It is difficult to know exactly how many coverage denials there are because the American health care system is notoriously fragmented. This chapter introduces a novel survey of 1,340 US adults, finding that 36 percent of respondents have been denied at least once, and typically experience multiple denials. Those in private health insurance experience denials to the greatest degree, which is consistent with private insurers’ cost containment objectives. Health care can be denied for any number of reasons, such as the lack of medical necessity, the absence of a required prior authorization, or an assessment that the care is experimental or investigational. Combining survey and interview evidence, the chapter highlights the destabilizing impact that denials – whether pre-treatment (as with prior authorization) or post-treatment (as with emergency care) can have on patients, whose trust in the health insurance system can be shaken. While prior authorization and other coverage denials can constitute important ways to guard against overtreatment in the American health care system, this chapter presents new evidence that managed care tools may overcorrect, instead denying appropriate care.

This chapter places Tony Blair government's modernisation agenda within the context of arguments about the configuration of local political decision-making. It addresses a number of vital questions that are raised by the introduction of a directly elected form of local political leadership. Local government in England is the means by which the provision of local services is brought together with the world of politics, and party politics in particular. Some common themes of past examinations of local government have been low levels of public awareness and engagement, the intensity and appropriateness of party politics, and the lack of visibility and transparency in political decision-making. The advent of directly elected mayors within English local government raises a wide but simple set of questions about the effect of direct election to executive political office on local democracy and representation. Finally, an overview of the chapters included in this book is shown.

This chapter focuses on the history of India. It explores the roots of Indian identity and discusses how the Indian civilisation was influenced by various processes such as foreign invasions, foreign trade and cultural imperialism. This chapter suggests that these processes have forged links between Indian and other societies and explains that these links are being emphasized by both the Indian government and the media in this age of globalisation.

Since 1988, Japan and Britain have responded to the common threat of global warming. Both countries voluntarily established a policy to tackle the problem before the adoption of the United Nations Framework Convention on Climate Change. Once it was established, they developed and implemented policies and measures to meet its requirements as well as the goals they set for themselves. The picture that emerges from the present detailed examination of climate policy in Japan and Britain is a mixture of policy similarities and differences. This chapter compares, contrasts, and analyses Japanese and British global warming policy, focusing on the speed of policy change, policy contents including instruments employed, the degree of policy integration, and policy stringency. It then considers two questions: What is the effect of corporatist institutions on a country's ability to tackle challenges to sustainable development? What are the interactions between the institutional and issue-based approaches? The chapter also discusses Britain's measures for reducing carbon dioxide emissions, the politics of carbon tax, consensus corporatism and majoritarian pluralism, and the institutional approach vs. the issue-based approach.

Drawing on theories of strategic culture, this book analyses the process and outcome of Germany's transformation. It shows how the new German security posture is based on a working consensus between two very different domestic schools of thought about international security and Germany's role in the world. It examines the lengthy and at times acrimonious domestic German out-of-area debate as it unfolded in the German Bundestag—the debate's major public forum—in the period between the first Gulf War in 1991 and the war against Iraq in 2003.

This book explores how Japan and Britain responded in the face of the common policy imperative of tackling global warming. It considers two theoretical perspectives. One is the institutional approach, which emphasises the importance of national institutions in shaping politics and policy. The other is the issue-based approach, which emphasises the constraints inherent in an issue that fall on rational actors regardless of the institutions in which they are operating. Rather than examining which approach is right or better, the book combines the two in analysing Japanese and British policies on global warming and to explore the relationships between the two approaches, and hence the role of institutions in explaining politics and policy. It also explores four aspects of environmental policy: the speed of policy change; the content of policy, including the choice of policy instruments; the degree of integration of global warming concerns into the policy areas of energy and transport; and policy stringency. Moreover, it discusses the United Nations Framework Convention on Climate Change, consensus corporatism and majoritarian pluralism, and styles of environmental policy-making in Japan and Britain.

The adoption of the Kyoto Protocol in December 1997 brought global warming politics to the next stage. With legally binding reduction targets for greenhouse gas (GHG) emissions allocated to developed countries and, as many of them had failed to control their carbon dioxide emissions, efforts at reducing GHG emissions were strengthened in many developed liberal democracies. This epilogue examines major policy developments in Britain and Japan and discusses the implications for the main findings in this book. The change of government in Britain in May 1997, when the Labour Party won the general election with a landslide after eighteen years of Conservative government, also provides an interesting test of whether and to what degree British policy characteristics are the consequences of deep-seated state orientations underpinning its institutions or specific party ideologies. Climate policy and politics in Japan are also considered, along with the country's green automobile taxation, energy-related taxation and spending, renewable energy portfolio standards, climate change levy package in Britain, and emissions trading in Britain and the European Union.

This chapter considers the powers, responsibilities and activities of English mayors against the expectation. It also addresses the development of the office of elected mayor in England and some options for how that development might occur. The directly elected mayors have expressed their frustrations with the configuration of political power within their councils. It is noted that holding local executive political office is not the sole property of the political party. Mayoral power and responsibility rest currently on the type of council the mayor inhabits: district, county, unitary or London borough. As usual in English politics, greater power has to be earned, not granted as a right, and elected mayors must prove a case for more power, for both their office and their council. The English mayor requires a different legislative framework, a different political and institutional set of arrangements, and considerably more political and governing power.

This chapter examines, through three case studies, how the elected mayors have engaged with local political issues that have stimulated intense public interest and political activity. The Hartlepool ‘ghost ships’ saga is interesting because it arose in an area governed by an elected mayor and because it affected an area in which two elected mayors—Stuart Drummond and Ray Mallon—held conflicting positions on the issue. The Liberal Democrat mayor of Watford had originally opposed the introduction of an elected mayor to the borough and announced before her election (as mayor) that she wished to see it replaced. The case studies show that English mayors must navigate a complex set of interrelationships when governing and that they cannot rely on being able to make a decision at the end of such negotiation.

In the decades before and after 1900, portrait photographs offered new ways of studying and perceiving the human face. As we have seen, Proust, Kafka, and Woolf all took an interest in the medium and depicted how their characters engaged in the reading of portrait photographs. Yet this literary attention to the medium should be correctly understood. When Proust, Kafka, and Woolf describe the cultural and affective practices surrounding portrait photographs, these scenes are not merely representations of a set of trivial media habits, subordinated to the respective novel's course of action. Rather, such scenes serve as fictive laboratories for the study of portrait photographs and their relation to the beholder. They could be described as modernist media labs, exploring the attraction of portrait photographs and the uncertain status of the mediated face. Even if such scenes are usually not in the foreground, they are of great significance. Reading them attentively, we see that Proust, Kafka, and Woolf took the impact of portrait photographs seriously and explored the ways in which such pictures work on the beholder.

When literary texts reflect on the media situation, this allows us to consider the media as part of a lived environment and to comprehend the emotional and relational implications of media change. As media theorist Friedrich Kittler states, modernist literature was highly sensitive to the new media technology: