bluuebunny/crossref_metadata_2025 huggingface dataset:
Picture Poetry, Mannerism, and Sign Relationships
Authors: Tsur Reuven
Published: December 2005

This article explores some cognitive and aesthetic principles about picture poems. It regards language as a hierarchy of signs: the graphemic string signifies a phonological string, which signifies units of meaning, which signify referents in extralinguistic reality. Our linguistic competence urges us to reach the final referents as fast as possible. Poetic language draws attention to itself, that is, to the hierarchy of signifiers. In manneristic styles there is a greater awareness of the separateness of signifiers than in nonmanneristic styles; hence their witty or disorienting effect. Whereas rhyme, meter, and alliteration impose additional patterning on the phonological signifiers, picture poems, acrostics, and some other manneristic devices impose additional patterning upon the graphemic signifiers. When alliterations are turned into puns, they become manneristic patterning of the phonological signifier. It is argued, by analogy with synesthesia, that stable characteristic visual shapes obstruct smooth perceptual fusion, and, on the basis of speech perception, that speech sounds are special in our cognitive economy, and visual patterning cannot achieve the naturalness of their patterning. That is why visual patterning is not admitted in nonmanneristic styles. Cognitive poetics suggests that in the response to poetry, adaptive devices are turned to an aesthetic end. In a universe in which “the center cannot hold,” readers of poetry find pleasure not so much in the emotional disorientation caused by manneristic devices, but rather in the reassertion that their adaptive devices, when disrupted, function properly. This is one reason manneristic styles recur in cultural and social periods in which more than one scale of values prevails.
“Shpeaking Plain” and Writing Foreign: Abraham Cahan's Yekl
Authors: Wirth-Nesher Hana
Published: December 2005

Abraham Cahan's first English novel, Yekl: A Tale of the New York Ghetto, is a multilingual narrative whose literary strategies bear the marks of both Yiddish language and literature and American local color writing at the end of the nineteenth century. This article examines two aspects of“plain speaking” in Cahan's writing; the intersection of these two different cultural and literary traditions in relation to prevailing notions of realism exemplified by the role of William Dean Howells in the creation ofYekl and the poetics of ethnic writing exemplified by the use of dialect, translation strategies, multilingual word play, and other techniques.
“Civilised Off the Face of the Earth”: Museum Display and the Silencing of the /Xam
Authors: Skotnes Pippa
Published: December 2005

The end of apartheid in South Africa initiated a period of intense analysis of historical and contemporary questions of identity. In the Cape, people who had been classified as “coloured” or “other coloured”began to reclaim their precolonial identities. This process has been made difficult by wide-scale language death during the twentieth century and the accompanying death of cultural traditions. In the case of the first people of South Africa, the bushmen, this process was further complicated by their depiction in museum exhibits and displays as “living fossils,”alienated from history and culture. This article examines these stereotypes and the historical circumstances that gave rise to them. As a counterpoint it looks at an extraordinary archive of nineteenth-century folklore that was created through a unique collaboration between settler and native. Finally it examines an exhibit mounted in 1996 at the South African National Gallery in Cape Town in which bushman identity was held up to scrutiny and the prevailing stereotypes confronted.
“Prodigious mixtures and confusions strange”: The Self-Subverting Mixed Style ofThe Cenci
Authors: Bruhn Mark J.
Published: December 2005

This study positions Percy Bysshe Shelley as an important though ultimately unwilling contributor to the development of mixed-style mimesis and thus to the evolution of Western drama from neoclassicism to realism. To capture the historical dimensions and final irony of this thesis, I frame my analysis of Shelley's dramatic style with a set of poetic and critical contrasts. Judged in the light of twentieth-century treatments of the Cenci story by Antonin Artaud, Bertrand Tavernier, and George Elliott Clarke, Shelley's style appears comparatively unmixed and unrealistic or, as Stuart Curran has argued from different evidence, essentially neoclassical. Viewed in the light of Racinian tragedy, however, or even in the more restricted context of the post-Restoration English drama, Shelley's style appears radically mixed, not an antithesis to twentieth-century approaches to mimesis but a revolutionary anticipation of them. Situating Shelley by means of this double perspective, I show how he disposes the modern mixed style in Prometheus Unbound andThe Cenci to make it subserve the ideal poetics and metaphysics of antiquity. As his Defence of Poetry argues and his stylistic treatment of Beatrice Cenci confirms, Shelley thus intended to legislate against his own mimetic breakthrough and, it would appear, significantly failed.
Advertising, Rhetoric, and Literature: A Medieval Response to Contemporary Theory
Authors: Cowell Andrew
Published: December 2005

