at the drop of a hat, egged on by greedy lawyers, and receive eye-popping awards that insurance companies, hospitals, and doctors themselves struggle to pay. The plaintiffs and lawyers always win; doctors, and the nonlitigious, always lose; and affordable health care is the real victim.

This, according to Tom Baker, is the myth of medical malpractice, and as a reality check he offers The Medical Malpractice Myth, a stunning dismantling of this familiar, but inaccurate, picture of the health care industry. Are there too many medical malpractice suits? No, according to Baker; there is actually a great deal more medical malpractice, with only a fraction of the cases ever seeing the inside of a courtroom. Is too much litigation to blame for the malpractice insurance crisis? No, for that we can look to financial trends and competitive behavior in the insurance industry. Are these lawsuits frivolous? Very rarely. Point by point, Baker—a leading authority on insurance and law—pulls together the research that demolishes the myths that have taken hold about medical malpractice and suggests a series of legal reforms that would help doctors manage malpractice insurance while also improving patient safety and medical accountability.

President Bush has made medical malpractice reform a priority in his last term in office, but if history is any indication, legislative reform would only worsen the situation and perpetuate the gross misunderstanding of it. The debate surely will be transformed by The Medical Malpractice Myth, a book aimed squarely at general readers but with radical conclusions that speak to the highest level of domestic policymaking.

In the two decades since a new social movement put environmental issues high on the national policy agenda, Washington has become home to a small group of people—the risk professionals—whose careers center on the identification, assessment, and management of risks to public health and safety. These men and women, experts working in federal agencies, Congress, activist organizations, and corporations, help transform mass concern into government policy, shaping the way our society responds to environmental and technological hazards. Based on nearly 230 interviews, The Risk Professionals provides the first comprehensive sociological analysis of our "danger establishment." Dietz and Rycroft explore the social, educational, and career profiles of risk professionals; their worldviews and ideologies; their networks and norms. Not content to view risk professionals from a single perspective, the authors build an integrated description that considers commonalities in their subjects' backgrounds, interests, values, and communication patterns. The result is a uniquely revealing look into the heart of the risk policy system, and a broader illumination of the social structures and dynamics that will influence environmental policy for years to come. A Volume in the Russell Sage Foundation's Social Science Frontiers Series

Why did the United States lag behind Germany, Britain, and Sweden in adopting a national plan for the elderly? When the Social Security Act was finally enacted in 1935, why did it depend on a class-based double standard? Why is old age welfare in the United States still less comprehensive than its European counterparts? In this sophisticated analytical chronicle of one hundred years of American welfare history, Jill Quadagno explores the curious birth of old age assistance in the United States. Grounded in historical research and informed by social science theory, the study reveals how public assistance grew from colonial-era poor laws, locally financed and administered, into a massive federal bureaucracy.

Written for nonexperts, this is a brisk, engaging history of American healthcare from the advent of Medicare and Medicaid in the 1960s to the impact of the Affordable Care Act in the 2010s. Step by step, Jonathan Engel shows how we arrived at our present convoluted situation, where generic drugs prices can jump 1,000 percent in a day and primary care physicians can lose 20 percent of their income at the stroke of a Congressional pen.

Unaffordable covers, in a conversational style punctuated by apt examples, topics ranging from health insurance, pharmaceutical pricing, and physician training to health maintenance organizations and hospital networks. Along the way, Engel introduces approaches that other nations have taken in organizing and paying for healthcare and offers insights on ethical quandaries around end-of-life decisions, neonatal care, life-sustaining treatments, and the limits of our ability to define death. While describing the political origins of many of the federal and state laws that govern our healthcare system today, he never loses sight of the impact that healthcare delivery has on our wallets and on the balance sheets of hospitals, doctors' offices, government agencies, and private companies.