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SCIENC~ V ANDMODERN V l N ' ~mHP'lilt y (Volume 44, Number 1) Islamic Economics and Global Capitalism Robert W. Hefner y any measure, the scriptural and early historical legacy of Islam is among the most marketfriendly of all the world religions. In contrast to Christianity's merchant-thrashing Jesus, the Prophet Muhammad was a trader, and the Qur'an abounds with commercial imagery. Islam's holy book enjoins believers to engage in trade in a spirit of goodwill (4:29), faithfully fulfill contractual obligations (5:1; 16:91), and behave in a manner that recognizes the importance of private property and uncoerced exchange. The first three centuries of the great Islamic expansion are recognized as having been an age of unprecedented commercial growth. By the tenth century, Muslim merchants and jurists had developed credit and investment institutions that were among the most advanced in all of Eurasia. Although the late Middle Ages (12501500) saw a decline in the Middle East's economic dynamism, the period was followed by a commercial boom in the Muslim-dominated Indian ocean. There Muslim merchants created the world's largest and most lucrative trade emporium, a vast network that tied coastal East Africa, southern Arabia, South Asia, and Southeast Asia into a vast trading zone. In the Southeast Asian wing of this trade oecumene, the fifteenth and sixteenth centuries saw the development of an independent merchant class that, like its counterpart in Renaissance Europe, patronized the arts, promoted individualized styles of religiosity, and even sought to curb the authority of rulers. Notwithstanding these precedents, Muslim civilization never developed the banks or other corporate instruments so central to the development of modern B capitalism in the West. Muslim civilization's relative decline was visible in other spheres as well. By the twelfth century, the Muslim world's "colleges" (madrasas) had institutionalized a curriculum that, with the exception of schools in Iran and northern India, banished science and Hellenistic philosophy from religious education. By the fifteenth century, the Muslim world's proud tradition of astronomy, physics, and mathematics had begun to lag behind that of Western Europe. When, in the late eighteenth and nineteenth centuries, Europeans challenged the world's three powerful Muslim empires, the Ottoman, Safavid-Iran, and Mughal India, Muslim observers were startled to realize that their once self-sufficient societies had fallen far behind those of the West. y purpose in this paper is not to explain just why it was that a civilization as great as that of Islam s came to lag behind its upstart rival on the northern shores of the Mediterranean sea. That question has preoccupied historians and sociologists for more than a century, and an adequate survey of their analyses would take us far beyond the main topic of this paper, namely, how adherents of different religions have responded to modern capitalism. To understand Muslims' response to modern capitalism, however, it is important to know something of this broader historical background, since it has conditioned Muslims' perceptions of their place in the world. With good reason, Middle Eastern and South Asian Muslims had long tended to see themselves as politically and culturally self-sufficient. This civilizational legacy only made Muslims' recogni- M This symposium is based on a conference hem on May 4 and 5, 2006 under the auspices of the Institute on Culture, Religion, and Worm Affairs at Boston University. Grateful acknowledgement is made to the Lynde and Harry Bradley Foundation for its generous support in making the conference possible. 16 SOCIETY| ~ NOVEMBER/DECEMBER2006 tion of their own lag vis-h-vis the West all the more awkward. It has also deepened some Muslims' ambivalence about a global economic order that bears the all-too-clear imprint of having been "made in the West." In the remainder of this paper, I want to focus on the nature of the Muslim responses to modern capitalism. My discussion will focus less on the sociology of Muslimowned business organizations than on the religious and ideological effort to devise what has come to be known as an "Islamic economics." Islamic economics is an intellectual and economic enterprise that professes to provide the terms for an alternative economics to that of the modern West. The central claim of Islamic economics is that Islam provides an all-encompassing model for social, economic, and political life. The concerns and debates of Islamic economics provide a fascinating point of entry into the thoughts of Muslim leaders on global capitalism, as well as the depth of the ideological schisms that run through public opinion in the modern Muslim world. The Third Way Islamic economics is not an ancient intellectual tradition, but a modern movement that asserts that Islamic traditions of law and organization provide a more just and equitable model for economic growth than do the rival systems of Western capitalism and socialism. Western capitalism, it is said, has been capable of great dynamism and expansiveness, but its achievements have been premised on gross inequality and the exploitation of workers by capitalists. By contrast, the Islamic economist avers, socialist economies have placed greater emphasis on equity and social justice, virtues also highlighted in Islamic economics. But socialists, the Islamic economist laments, have highlighted these values while also suppressing commercial traditions of which Islam approves. In principle, then, Islamic economics presents itself as a salutary third way: avoiding the inegalitarian excesses of modern capitalism, but unleashing the energies of entrepreneurs and merchants. Leaving aside the question of whether their characterizations of capitalism and socialism are accurate, Islamic economists' appeals for a third way between the two Western systems are of recent origin, having taken shape only since the 1970s. Indeed, the first and most important fact to underscore about Islamic economics is its unquestionable modernity. Although some of the institutions that Islamic economics highlights as Islamic have their roots in classical and middle Islamic history, others, like the centerpiece institution of Islamic banking, have no direct cultural precedent. Calls for the implementation of an Islamic economics began to be heard in the 1960s and 1970s as a result of three developments. The first was the decline of Arab and Muslim socialism, itself the result of the discrediting of its allied ideological current, Arab nationalism, after the shocking defeat of Arab armies in the 1967 war with Israel. The second major influence appeared shortly thereafter. Beginning in the 1970s, a resurgence of Islamic piety and activism swept across the Muslim world, and it fueled a growing interest in Islamic alternatives to all manner of political and economic institutions. Although in the 1950s and 1960s, modernization theorists like Daniel Lerner had forecast the decline of Islam as a public religion, the revitalization of Islamic piety showed that there was to be no end of religion in Muslim-majority societies. The political temperament of the Islamic resurgence varied from moderate or moderately conservative to radical and even revolutionary. Notwithstanding this political variation, most Muslim resurgents agreed with an idea popularized by earlier Islamist ideologues, such as Egypt's Sayyid Qutb and Pakistan's Sayyid Abdul-Ala Mawdudi, that Islam was a "total way of life" and it provided positive prescriptions for politics, economics, and culture. The third and final influence underlying the recent popularity of Islamic economics has been the related effort to bring about an "Islamization of knowledge." Not all Muslim intellectuals agree with this movement's demand that science and modern inquiry be purged of their allegedly secularist and Western biases. Indeed, as illustrated in the writings of the great Indonesian modernist, Nurcholish Madjid (d. 2005), and the Iranian reformer, Abdulkarim Soroush, a leitmotif of modernist and liberal Muslim thought has always been that science and technology of "Western" provenance are best regarded as the fruits of God-given human reason, not things that are uniquely Western. Science is a gift of God to all of humanity. Nonetheless, in keeping with the ideas that Islam is a total and perfect way of life, the movement for the Islamization of science and knowledge gained momentum in the 1970s and 1980s. Islamic economics has come to be regarded as one of this intellectual movement's most important pillars. Islamic Banking Although aspiring to provide a full-blown alternative to neoclassical economics, the programs recommended ISLAMIC ECONOMICS AND GLOBAL CAPITALISM 17 by Islamic economists are actually modest in scope. They focus on the effort to build two institutions: a system of Islamic banking that steers clear of charging interest, and a program of religiously mandated almsgiving, the zakat, the purpose of which is to purify wealth and redistribute some of its surplus to the needy. he religious premise that underlies the first of these institutions, Islamic banking, is that the Qur an prohibits riba, and that riba refers to interest on capital in all forms. Although all Muslim scholars agree that the Qur'an prohibits riba, the term's translation as "interest" is controversial. In Islam's first centuries, some jurists argued that riba refers not to interest on capital per se, but only the usurious forms of interest once widespread in Arabia. In those early years, individuals who defaulted on loans were liable to being condemned to debt-bondage or slavery. It is predatory arrangements like these, some jurists insisted, to which the prohibition on riba really applies. By the Middle Ages, however, the majority of jurists adopted the broader position, insisting that the prohibition on riba referred to all forms of interest on capital. Notwithstanding the jurists' consensus, the practice of lending money with interest remained widespread across the medieval Muslim world; it remains so today. In the early twentieth century, Western banks began to play an important role in the economies of many Muslim-majority countries. The growth of conventional banking encouraged Muslim jurists to revisit the question of riba's meaning. Although many continued to insist that the prohibition on riba applied to all forms of interest, several influential jurists in Egypt and Indonesia argued to the contrary. They said that non-usurious rates of interest on loans were compatible with Islam, because they brought benefit to both individuals and the community. Although many jurists continued to disapprove of conventional banking, from the 1920s on, the institution played a growing role in the economies of Muslim-majority countries. Today conventional banks remain the most popular institution for savings and finance in all Muslim-majority countries except Iran and Sudan, which have abolished interest-charging banks outright. The first tentative steps toward the creation of nointerest "Islamic" banks were taken in the 1960s. The initiative gained further momentum a decade later, in the aftermath of the spectacular increase in oil prices and state revenues during the early 1970s. Governments T 18 SOCIETY| 9 NOVEMBER/DECEMBER2006 and private foundations in Saudi Arabia and the Gulf committed some of their new wealth to religious programs, including think-tanks and institutions dedicated to the cause of Islamic banking. The founding of the Saudi-finance Islamic Development Bank in 1975 lent additional support to the cause, since the bank was supposed to sponsor interest-free financial institutions. Soon Islamic economics caught the attention of politicians. In the late 1970s and 1980s, Pakistan took steps to reorganize its banking system along Islamic economic lines; Iran followed suit in the early 1980s. Today institutions dedicated to Islamic forms of banking have succeeded in establishing a significant presence in most Muslim-majority countries. They have also acquired a foothold in several Western countries. Where conventional banks remain legal, however, they remain the preferred financial institution for the majority of Muslim businesses. Western banks like Citicorp and the Deutsche Bank have also developed deposit and credit arrangements based on Islamic banking principles. Although Islamic banks have not been able to fulfill all the hopes of their promoters, they have succeeded in carving out a small, but respected position in global finance. The prohibition of interest is the sine qua non of Islamic banking, and, so as to conform to this ambition, Islamic banks have developed a handful of lending arrangements based on profit-and-loss sharing rather than interest. The two most popular instruments are mudaraba and musharaka, economic partnerships that were recognized in classical Islamic law. It is interesting to observe, however, that the legal partnerships recognized in Islamic law refer to relationships between individuals, not corporations. Islamic jurisprudence did not develop laws for corporations, and, therefore, it did not develop a concept of banking or corporate finance. This is to say that the broader legal framework on which Islamic banking depends actually owes more to Western civil law than it does to classical Islamic precedents. otwithstanding this latter genealogical linkage, in matters of finance, Islamic banks do differ from their conventional counterparts. Under the terms of mudaraba, a bank or group of investors provides capital to a producer or merchant, who invests the money in his enterprise and then repays the bank with a previously agreed share of the profits, along with principal. If the enterprise fails, the bank or investors bear the loss. Musharaka works in a similar fashion, ex- N cept that the merchant or producer also risks some of his and its opportunity costs. As in any other economic own capital in the enterprise, thereby earning a higher enterprise, the costs of an Islamic bank's intervention share of the profits than under mudaraba contracts. in the management and execution of a project increase Deposits in Islamic banks are premised on a similar the more deeply involved the bank becomes in these profit-and-loss sharing principle. Under one type of activities. Costs to the bank also increase in proportion deposit, depositors earn no return on their capital but to the variety of fields of enterprise in which the bank the deposit is risk free. A second category of deposit, chooses to become involved. Where an Islamic bank the investment deposit, exposes the depositor to the risk has many venture partners and those partners operate of capital loss, but this arrangement also provides the in differing economic fields, the bank may have to depositor with a share of the bank's earning. devote additional staff resources to learning the rules As this brief overview indicates, from the perspecof these different business games. The costs the bank tive of Western finance, the principles underlying Isincurs will rise accordingly. lamic banking are not in the least alien. On the contrary, In the case of Western venture capitalism, investors they operate in the same manner as the venture capital have sought to reduce transaction costs of this sort industries that have financed some of the American by concentrating their investments in fields such as economy's most dynamic enterprises, including Silicon computers or software engineering where the venture Valley's software industries. As with capitalist already commands the exthose venture capitalists, the Islamic pertise required to assess the business Costs to the bank also prospects of his partner. Although bank typically gets more deeply involved in assessing the profitability of increase in proportion some of its supporters have tended the entrepreneur's project than is the to the variety of fields to overlook this fact, Islamic banks case with conventional banks, since of enterprise in which have had to respond to the costs of the terms of the investment contract the bank chooses to partnering with their business partners depend on the scale of the risk assumed become involved. using a similar cost-benefit calculus. by the bank-investor. Proponents of Unable to be a financial jack-of-allIslamic banking often cite the greater involvement of trades, many Middle Eastern banks have concentrated Islamic banks in project management and execution their investments in real estate, commercial trade, and as proof of the greater fairness of Islamic banking by other relatively safe enterprises that do not demand a comparison with conventional banking, on the assumpspecialized technical knowledge. tion that bank involvement provides helpful managerial Idealistic proponents of Islamic banking are often assistance to the enterprise in question. disappointed to realize that Islamic banks operate in As with venture capital finance, there may be truth so conventional a manner, since one of the ambitions to the claim that Islamic banks provide useful manaof Islamic banking has been to provide investment gerial services, but the claim is true only inasmuch services to Muslim enterprises too poor, too varied, and as the transaction meets two empirical conditions: too poorly connected to get access to conventional bank first, that the bank actually has some technical or loans. However laudable this ambition, its proponents managerial expertise to provide its business partners, have sometimes overlooked the fact that the effective and, second, that the bank staff have the time and opprovision of managerial services requires hands-on as portunity to provide the relevant managerial counsel. well as general knowledge, and the acquisition and Although proponents of Islamic banking often write provision of this knowledge has economic costs. Alas if these conditions are automatically met as a result though, particularly in their early years, Islamic banks of the terms of a bank's investment in an enterprise, in countries like Indonesia and Pakistan made a laudthe recent history of Islamic banking has shown that able effort to provide capital to small-scale businesses, this is by no means always the case. There are sound the high cost of doing so has meant that succeeding economic reasons as to why this is so. The acquisition generations of bankers have opted to commit much of and provision of business expertise is not a free good their capital to safe and relatively established business but, like any business service, has economic costs. The partners. Inasmuch as this has been the case, the effect costs of managerial expertise are related to the difficulty of Islamic banking on the neediest sectors of the capital of its acquisition, the time required for its transmission, market has typically been modest, to say the least. ISLAMIC ECONOMICSAND GLOBALCAPITALISM 19 A second problem that has limited Islamic banks' ability to play a larger role in financial markets is related to what Muslim economist Timur Kuran (an articulate critic of Islamic banking) has called the "adverse selection problem." In the great majority of Muslim-majority countries, conventional banks operate alongside a smaller Islamic banking sector. As a result, entrepreneurs interested in getting access to capital have a choice as to which type of financial instrument they may use. For entrepreneurs worried that their business venture may not be profitable, it is economically rational to opt for a profit-and-loss sharing arrangement like that offered by an Islamic bank, since this minimizes their exposure to loss in the event that the venture fails. By contrast, for entrepreneurs confident that their business can reap great rewards, it makes better economic sense to work with a conventional bank, since the fixed loan rates it provides allow entrepreneurs to keep a greater share of their profits. Inasmuch as this adverse selection problem has influenced Islamic banking, it has undercut Islamic banks' profitability, and insured that the conventional banking sector often remains the more dynamic in countries where both types of banks exist. In this and other examples, the social impact of Islamic banking has been limited by the fact that, notwithstanding idealistic hopes to the contrary, the Islamic system is subject to the same constraints of cost, benefit, and information management as conventional banking. Religious Redistribution One of Islam's five pillars, the zakat is a tax levied on income and wealth for the purpose of their purification; the levy is also intended to provide assistance to the indigent, the handicapped, travelers in need of aid, and teachers or leaders active in the promotion of Islam. In modem times, proponents of Islamic economics have pointed to the zakat as a key symbol of the difference between Islamic economics and capitalism. Muslim authors of a progressive or "social transformationalist" disposition (to use a phrase popular in some Islamic countries as an alternative to what Western writers might call "left-leaning") have tended to cite the zakat as proof that Islamic economics show greater concern for the disadvantaged than does Western capitalism. As with Islamic banking, claims of this sort place a heavy burden on the shoulders of an institution of considerable symbolic significance, but, in the broader scheme of things, modest economic impact. Although 20 SOCIETY* ~ NOVEMBER/DECEMBER2006 the Qur'an makes clear that the payment of zakat is incumbent on those who can afford it, it is unspecific on the types of wealth to be taxed, relevant rates of taxation, to whom the accumulated wealth should be redistributed, and whether the zakat should be administered by the state or private individuals. During the early years of the Prophet's leadership in Mecca, the Muslim community's assistance to the poor was personal and voluntary. After Muhammad's flight to Medina and establishment of a state in 622 C.E. the zakat became compulsory and was administered by state officials. After the Prophet's death in 632 C.E., however, leadership struggles broke out among different factions in the Muslim community. The conflict caused the collapse of state bureaus responsible for zakat administration. From that point on, the state zakat was replaced by a variety of decentralized and voluntary arrangements. In the great majority of Muslim countries, decentralization has remained the pattern for zakat payment to this day. In a few countries--Saudi Arabia, Pakistan, and Malaysia--however, the government has re-instituted the policy of administering the zakat through state agencies. Although Islamist politicians in other countries have advocated a similar policy of dtatization, the levy elsewhere remains voluntary. Consistent with this decentralized pattern, the zakat is collected by a variety of social agencies, including religious schools, welfare associations, village councils, and local networks of family and neighbors. Just as there is disagreement over the proper form for administering and distributing zakat, jurists and activists disagree over the types of wealth subject to taxation, and the rates that should apply. Mainstream jurisprudence has tended to emphasize that the tax should be levied on the types of wealth to which it was applied in seventh- and eighth-century Arabia: agricultural produce, livestock, precious metals, and minerals. The same sources provide different rates of taxation for each of these categories of wealth, ranging from 2.5 percent for precious metals to 20 percent for minerals. Since modern economies have a wider array of income-generating activities than was the case in classical Arabia, many Islamic economists have suggested that modem sources of revenue, like manufacturing and services, should also be subject to the levy. Strict-constructionist jurists have objected to this suggestion, insisting that to innovate in this fashion is to violate the letter of God's law. In countries where the zakat has been made compulsory, state officials have o~ often fallen back on a compromise position, extending the scope of coverage to new sources of income, while keeping close to the letter of the law with regard to rates for traditionally recognized revenue sources. Proponents of the zakat have also had to deal with the thorny problem of convincing the Muslim public to pay the levy, and what to do with the funds once they are collected. In most countries today, even where the state administers collection, enforcement remains difficult, not least of all because modern forms of savings and investment have made it easier to hide personal wealth. The enforcement problem is aggravated by the fact that in many countries the zakat administration has been plagued by corruption and disagreements over just who should receive the payment. There is also a longestablished tradition in Muslim jurisprudence that, not merely the poor and handicapped, but those involved in the promotion of Islam, such as teachers and religious leaders, should receive part of the levy. Sometimes the share given to well-connected leaders becomes the lion's share. In these instances, then, rather than diminishing inequality, the zakat can actually reinforce it, channeling the Muslim community's surplus wealth back to the well-connected and powerful. Many of the world's religions make provisions for some kind of religious charity, and most of them have had to deal with problems similar to those faced by proponents of the zakat. As the administration of zakat has become subject to greater public scrutiny, reformers have called for the distribution to be made more transparent. In many countries, the once-controversial idea that zakat should be used not merely to provide payment to individuals but for broad-based programs of education and poverty elimination, has come to be accepted even by traditionalist jurists. These examples illustrate that, rather than an unchanging entity, the zakat is and will continue to be drawn into modern discussions of the proper forms and meanings of Islam, similar to the debates that have taken place in other religious traditions in modern times. This is to say that the uses of zakat today have less to do with timeless traditions, than they do with the efforts of believers to imagine and organize themselves in the new public spheres of the nation-state and the global economy. Moral Idealism and Market Realities Notwithstanding the efforts of Islamist activists, Islamic economics remains a respected but decidedly peripheral portion of the Muslim world economy. The situation of Islamic banking is telling in this regard. Empirical studies confirm that most wealth created in Muslim countries today is recycled into conventional banks and equity markets, not Islamic banks. For pious Muslims who believe that God's law prohibits interest on capital, Islamic banks provide a useful and rational instrument for capital investment. However, the Islamic banking system has not created a comprehensive alternative to global capitalism. Moreover, in everything from their passbooks to their tellers, Islamic banks draw more heavily on the conventions of Western banking than on some timeless Islamic precedent. Equally important, the investment capital that these banks direct for a few brief moments through the sluice gates of mudaraba and musharaka quickly flows back into a global market dominated by conventional financial instruments. For Western critics inclined to gloat in the face of Islamic economics' limited impact, it is worth remembering that the tensions that led some Muslims to dream of an alternative economics are far from resolved. Many Muslim countries are still having difficulty jump-starting their economies, and the problem has become all the more disquieting as capitalist economies