This article examines the earliest examples of advertising and consumer commodities in medieval texts in relation to twentieth-century critical theories of the social role of advertising and its relation to both“literature” and “rhetoric.” It discusses the ways advertising and rhetoric have been linked in these recent theories and the ways literature has been excluded from this nexus. Turning to the Middle Ages,the article examines a different nexus between literature and rhetoric. Whereas advertising is typically seen in current theory as fundamentally“antipoetic,” it was in the Middle Ages central to the birth of literary textuality, a discourse that challenged the status of rhetoric and religiously oriented literature. The birth of the commodity and its advertisement corresponds to a birth of the “poetic” in the Western vernacular tradition.
Form and Context: An Essay in the History of Narratology
Authors: Darby David
Published: December 2005

This essay compares two distinct traditions of narrative theory: on the one hand, that of structuralist narratology as it emerged in the 1960s and in its various subsequent manifestations; on the other, that of German-languageErzähltheorie as codified in the 1950s, with a prehistory dating back to German classicism. Having mapped the connections between these traditions, this essay then concentrates on exploring how narratology, unlike German narrative theory, has come to broaden its project exponentially since its first critical incarnation as a strictly formalist poetics. While the German tradition has concentrated on rhetoric and voice (with reception theory constituting a largely separate area of inquiry), narratology, which frames the text within a symmetry of real, implied, and fictional intelligences, has always had the potential to pose questions about how narrative functions in relation to a surrounding world of ideas. Of the two only narratology can therefore theorize both authorship and reading. In specific terms, this essay argues that the controversial narratological abstraction of implied authorship represents the only point at which a negotiation between textual and contextual worlds can logically take place. Evidence of how crucial such theorization has been in the development of contextualist narratology is sought in the examination of a test case, namely the much-disputed project of feminist narratology.
Darwin and Derrida: Cognitive Literary Theory As a Species of Post-Structuralism
Authors: Spolsky Ellen
Published: December 2005

Rather than denying the insights of post-structuralist theory, literary interpretation and theory with an evolutionary cognitive perspective actually nestles nicely within a central niche of deconstructionist thinking, that is,the critique of representation. What we learn from recent cognitive science is that the meanings of texts are indeed unstable and dependent upon contingent contexts. While theories of neuronal activity can be understood as analogous to the critique of representation, the cognitive evolutionary argument supports Stanley Cavell's counterproposal, that is, that while our representational powers are not ideal they are sufficient. It is possible then to argue further that the very flexibility that destabilizes meaning is not only good enough, it is responsible for our success, such as it has been, in building and revising human cultures.
The Politics of Love: Propaganda and Structural Learning in Aphra Behn's Love-Letters between a Nobleman and His Sister
Authors: Steen Francis F.
Published: December 2005

Given her influential and decidedly liberal feminist social agenda, Aphra Behn's political convictions during the struggles of the 1680s between Parliament and Charles II have struck several critics as incongruously reactionary. This essay proposes a partial resolution to this apparent contradiction by examining how Behn employs the psychology of transgressive love to model the relation between the king and his subjects. By drawing selectively from the different sets of inferences present in the conceptual spaces of passionate love and autocratic power, Behn produces an unstable but potent conceptual blend. The emerging “liberal royalism” is driven by desire and characterized by an emotionally irresistible reciprocal attachment.
Illusion, Lie, and Metaphor: The Paradox of Divergence in Early Chinese Poetics
Authors: Ekstroem Martin Svensson
Published: December 2005

I approach the closely interrelated topics of classical Chinese poetics and theories of language from a somewhat unconventional perspective, namely the relationship between some early texts dealing with aural and optical illusions and the reading of poetic imagery in the Confucian scholar Mao Heng's exegesis of the Book of Poems (Shijing, China's oldest collection of poetry). Polemically, I suggest that the poetics of the second centuryb.c. and its interest in metaphoricity originated in a philosophizing on the phenomenon of illusion, that is, the deceptive resemblance (si) between disparate objects, the discrepancy between appearance and actuality. Illusion, thus defined, may appear as confusing or uncanny in everyday experience (the doppelgänger, the mirage, the philanderer posing as saint, or linguistic ambiguity); yet this clash between form and content is an essential aspect of Confucian ritualism(li), observable in rules of mourning, or in the use of metaphorical poetry as ritualized discourse.
A Measure for Menippean Discourse: The Example of Shakespeare
Authors: Milowicki Edward J. , Wilson Robert Rawdon
Published: December 2005

