Winners and losers under medical savings accounts

As legislators wait to see how the MSA approach to health care reform plays out in the laboratory of the states, authors Marilyn Moon, Len M. Nichols and Susan Wall have put the numbers to work. The researchers simulated the effects of introducing MSAs into the health insurance market. What they found is what critics of MSAs suspected: As the young and healthy shift to MSAs, the premiums for those left in the remaining insurance pool will escalate. However, the authors conclude that if you are male, young and healthy, you stand to gain a lot from the MSA experiment.     

Intelligently Designing Deliberative Health Care Forums: Dewey's Metaphysics,Cognitive Science and a Brazilian Example

Imagine you are the CEO of a hospital [. . .]. Decisions are constantly being made in your organization about how to spend the organization's money. The amount of money available to spend is never adequate to pay for everything you wish you could spend it on, therefore you must set spending priorities. There are two questions you need to be able to answer . . . How should we set priorities in this organization? How do we know when we are doing it well? When people seek to achieve good public policy, the result will tend to be good public policy. In a collective choice process, public‐spirited individual participants produce good public policy by deliberating—talking with each other, listening to each other's arguments, and being willing to learn and change their minds based on such dialogue. – Steven Kelman (1992 : 181)

Public policy scholars agree that those persons (or agencies) vested with the authority to establish health care priorities should elicit public input before making rationing decisions. The two most common approaches are (i) consultation and (ii) deliberation. Though deliberation has obvious advantages over consultation, it falters in the face of the objection that ordinary citizens lack the cognitive resources for the extended, rigorous inquiry required of them in undertaking the priority‐setting task. To overcome this objection, I propose that deliberative forums for health care rationing should be designed so that they imitate the natural pattern of human experience. The experience of deliberation should encompass both prolonged periods of less‐demanding cognitive activity, in which citizens passively receive information, and briefer periods of more‐demanding cognitive activity, in which they engage in active problem‐solving. In arguing for this thesis, I rely on two theoretical sources and one practical case study, in the following order: (i) John Dewey's metaphysics of experience, (ii) cognitive science research on schemas and frames, and (iii) the Health Care Council in São Paulo, Brazil.     

Bureaucratic institutional design: the case of the Italian NHS

We propose a model where a regional government’s choice of the number of bureaucratic agencies operating in a region depends upon the degree of substitutability and complementarity of the bureaucratic services being demanded. We show that, if the government perceives the citizens’ demand as a demand for substitutable services, it will choose provision by two independent agencies. If the government perceives the citizens’ demand as a demand for complementary services, it will choose provision by a single consolidated agency. Exogenous shocks to the number of citizens amplify these incentives. Evidence from the Italian National Health Service (NHS) supports this hypothesis. Results show a positive effect of proxies of substitutable services on the number of regional local health authorities and a negative effect of proxies of complementary services. The major immigration amnesties, taken as shocks to the number of citizens entitled to the service, magnify these effects.     

浅谈体育游戏在中学体育与健康课教学中的运用

体育游戏对于促进学生智力的发展,促进学生身体的生长发育,培养运动兴趣具有重要意义,对于提高中学体育与健康课的教学质量,顺利完成教学任务,具有积极的作用,体育游戏是进行中学体育与健康课教学的手段之一,是体育与健康课教育的重要方法。根据游戏的特点和价值,结合中学教材内容,正确科学选择游戏并合理组织实施,既能充分调动学生的情趣,又能很好地辅助教学任务的完成。     

THE QUALITY OF LIFE IN THE GROWING CITY

When the stranger says: “What is the meaning of this city? Do you huddle close together because you love each other?” What will you answer?“We all dwell together to make money from each other” or “This is a community”?     

Making the most of the best: Formulating a knowledge management strategy for a government advisory body

‘Well, there seems to be a growing consensus among companies doing knowledge management that the correct focus should be neither on the individual nor the enterprise, but instead on some grouping of people who share common context, stories and passion, around a subject’ (Larry Prusak).¹ What do you get when some 20 people meet every three or four months, each one at the top of their respective fields and from different organisations and with different backgrounds, in different cities around Australia? In the case of the Family Law Council you get scintillating intellectual pyrotechnics, sharing of insights and even, in a typically understated Australian way, passion. The Family Law Council (the Council) is a government advisory body. Advisory bodies have two primary functions: to provide expert and representative advice in an increasingly specialised and complex social environment; and to open up channels of communication between government and the people (Hughes 1995). This article examines how the tools and analytical techniques of knowledge management (KM) can add value to the two primary functions of the Council. Drawing on the conceptual framework of KM, and on the basis that the Council forms a knowledge system, this article will examine the workings of the Council. It will look at its statutory role, environmental background and logistics, in order to propose a KM strategy adapted to its specific circumstances. And it will, where appropriate, illustrate points with discussions based on methodologies and case studies from the flourishing academic field of KM.     

Organizational meanings of program evaluation

Program evaluation has to be understood as an organizational phenomenon: it is a way of understanding and evaluating action in and between organizations. But it rests on assumptions about organization which need to be challenged, and which have to be understood as a particular framing of organizational activity which will facilitate hierarchical control. Attention needs to be given to the way in which ‘evaluation’ are used to structure organizational activity. This raises significant questions about the relationship between the analysis of organizational activity and the activity itself. ‘Colonel Cargill envies you because of the splendid job you're doing on parades. He's afraid I was going to put you in charge of bomb patterns.’ Colonel Scheisskopf was all ears. ‘What are bomb patterns?’ ‘Bomb patterns?,’ General Peckem repeated, twinkling with self-satisfied good humor. ‘A bomb pattern is a term I dreamed up several weeks ago. It means nothing, but you'd be surprised at how rapidly it's caught on.’ Joseph Heller,Catch 22     

《机械制图》项目化教学改革

项目化教学是一种以工作任务为中心,选择、组织课程内容,并以完成工作任务为主要学习方式的课程模式,它是当前中国职教课程改革的主要方向。文章以《机械制图》为例,系统介绍了该课程的"项目化"方法,包括课程结构的设计、项目选择和设计、教学方法的设计等。     

The effect of health on retirement

Results from retirement research suggest the following conclusions about health, retirement, and the likely effects of the changes in retirement age made by the 1983 Social Security Amendments. First, after controlling for non-health-related factors, it is clear that older workers who are in poor health retire earlier than workers with similar economic circumstances who are in good health. Second, the research reviewed here tends to indicate that the response of the average worker to the changes made in the social security full retirement age by the 1983 amendments will be small. Estimates suggest than the average increase in the retirement age will be between zero and 3 months. Finally, while the evidence is much less certain, research results suggest that older workers in poor health may respond even less than the average worker. It is not possible to say precisely what will happen to lifetime incomes as a result of these changes. A small labor supply response suggests that not much of the lost social security benefits will be made up by additional earnings, either for workers on average or for workers in poor health. However, earnings are only part of the total income picture. Other than a brief mention, this article has not addressed how workers may adjust their savings behavior, or how private pensions may adjust, and particularly whether the potential for adjustment through these avenues is the same for workers in poor health as for the average worker.     

GIS, Public Service, and the Issue of Democratic Governance

Geographic information systems (GIS) provide unparalleled power to examine social, economic, and political circumstances. As this technology becomes more prominent in the public sector, it brings new challenges to democratic decision making. How we choose to apply this technology will determine the relationship between those who control technology and those who engage in governance. This article provides examples of how GIS is being used for policy implementation and then explores the democratic implications of GIS.     

Power in Public Implementation: A Complex, but Important Part of Power Studies

Based on data disclosing differential treatment of regulated companies, this article shows that it is important to look at the implementation phase as well as the political decision-making phase when one talks about distribution of power in Western democracies. Doing so gives a more nuanced picture of the distribution of power. However, explaining differential treatment throughout the implementation phase with variation in the possession of different power resources gives a more or less kaleidoscopic picture and calls for a complex theory of power. Local economic strength, networks, knowledge and organizational similarity do lead to more lenient regulatory inspection, but the effect depends on whether the company is public or private. Therefore, to have power and influence, one must possess the right resources, understand how to use them and be able to handle the fact that people might expect something different from you than they expect from others – not because of what you do, but because of who you are.     

The Clinton solution

Twelve days before Bill Clinton was to address Congress and the nation, the leaked disclosure of his plan for health-care reform ignited the debate about the issue that will define his presidency. Newsweek assesses the president's plan--and looks at what it will mean for you.     

Strategic Incentives,Issue Proximity and Party Support in Europe

The Issue Yield model predicts that parties will choose specific issues to emphasise, based on the joint assessment of electoral risks (how divisive is an issue within the party support base) and electoral opportunities (how widely supported is the same issue outside the party). According to this model, issues with high yield are those that combine a high affinity with the existing party base, together with a high potential to reach new voters. In previous work, the model showed a remarkable ability to explain aggregate issue importance as reported by party supporters, as well as issue emphasis in party manifestos. This paper tests the implications at the individual level by comparing a conventional model where issue salience is determined from manifesto data with a revised model where issue salience is determined by issue yield. The empirical findings show that issue yield is a more effective criterion than manifesto emphasis for identifying the issues most closely associated with party support in the minds of voters.     

Policy integration: placing the spatial dimension in the health agenda. Evidence from Portugal

The significance of spatial policies for health and well-being is well recorded. While there has been an increasing body of literature illustrating the importance of including a territorial perspective in health decision-making processes, evidence shows that policy integration between spatial and health policies is still scarce. This paper aims to develop a deeper understanding of how this integration can be considered in conceptual terms and how it is actually embraced in practice by health decision-makers. Drawing upon the concept of territorial cohesion, the paper presents and discusses the results of a research held in Portugal aiming to understand this topic.     

Fear and youth citizenship practices: insights from Montreal

This article explores how fear contributes to empowerment and citizenship practices among youth who choose alternative lifestyles. Fear is conceived in a threefold manner: (1) as a manipulated resource in the political process, (2) as energy to be tamed through individual will, and (3) as radiating from actors and flowing through situations of action. Through an examination of how ‘risk-taking’ youths play with fear, the article critically reflects on the modern and advanced modern conceptualizations of the political ‘heroic’ actor and its articulation with an understanding of political action as decentered from human actors. Citizenship practices, it is argued, operate on five distinct levels of political engagement ranging from an awareness of the world outside of oneself to empathy for others and activism. Rather than being state-centered, the article develops an understanding of intersubjective citizenship based on affective memory.     

Taking the Law to Court: Citizen Suits and the Legislative Process

The institution of citizen suits is a decentralized form of public participation that allows citizens to influence the implementation of public laws in courts. How does this institution influence policymaking? This article proposes a model of citizen suits. It then analyzes how this institution influences legislative decisions. The legislature bargains to choose the budget, distributive spending, and spending on an ideologically contested public good (e.g., health care or environmental protection). I find that citizen suits enable courts to forge a compromise between opponents and proponents of the public good by responding to the diverse claims of citizens. Anticipating the mobilization of citizens in courts, legislators in turn craft more socially efficient bills, with less distributive spending, which better represent the distribution of preferences for the public good compared to when citizens have no role in the implementation of legislation.     

Cracks in the Opposition: Immigration as a Wedge Issue for the Reagan Coalition

The absence of a core means that a majority coalition can never choose a policy that will keep it safe from minority appeals to its pivotal members. In two dimensions, strategic minorities will always be able to offer pivotal voters attractive policy concessions. We argue that this instability of multidimensional politics explains why minorities raise wedge issues and how wedge issues result in partisan realignment in legislative politics. Applying agenda‐constrained ideal point estimation techniques to immigration debates, we show that the Reagan coalition—pro‐business and social conservatives—has been vulnerable on the wedge issue of immigration and that parties have switched their positions on immigration over the last three decades. We use the uncovered set as the best‐fit theoretical solution concept in this legislative environment, to capture the limits of majority rule coalitional possibilities and policy change in the two‐dimensional absence of a core.     

The economic impacts of the tobacco settlement.

Recent litigation against the major tobacco companies culminated in a master settlement agreement (MSA) under which the participating companies agreed to compensate most states for Medicaid expenses. Here the terms of the settlement are outlined and its economic implications analyzed using data from Massachusetts. The financial compensation to Massachusetts (and other states) under the MSA is substantial. However, this compensation is dwarfed by the value of the health impacts induced by the settlement. Specifically, Medicaid spending will fall, but only by a modest amount. More importantly, the value of health benefits ($65 billion through 2025 in 1999 dollars) from increased longevity is an order of magnitude greater than any other impacts or payments. The net efficiency implications of the settlement turn mainly on a comparison of the value of these health benefits relative to a valuation of the foregone pleasure of smoking. To the extent that the value of the health benefits is not offset by the value of the pleasure foregone, the economic impacts of the MSA will include a share of these health benefits.     

Revisiting the Income Tax Effects of Legalizing Same‐Sex Marriages

In this paper we estimate the impacts on income tax collections of legalizing same‐sex marriage. We utilize new individual‐level data sources to estimate the federal income tax consequences of legalizing same‐sex marriages. These data sources also allow us to estimate the impact of legalization on state income tax collections. We find that 23 states would realize a net fiscal benefit from legalization, while 21 states would experience a decline in revenue. The potential (annual) changes in state tax revenue range from negative $29 million in California to positive $16 million in New York. At the federal level, our estimates suggest an overall reduction in revenues, ranging from a potential loss of $187 million to $580 million. Overall, we find that the federal and state impacts are quite modest. We also find that our estimates are only marginally affected by alternative assumptions about how many same‐sex couples will choose to marry and which partner will claim any children for tax deduction purposes.     

Photographing Handsworth: photography,meaning and identity in a British inner city

ABSTRACT

‘If you say “Handsworth”’, the novelist Salman Rushdie remarked in 1986, ‘what do you see? Most people would see fire, riots, looted shops … and helmeted cops … a front page story.’ In the 1980s, ‘front page’ images of violence and disorder had come to define areas of black settlement such as Handsworth. However, for both Stuart Hall and Paul Gilroy, photography has the potential of unearthing alternative histories of black people in Britain. Connell explores how this might work in practice by taking Handsworth, an inner-city area of Birmingham, as its case study. Following the Handsworth riots in 1985, a photograph of the ‘black bomber’ appeared on the front page of every national tabloid newspaper, and Handsworth became conceptualized by the media as ‘Frontline Britain’. At the same time, there are numerous examples of photographs from within Handsworth that attempt to present a different view of the community: images taken at high-street portraiture studios, community photography projects and the documentary work of the professional photographers Vanley Burke and Pogus Caesar. What such images offer the historian, it will be shown, is not clear cut. Photographs from within Handsworth are suggestive of possible themes in any alternative history of race in Britain, particularly in their emphasis on everyday life. However, Connell shows that it is also necessary to understand what is often the unacknowledged politics behind these images, something that makes them—in differing ways—as problematic as the stereotypical narratives presented on the front pages of tabloid newspapers.