have put down firm roots in places like China and India. The tensions are also related to the fact that many of the consumption habits promoted by global markets and media are seen as antithetical to Muslim ethical traditions. Libertarians may dismiss this last concern, on the grounds that ethical questions are best left to the discretion of private individuals. But the libertarian claim is a normative prescription rather than a settled social fact, one to which many Westerners as well as Muslims take exception. Moreover, the chances that such a privatistic approach to ethics will find much acceptance in the Muslim world any time soon seem slim. At the heart of Islamic ethics lies the injunction that believers should command what is right and forbid what is wrong (al-amr bi'l-ma'ruf wa'l-nahy "an al-munkar). All religions change, and the content of this injunction has been understood differently in different times and places. But the injunction's underlying impulse, that ethics must be treated as a compelling public good, continues to resonate powerfully across the Muslim world. As far as modern capitalism is concerned, this latter cultural fact has interesting implications. It means that we should expect that the front lines in the Muslim engagement with global capitalism may lie less in the realm of Islamic banking and zakat collection than in ISLAMIC ECONOMICSAND GLOBALCAPITALISM 21 the public effort to impose ethical constraints on the consumption practices and lifestyles modern capitalism makes possible. With its endless exploration of new frontiers of consumer demand, late modern capitalism has made an industry of destabilizing consumer values and preferences. Consumerist capitalism and the media and advertising industries it has spawned have strained, if not severed, the ties that Max Weber identified a century ago between capitalism and the Protestant ethic. In the Muslim world, the tension surrounding consumer tastes is all the greater, not least of all because so many of the dress styles, entertainment trends, and sexual media now available for mass consumption are of Western and East Asian provenance. fact remains that global capitalism, in all it,s cross-cultural expressions, is today the world s dominant economic system, and its products and lifestyle-images will continue to flood world markets and media. Contrary to the forecasts of some globalization theorists, these processes will not inevitably lead to the homogenization of global culture. In the Muslim world, we can expect to see continuing tinkering at the edges of the productive and financial system, along the lines of Islamic banking and the zakat. We can also expect that the largest and most successful Muslim-owned businesses will continue to operate, as most currently do, according to management principles that owe rather little to the discipline of Islamic economics. T h e Rosemary Stevens Meanwhile, the more serious controversy will likely rage in economic spheres related to consumption and lifestyle. In these domains, we can expect to see continuing argument and occasional culture wars over the proper balance between private choices and public ethics. The battle lines in this exchange will not pit a unitary Muslim populace against an equally monolithic West. The fiercest exchanges will likely involve Muslims taking issue with fellow Muslims over the question of how to consume and behave ethically. Seen from this Muslim perspective, the globalization of modern capitalism has not ushered in an end to economic history. In the Muslim world, capitalism's ascent has intensified debates over that which advertisers and marketers in the West have also long made a target: the tastes and lifestyles of millions of citizen consumers, who use goods and services to explore who they are and how they should behave. In all this, one thing seems certain. It is that, for the world's 1.2 billion Muslims, the culture-wars chapter in the capitalist revolution has just begun. Robert W. Hefner is professor of anthropology, associate director of the Institute on Culture, Religion and World Affairs at Boston University, where he directs the program on Islam and civil society. He has published more than a dozen books, as well as several major policy reports. He is author of among many books, Civil Islam: Muslims and Democratization in Indonesia. Essays on the History of American Health Care Policy The distinctive mixing and continuous remixing of public and private roles is a defining feature of health care in the United States. The Public-Private Health Care State explores the interweaving of public and private enterprise in health care in the United States as a basis for thinking about the history of health care and its continuing evolution today. Historian and policy analyst Rosemary Stevens examines the flexible meanings of the terms "public" and "private," and how useful their ambiguity has been and still is; the role of ideology as ratifying rather than preordaining change; and the common behavior of public leaders and corporate entities in the face of fiscal opportunity. Rosemary Stevens is a DeWitt Wallace Distinguished Scholar in social medicine and public policy at Cornell Medical College, Professor Emeritus, University of Pennsylvania. ISBN: 0-7658-0349-6 (cloth) December 2006 385 pp. $39.95 ]~ transaction Publisherof Record in International Social Science Rutgers--TheStateUniversityof NewJersey DepartmentBKAD06SO09 35 BerrueCircle Piscataway,NJ 08854-8042 22 SOCIETY | 9 NOVEMBER/DECEMBER 2006 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.