A vigorous classical tradition was adopted and adapted in the English Renaissance, a way of satirical writing that we call Menippean discourse. This tradition was well known to Shakespeare; indeed, it challenged his deepest creative instincts, and he deployed it extensively in his Troilus and Cressida. While delineating Menippean elements in Troilus, we also confront certain problems involved in defining— even in discussing—genre and character. Whether or not a distinct genre,traditionally called Menippean satire, can be arrived at or agreed upon remains problematic, as does the concept of genre itself. Instead, we attempt to establish a taxonomy that isolates and identifies what we call the major colligatory motifs, numerous yet distinct, that constitute Menippean discourse, recognizing and applying where profitable the generic analysis of Garry Sherbert (influenced by Northrup Frye), Mikhail Bakhtin's cultural-historical view of Menippean texts, and the taxonomic work of Eugene Kirk, Joel C. Relihan, and W. Scott Blanchard. The result of our study is a strong indication that Shakespeare's apprehension of the classical tradition was wide and deep, with an abiding concern for traditional forms and a bold,even daring tendency to experiment radically with those forms but especially with structure and characterization.
Doxa in Poetry: A Study of Aristotle's Poetics
Authors: Eggs Ekkehard
Published: December 2005

The aim of this article is to show that doxa is the point of reference and evaluation from which all of Aristotle's central poetic concepts—mímesis, mythos, peripeteia, praxis téleia,éleos, phóbos, and so forth—can be properly grasped. I first show the endoxical and opinion-bound character of catharsis in discussing pity and fear within the framework of Aristotle's theory of the passions. Since the understanding of the meaning and the function of the plot necessitates a comprehension of the necessary, the probable, and the contingent, I then analyze these logical and poetic categories in the context of the Rhetoric, the Topics, and thePoetics. On the basis of these analyses, I discuss in the last part three endoxical dimensions of mimesis: (i) astonishment and pleasure, (ii)ethos and social praxis, and (iii) style and representation.
Multiparty Talk in the Novel: The Distribution of Tea and Talk in a Scene from Evelyn Waugh'sBlack Mischief
Authors: Thomas Bronwen E.
Published: December 2005

This article argues that studies of fictional dialogue have hitherto neglected the specific dynamics of multiparty talk. I will contend that this neglect contributes to the perpetuation of an “ideal” of conversation that allows no space for either the frustrations and inequalities of such encounters or the unique pleasures they may bring to the reader. I urge the importance of distinguishing between group talk, in which there is some element of cohesion and shared goals, and multiparty talk, in which the representation foregrounds fragmentation and explores the often subtle power games played by the participants. Focusing on a scene from Evelyn Waugh'sBlack Mischief (1986 [1932]), I argue that Waugh is sensitive to the dynamics of multiparty talk while orchestrating the representation for comic effect. I propose that analyzing such scenes of multiparty talk must make us reassess not only how we theorize fictional dialogue, but how far our models of everyday speech serve to privilege and universalize certain conversational practices and mechanisms based almost exclusively on the duologue.
Focalization and Narration: Theoretical and Terminological Refinements
Authors: Nieragden Göran
Published: December 2005

This short article suggests a revision of the hierarchical levels of focalization and narration. It argues that greater precision in distinguishing degrees of both narrators' and characters' involvement in these distinct processes will result in a more flexible and more adequate typology. To achieve this purpose, the well-known systems of narrative situations in Bal 1981, 1985 [1977] and of focalization in Genette 1980 [1972] are reconciled with those of homodiegetic narration in Lanser 1981 and Füger 1993. A revised and comprehensive version of possible identity relations among narrators and focalizers is suggested and briefly exemplified through a number of well-known Anglo-American novels.
From Practical Criticism to the Practice of Literary Criticism
Authors: Goodblatt Chanita , Glicksohn Joseph
Published: December 2005

In Practical Criticism: A Study of Literary Judgment (1963[1929]), I. A. Richards marks his standing as the herald of three trends of literary criticism: the empirical study of literature, New Criticism, and Reader-Response Criticism. What is more, in this book he affiliates himself with the experimental psychology of his time and by extension with the rising prominence of Gestalt theory within this discipline. Our research weaves together not only these three trends but also his Interaction Theory of Metaphor, detailed in The Philosophy of Rhetoric (1936). This essay draws out the implications of Richards's approach to cognitive literary studies for our work on poetic metaphor. In the section entitled “A Gestalt Approach to Poetry” we develop and incorporate his Interaction Theory of Metaphor into our Gestalt-Interaction Theory of Metaphor, applying it to a reading of John Donne's poem “The Bait.” In the section“An Empirical Study of Poetry” we discuss Richards's empirical study of poetry, followed by our own empirical study, in line with the same Gestalt-Interaction Theory of Metaphor.
Cognitive Science and the Problem of Representation
Authors: van Oort Richard
Published: December 2005

In this article, I argue that the problem of representation stands at the center of the debate concerning the legitimacy of cognitivism as a research strategy for the humanities. Yet, curiously, very few commentators in this debate see representation to be a problem at all. Questions about the anthropological origin and function of representation tend to be regarded as at best supplemental, and at worst simply irrelevant, to the synchronic question of the causal mechanisms involved in the production of representation in the brain. I argue that this view is fundamentally mistaken and,furthermore, that we won't get clear about the central issues in the debate over cognitivism in literary studies until we get clear about the problem of representation. The problem is essentially one of how to define the human in terms of its most unique trait: the capacity for symbolic representation. After a review of how cognitivism misinterprets this question as a gradually evolved genetic adaptation of the nervous system, I turn to the theory of representation proposed by the neuroscientist and anthropological researcher Terrence Deacon in The Symbolic Species: The Co-Evolution of Language and the Brain (1997). Deacon stands out among cognitive scientists for his conclusion that language—symbolic reference—is an“evolutionary anomaly,” that is, inassimilable to the mechanism of gene replication. By understanding the exact nature of this evolutionary anomaly, we are in a much better position to assess the skepticism that is routinely directed toward those who use cognitive science to interpret literature. More precisely, I argue that the originary function of the symbolic sign is the deferral of lower-level indexical reference strategies. This originary anthropological function is most clearly evident in literature,art, and religion.
History of Narratology: A Rejoinder
Authors: Fludernik Monika
Published: December 2005

The comment takes issue with David Darby's presentation of German narratology, arguing that German contributions to the field of narrative studies are much broader and more varied than argued by Darby in his article in Poetics Today, vol. 22, no. 4 (2001).
Materialism and the Book
Authors: Ayers David
Published: December 2005

Contemporary materialist theory is converging with the study of material culture, as evidenced by increasing attention given to the book as a material object produced, circulated, and consumed as a commodity. It is, however,problematic to conceive of the book as a material object, since writing itself cannot be straightforwardly conceived as a material thing, as Derrida has shown. Moreover, it is difficult to conceive the book as a commodity, since the notion of the commodity is also problematically rooted in the notion of the material, as can be established by reference to Marx and Benjamin. To consider the materiality of the book we need in place an architext of the use of the terms matter and materiality in theoretical thought. These terms are central but elusive, even when they are consciously thematized, as they are, for example, in the work of Judith Butler. This elusiveness arises only partly because the distinction between Cartesian and Aristotelian matter is forgotten, but mainly because these terms are used in an approximate fashion by Marx, who is the principal source of this vocabulary in contemporary theory. We should treat the term matter with the same skepticism we employ when dealing with other idealist concepts, not as their preconceptual other and redemption.
Recuperating the Archive: Anecdotal Evidence and Questions of“ Historical Realism”
Authors: Laden Sonja
Published: December 2005

This essay argues that the critical practice of New Historicism is a mode of “literary” history whose “literariness” lies in bringing imaginative operations closer to the surface of nonliterary texts and briefly describes some of the practice's leading literary features and strategies. I further point out that the ostensible “arbitrary connectedness” (Cohen 1987) of New Historicist writing is in fact aesthetically coded and patterned, both stylistically and in terms of potential semantic correspondences between various representations of the past. I then move on to address the question of why anecdotal evidence features centrally and has come to play a key role in New Historicist writing. Here, I contend that, as components of narrative discourse, anecdotal materials are central in enabling New Historicists to make discernible on the surface of their discourse procedures of meaning production typically found in literary forms. In particular, anecdotal materials are the fragmented“stuff” of historical narratization: they facilitate the shaping of historical events into stories and more or less formalized“facts.” This essay examines how the New Historicist anecdote remodels historical reality “as it might have been,” reviving the way history is experienced and concretely reproduced by contemporary readers of literary history. Finally, the essay confirms how the textual reproduction of anecdotal evidence also enables the New Historicist mode of“literary” history to secure its links to literary artifacts,literary scholarship, and conventional historical discourse.
Proust, His Narrator, and the Importance of the Distinction
Authors: Landy Joshua
Published: December 2005

Although it is, in principle, almost universally accepted today that authors and narrators must be rigorously demarcated, somehow scholars of Marcel Proust seem—whether wittingly or unwittingly—to make an exception for In Search of Lost me. Because it is written in the first person and because it incorporates scenes borrowed from Proust's own life, the fictional narrative is routinely read as his thinly veiled autobiography, if not as evidence for any number of psychiatric disorders. At the very least, critics tend to have no hesitation in taking theses put forward by the narrator as Proust's own vision of the world and the narrator's future masterpiece as the Search itself. Now these are not only mistakes, as evidence both internal and external clearly shows, but alsoconsequential mistakes: they prevent us, that is, from understanding how the novel functions and from taking advantage of all it has to offer. For above and beyond the dry, theoretical insights it presents for our consideration, it grants us the opportunity to train ourselves, both in the complicated art of self-fashioning and in the related art of self-deception. And it is only because the narrator's insights do not entirely add up—a weakness, so long as one treats the Search as a treatise—that the implied author can produce the training effect, one which gives his novel its ultimate strength.
Reading Strategies in Everyday Life: Different Ways of Reading a Novel Which Make a Distinction
Authors: Charlton Michael , Pette Corinna , Burbaum Christina
Published: December 2005

The article presents some selected results from our multimethod study“Lesesozialisation im Erwachsenenalter: Strategien literarischen Lesens in ihrer Bedeutung für Alltagsbewältigung und Biographie”[Reading socialization of the adult: Strategies of literary reading and their meaning in terms of coping with daily life and in terms of a person's biography]. In the first, ethnographic part of this study, six volunteer readers (who had spontaneously purchased a recently published novel) observed their own reading practices. The subjects were interviewed before, during, and after reading the novel. On the basis of these interviews, a great number of strategies for dealing with a literary text emerged. Most of these strategies appeared to be polyfunctional; nevertheless, certain techniques proved to be better than others for attaining specific goals. Different readers in different situations thus preferred different reading strategies. In the second part of our study, we conducted interviews with a representative sample of 1,025 experienced German novel readers and asked about their reading habits in general—not limited to the specific novel of part one. It emerged that female and male readers as well as readers with different sociocultural backgrounds (in Pierre Bourdieu's sense) preferred different reading strategies.
Hopkins's “The Windhover”: Not Ideas about the Thing but the Thing Itself
Authors: Cosgrove Peter
Published: December 2005

This article analyzes some of the problematics of allegorical reading and suggests a method of reading poetry by paying attention to the impenetrable“thingness” of tropes and figures, using as an example a poem notorious for the prevalence of allegory in the history of its interpretations, “The Windhover” by Gerard Manley Hopkins. Contending that the variety of the interpretations of this sonnet reveal the inconsistency and arbitrariness of the allegorical method, I also draw attention to commentators' lack of rigorous understanding of the allegorical pretext, the failure to distinguish between allegory and symbol,allegoresis, and typology. A study of the lability of the terms used to advance the Christological reading reveals that they do not sustain a reference to a single emblematic figure and, extrapolating more broadly from this discovery, that allegorical readings in general have severe drawbacks. In conclusion, I propose that the “ungrammaticality” of “The Windhover'”s tropes and the importance of the notion of“thing” puts Hopkins in proximity to the problems of the later modernist poets, such as William Carlos Williams and Wallace Stevens, who struggle with the paradoxical ability of the conceptualizing power of mind to simultaneously apprehend an external object and to distance us further from it.
Ethical Modernism: Servants as Others in J. M. Coetzee's Early Fiction
Authors: Attridge Derek
Published: December 2005

The distinctive ethical force of literature inheres not in the fictional world portrayed but in the handling of language whereby that fictional world is brought into being. Literary works that resist the immediacy and transparency of language— as is the case in modernist writing—thus engage the reader ethically; and to do justice to such works as a reader is to respond fully to an event whereby otherness challenges habitual norms. When the fiction itself concerns the ethics of otherness, as in J. M. Coetzee's two earliest fictions, Dusklands and In the Heart of the Country, modernist techniques can be especially powerful as a means of involving the reader ethically. In these two works, Coetzee undermines the conventional discourses that are traditionally employed to represent—and in so doing disempower—servants in the same gesture by which he tests the conventions of fictional representation.
Creative Accounting: Role-Playing Games, Possible-World Theory, and the Agency of Imagination
Authors: Punday Daniel
Published: December 2005

Role-playing games have many qualities of narrative (character, plot, setting), yet they have received virtually no attention from narratologists. This essay discusses the way that role-playing games construct narrative worlds and compares that to recent theories of fiction based on possible-world models. In both, emphasis is placed on the objects that make up this world. In role-playing games and recent theories of fictional world, this essay argues, emphasis on objects makes possible intertextual comparisons, which in turn help to define and rejuvenate the agency of readers and critics against the backdrop of challenges to that agency by market culture and structuralist literary theory.
Intention in Extremity: Reading Dickinson after the Holocaust
Authors: Friedlander Benjamin
Published: December 2005

Trauma theory posits an unrepresentable excess to experience, but because most studies of trauma deal with experiences that are known and named, at least in general terms (for instance, the Holocaust), there is a tendency to treat the limits of representation as objective borders determined by the inherent character of specific events rather than as subjective borders determined by the way an event is experienced. In this essay I propose a different model. Taking as my example the work of Emily Dickinson—a poet whose descriptions of psychic distress, often presumed to be autobiographical,have no known basis in the historical record—I argue that the limits of representation are best conceived as functions of the limits of intention. Further, because intention's failure—whether conceived as an inability or as an unwillingness to form meaningful utterance—is necessarily indistinguishable from the unintended or purely random utterance, I argue that representation's limits are met at precisely those moments when interpretation founders in doubt.
Isaac D'Israeli and Literary History: Opinion, Anecdote, and Secret History in the Early Nineteenth Century
Authors: London April
Published: December 2005

