I. Essay: Private Foundations, Government, and Social Change: Home and Community-Based Care for the Elderly

Prologue: The social dilemmas facing the twentieth century loom ever larger. Challenges such as the ravages of cancer and acquired immunodeficiency syndrome, the arms race, and grinding poverty demand immediate national and international attention, but the capacities of nations are limited. Within the U.S., society has recently embraced policies that call for a less formidable central government and have thus moderated the growth of tax-financed expenditures. These decisions have placed in more prominence the role of private philanthropy. While philanthropy cannot hope to replace all government spending reductions, creative grantmaking can become an influential force for innovative change. Given the new importance that many interests attach to private grantmaking, Health Affairs is inaugurating, with this issue, a new section that will report the trends of health philanthropy. The new section has three parts: an essay analyzing a public policy issue of particular concern to foundations (and thus society);...