Isaac D'Israeli's contributions to the formation of literary history in the late eighteenth and early nineteenth centuries remain unexplored, his voluminous writings mined for apt quotations rather than considered as significant in their own right. This article argues that his questioning of genre hierarchies and period distinctions grew out of an attempt to correct what he saw as the limitations of contemporary historiographic and literary critical representations. Following his renunciation of revolutionary ideals,these inquiries were framed by a “conservative iconoclasm” that was fostered by the need to adjust loyalist sympathies to fit his own peripheral status. Committed both professionally and temperamentally to a pluralist understanding of history writing, D'Israeli integrated into his work from the 1790s through to the 1840s biographical, political, social, and psychological elements that led him ultimately to a distinctively literary historical mode of thought. Drawing on the resources of opinion, anecdote, and secret history, he articulates possibilities for historicist inquiry that continue to stand as powerful alternatives to the romantic ideology.
Metaphor and Affect
Authors: Sopory Pradeep
Published: December 2005

Metaphors are both cognitive and affective in their meaning. However, a discussion of affect has been absent from recent theories of metaphor comprehension. This article looks at how affect, broadly conceptualized as positive and negative valence, may interact with cognition during the metaphor comprehension process to provide the full import of metaphorical meaning. Four major metaphor processing theories, which enjoy the most support from psychological studies, are discussed: conceptual structure, salience imbalance, class inclusion, and structure mapping. Given the comprehension mechanisms proposed by these theories, valence can contribute to the affective meaning of a metaphor as part of an experiential gestalt, as a pattern, or in a more componential fashion, as an attribute of an attribute of an object or category and as an attribute of an object or category itself.
Does Chronic Illness Affect the Adequacy of Health Insurance Coverage?
Authors: Stroupe Kevin T. , Kinney Eleanor D. , Kniesner Thomas J. J.
Published: December 2005

Although chronically ill individuals need protection against high medical expenses, they often have difficulty obtaining adequate insurance coverage due to medical underwriting practices used to classify and price risks and to define and limit coverage for individuals and groups. Using data from healthy and chronically ill individuals in Indiana, we found that chronic illness decreased the probability of having adequate coverage by about 10 percentage points among all individuals and by about 25 percentage points among single individuals. Preexisting condition exclusions were a major source of inadequate insurance, though not the only cause. Our results emphasize the impact of enforcing the Health Insurance Portability and Accountability Act(HIPAA) of 1997, which limits preexisting condition exclusions.
The Determinants of Time off Work after Childbirth
Authors: McGovern Patricia , Dowd Bryan , Gjerdingen Dwenda , Moscovice Ira , Kochevar Laura , Murphy Sarah
Published: December 2005

Relatively little is known about the role that leave policies—family,parental, or maternity-leave policies—play in facilitating time off work after childbirth. Yet time off is a critical element of leave policies, as it facilitates the mother's recovery from childbirth and promotes maternal-infant attachment. Using data from Minnesota, the state with the highest rate of female labor force participation, we examine the extent to which policies,relative to personal, job, and workplace characteristics, determine the duration of women's childbirth-related leaves from work. A random sample of women identified from vital statistics records is used to estimate the relationship between leave policies and time off work after childbirth. Of our sample 85 percent had access to some paid leave benefits, although only 46 percent had paid maternity leave benefits. The difference in duration of leave between women with and without paid leave policies was approximately four weeks, a substantial difference for most women and their infants. Paid leave policies and spousal earnings as primary determinants of maternal time off work, suggest problems in the use of unpaid leave for economically vulnerable women.
The Implementation of California's Tobacco Tax Initiative: The Critical Role of Outsider Strategies in Protecting Proposition 99
Authors: Balbach Edith D. , Traynor Michael P. , Glantz Stanton A.
Published: December 2005

Enacted in 1988, Proposition 99 increased California's cigarette tax by 25 cents per pack and allocated a minimum of 20 percent of the revenues to fund anti-tobacco education. Tobacco control advocates had used an initiative to secure the tax increase because the legislature had not increased the tobacco tax since 1967, even though public opinion polls showed that the tax was politically popular. Advocates, however, then had to return to the legislature to negotiate implementing legislation. Between 1989 and 1996, the legislature underfunded the Proposition 99 Health Education programs by over $273 million. This underfunding occurred because the public health groups failed to exercise power, ideas, and the leadership needed for legislative success. Even successful litigation against the governor failed to restore the programs. In July 1996, however, the underexpenditures stopped because the issue of the diversions received significant media and public attention. The tobacco control groups used a variety of outsider strategies, including paid advertising, free media, and a grassroots campaign, and the leadership of these groups, in addition to the lobbyists, got involved in the campaign to secure implementing legislation. Without ongoing public pressure, it is likely that policy changes created by tobacco tax initiatives will dissipate into something acceptable to powerful insider interests, such as the tobacco and medical service provider industries.
What Prompts Health Care Policy Change? On Political Power Contests and Reform of Health Care Systems (The Case of Canada and Israel)
Authors: Geva-May Iris , Maslove Allan
Published: December 2005

This article attempts to shed light on the complexity inherent in health care reform policies in the context of political power contests that trigger the changes imposed on the health care system. Rather than being solely a response to financial circumstances, as it is often claimed, we argue that these political contests lead to many of the changes in the systems. Furthermore, changes do not necessarily occur when worrying symptoms appear in the system, but rather when the contest reaches a peak and when neither side involved can emerge from the contest as winner or loser and as defender of the public interest. While in both cases fiscal problems in the health systems are usually brought up in order to justify reform, the trigger for change in Israel has been the power contest between the two main parties—the Labor Party and the Likud Party—with the Likud attempting to impair the financial basis of the former. In Canada, the power contests are between the provinces and the federal government.
A Simulation Model of Tobacco Youth Access Policies
Authors: Levy David T. , Friend Karen B.
Published: December 2005

Empirical studies have found that policies aimed at reducing youth access to tobacco have been successful at increasing retail compliance, but their effects on actual tobacco use are mixed. This article presents a model of youth access policies that helps explain the apparently conflicting results in the extant literature, provides a framework for future empirical studies, and suggests implications for public policy. Our model highlights the interaction of components in a well-designed policy, including sufficient compliance checks, penalties, and community involvement. It also illustrates why it will be difficult to eliminate all of youth supply. Nonretail sources, such as borrowing or stealing from parents and siblings and purchasing from older peers through black markets, are an important component of youth supply and become more important as retail access is reduced. The analysis is limited to policies that affect the retail supply of cigarettes but suggests the need for other policies that affect the demand for cigarettes, such as taxes and cessation policies, in order to further reduce youth smoking rates.
Community Control and Pricing Patterns of Nonprofit Hospitals: An Antitrust Analysis
Authors: Young Gary J. , Desai Kamal R. , Hellinger Fred J.
Published: December 2005

Traditional control of nonprofit hospitals by the communities they serve has been offered as justification for restraining antitrust enforcement of mergers that involve nonprofit hospitals. The community is arguably a constraint on a nonprofit's inclination to exercise market power in the form of higher prices; however, community control is likely to be attenuated for hospitals that through merger or acquisition become members of hospital systems—particularly those that operate on a regional or multiregional basis. We report findings from a study in which we examined empirically the relationship between market concentration and pricing patterns for three types of nonprofit hospitals that are distinguishable based on degree of community control: an independent hospital, a member of a local hospital system, and a member of a nonlocal hospital system. Study results indicated that when conditions existed to create a more concentrated market, (1) all three types of nonprofit hospitals exercised market power in the form of higher prices,and (2) hospitals that were members of nonlocal systems were more aggressive in exercising market power than were either independent or local system hospitals. The results have important implications for antitrust enforcement policy.
Children's Medicaid Enrollment: The Impacts of Mandates, Welfare Reform,and Policy Delinking
Authors: Kronebusch Karl
Published: December 2005

From 1984 to 1990, Congress enacted a series of mandates that expanded Medicaid eligibility for low-income children by gradually delinking Medicaid eligibility from welfare eligibility. The 1996 national welfare reform law nominally completed the delinking process when the statutory phase-in of children's Medicaid coverage was preserved even as the states were given increased flexibility for administering welfare programs. This article provides estimates of the impact of these federal policy changes on children's Medicaid enrollment rates and analyzes the degree of success in uncoupling children's Medicaid enrollment from welfare. Data from the Current Population Survey for 1979 to 1998 are used to provide standardized enrollment probabilities for the United States and individual states. The results show important enrollment increases associated with the period of the mandated expansions, followed by enrollment declines associated with welfare reform. The largest increases in enrollment during this period were in states with historically restrictive welfare eligibility, but rates also rose in states that previously had relatively expansive welfare eligibility. The net effect was a reduction in the extent of state-to-state variation in enrollment. The Medicaid expansion peaked in 1995, prior to the advent of national welfare reform. Since then, children's Medicaid enrollment has fallen, with the largest declines falling on families with the very lowest incomes. Consistent with the desire to delink children's Medicaid coverage from welfare, the association between Medicaid and AFDC/TANF enrollment weakened during the expansionary period, but there still was a relatively strong relationship between policyoutcomes for these two programs. Despite the policy changes,Medicaid coverage of children is still influenced by state-level welfare policy.
Managed Competition versus Industrial Purchasing of Health Care among the Fortune 500
Authors: Maxwell James , Temin Peter
Published: December 2005

The theory of managed competition has found favor with many health policy analysts and academic economists alike. Three characteristics—consumer choice, defined contribution, and dissemination of information—signal managed competition strategy. By requiring private employers to provide their employees with a choice of health carriers, a fixed-dollar strategy (defined contribution), and quality information to make appropriate choices among carriers, managed competition offers to remedy imperfections in both the consumer and provider sides of the market for health insurance. In an extensive survey of health care purchasing practices among Fortune 500 companies we found that major companies are not using the managed competition approach to health care purchasing. Instead, most of the companies surveyed are purchasing health care in the same way as they do other inputs to production—a pattern we call industrial purchasing.
Democratizing the Hospital: Deliberative-Democratic Bioethics
Authors: Dzur Albert W.
Published: December 2005

The increased presence of moral consultants, or bioethicists, within hospitals and clinics in the last two decades has begun to raise questions about their sources of authority and norms of practice. Under pressure from critics in the social sciences, a number of bioethicists have recently raised the ideal of democratic deliberation to defend and reconstruct their place in the medical field. This article sheds light on these developments by placing bioethics in a historical context that shows an early tension between bioethicists as whistle-blowers and bioethicists as incremental reformers of medical practice. This article also develops a conceptual framework for analysis that indicates how such tensions have grown more complicated for contemporary bioethicists because they occupy a fluid and structurally ambiguous role in which there are multiple sources of normative expectations and little guidance for meeting these expectations. The liminality of the role and the overload of expectations have made bioethics vulnerable to methodological criticisms from social scientists. This article concludes that such methodological criticisms cannot address the more systemic problems of liminality and overload. The ideal of democratic deliberation, though imperfect, does address these systemic problems because it shows bioethicists how to gain guidance and share responsibility for moral consultation.
Compensation for Medical Injury in New Zealand: Does “No-Fault” Increase the Level of Claims Making and Reduce Social and Clinical Selectivity?
Authors: Davis Peter , Lay-Yee Roy , Fitzjohn Julie , Hider Phil , Briant Robin , Schug Stephan
Published: December 2005

The issues of patient safety and quality of care have gained policy attention with a growing appreciation of the scale and impact of medical injury in health systems. While the focus is clearly on the prevention of iatrogenic injury, the question of patient compensation is now also considered important, if only because in fault-based tort systems the fear of litigation may itself be a barrier to the disclosure and open discussion of medical error. No-fault systems, by contrast, do not require proof of culpability, and thus may both reduce barriers to compensation and increase disclosure of error. Little evidence, however, is available on the performance of such systems.

This article reports on the analysis of two data sources—a sample of hospital admissions and a complete set of compensation claims for medical injury. Both are for the same year and region of New Zealand, a country that has maintained a no-fault system of accident compensation for a quarter of a century. Just over 2 percent of hospital admissions were associated with an adverse event that was potentially compensable under scheme criteria. While the claims process was well targeted, thelevel of claims making and receipt was low, with the ratio of successful claims to potentially compensable events being approximately 1:30. Comparison of social and clinical characteristics of the two data sets revealed a degree of selectivity. Compared with the hospital events, the typical successful claimant was younger and female and was much more likely to have experienced a surgical adverse event that, while unexpected, was not due to substandard care.

It is concluded that, in interpreting these results, account needs to be taken of a number of features unique to the New Zealand system. These include:the limited payoff for a compensation claim (no pain and suffering or lump sum, free hospital care); the relative complexity of the grounds for claim(either rarity and severity or practitioner error); and a history of limited litigation for medical error. This suggests that, while the New Zealand system is well targeted, cheap, and free of financial and legal barriers, a change in legal doctrine alone has not in itself been sufficient to remove completely the selective and low level of claims making traditionally associated with patient compensation under tort.
Impeding Earl Warren: California's Health Insurance Plan That Wasn't and What Might Have Been
Authors: Mitchell Daniel J. B.
Published: December 2005

It is widely believed that the turning point for U.S. health insurance came in 1949 when Congress failed to adopt President Harry Truman's proposal for a national system. The possibility that a system of state-level health plans might have emerged before Truman's plan has received little attention. Yet several attempts to enact such a plan were made in California by Governor Earl Warren in the mid-1940s. Had Warren succeeded, the California example might have been emulated by other states and the United States might have evolved a system similar to Canada's provincial programs.