Health care reform content and process:propositions from the states

Health care reform and cost containment have become central campaign and policy issues in the United States. Although focus now centers on federal health care reform policy, state governments have been actively introducing health care reform legislation. Some of the health care reform initiatives on the state level have influenced deliberations on the federal level and President Clinton's health care reform initiatives will spur further state experimentation regardless of legislative success in Congress, In 1992 nearly all 50 states had either legislation introduced, or special task forces assigned that addressed health care reform issues. This exploratory research compares the content and process of health reform in four states that attempted major reform in 1992—Florida, Washington, Michigan, and Wisconsin—and draws propositions for state reform based on comparisons of content and process. The four states chosen represent geographic diversity and a balance between legislation seeking partial change and legislation calling for universal health care reform. The principal reform bills in each state are compared and assessed on the degree to which they address eight reform elements; high tech medicine, administration, tort reform, long-term care, regulation, insurance mandates, small business insurance, and insurance portability. These initiatives are also compared on a series of reform process variables that relate to the political process for adopting reform: degree of health sector support, type of political strategy used, reform champion, degree of cooperation among policy stakeholders, and timing of initiative. Based on these four cases the phased/partial approach seems to have a greater chance for legislative success than immediate universal reform. Florida's partial, consensus-building approach resulted in the only signed bill of the four states. Washington's bill, which also took a partial approach, passed the state senate before ultimate defeat in 1992 and eventual passage in 1993. Neither of the more ambitious universal health care reform packages introduced in Wisconsin or Michigan got out of committee. Although some of the plans were thorough, none adequately addressed the tradeoff between increasing access to care and containing costs. In addition, this study will demonstrate that universal health care legislation, does not necessarily equate to comprehensive health care reform. The propositions derived from this research have implications for future state health care reform efforts, as well as for federal health care reform policy in terms of the substantive content of reform proposals and the political process by which they are advanced.     

The threat of international terrorism in the united states: The police response

Abstract

As the 1990–1991 Gulf crisis unfolded, leaders of the UN coalition against Iraq became increasingly concerned about the possibility of terrorism accompanying the initiation of hostilities with Baghdad. Such concerns were reinforced by Iraqi warnings and by Baghdad's long association with international terrorist movements. Ultimately, however, the Iraqis proved unable to make effective use of terrorism to support their war effort. This failure resulted for a variety of reasons including effective counterterrorism measures by the allies. Additionally, a number of other nations with terrorist linkages pressured their terrorist clients to refrain from helping Saddam Hussein. They did this for reasons of their own that nevertheless supported allied strategy. Finally, the Iraqis’ lack of any precrisis preparation for terrorist action meant that they were simply unable to mount more than a few ineffective operations.     

Regional and local economic development issues in the united states

The purpose of this symposium is to address several policy and managerial issues related to regional and local economic development in the United States. This symposium introduction first reviews the background information of regional and local economic development and then provides a summary of key issues or findings reported in the symposium articles. The issues and findings identified include: the development of state economic development strategies, the problem of local and regional development strategies, the relationship between government regulation and economic development, the use of strategic management in local economic development, the issue of neighborhood challenges to economic development, and the support of community-based development organizations.     

Worker ownership in the united states: an emergent response to cultural forces

Worker ownership evolved in the United States as an emergent response to cultural forces. Historically, worker ownership embraced a variety of formats, each contingent on the peculiar mix of economic, political and social factors operant in the culture. At times, worker ownership has existed in terms of union cooperatives, profit sharing programs, employee stock ownership plans or social reform efforts. This article outlines the development of worker ownership in the United States and the concomitant social, economic and political forces that shaped that development.     

National administrative agencies in transition: A comparison of sweden and the united states

The abilities of national administrative agencies in Sweden and the United States to function effectively are influenced by their responses to three major phenomena: 1) growth in the responsibilities of government; 2) decentralization; and, 3) privatization. This paper delineates how these phenomena have affected the development of national administrative organizations in these two countries. Implications for administering national agencies in increasingly complex interorganizational environments are discussed.     

Exploring perceptions of technology between the united states and ecuador

Despite an overall increase in technology research in recent years, the focus on perceptions of technological issues across diverse cultures has received little attention. Moreover, the transfer of technology from industrialized nations to developing countries has essentially been overlooked by scholars. The purpose of this study is to measure differences in perceptions of technology between managers from Ecuador and the United States. The typology of motivators and inhibitors of technological growth developed by Cragg and King (1993) is used as the basis for this empirical inquiry. Results suggest that improving planning and control is a key motivator in Ecuador while stimulating managerial enthusiasm is important to U.S. managers. Excessive cost was found to be a powerful inhibitor in both nations. These findings have vast implications for both the public and private sectors as the business environment continues to change in Latin America.     

Administrative ethics and organizational learning in Kuwait and the united states: an empirical approach

This article explores how a sample of public agencies in Kuwait respond to ethics failure. The learning response is examined in detail, in order to understand how these agencies attempt to inquire into the organizational causes of ethics failures and implement organizational changes in response to the inquiry. This study builds upon a previous methodology for measuring the strength of the organizational learning response. The data from Kuwait is compared to an earlier, similar study of organizational ethics learning conducted in the United States. The sampled agencies devote only moderate efforts to learning from ethics failure.     

Energy conservation policy in the united states and Sweden: Comparing research and development responses

This study assesses the comparability of public sector responses to energy conservation research and development (R&D) in the United states and Sweden. Using the evaluative criteria of policy objectives, organizational structure, and funding, the extent to which the institutional context for R&D either constrains or fosters conservation as an element of each nation's energy policies is examined. Sweden, unlike the United States, appears to have been successful in achievement consensus primarily through an open, deliberative process of mutual partisan adjustment regarding where specific allocations should be made in the energy R&D budget for optimal conservation results. To a great extent, it is within these differing institutional contexts of policy uncertainly that the content of specific energy conservation policies and strategies should be evaluated.     

Information technology and transitions in the public service: A comparison of scandinavia and the united states

New information technologies have the potential for transforming the ways governments are organized, the activities they perform, how they perform them, and the nature of work itself. Governments in the U.S. and Scandinavia have followed fundamentally different approaches to the introduction of computing and to dealing with its effects. These differences in approach to automation have influenced each country's view of the role of government in anticipating and dealing with the effects of changes in computer technology on the public service workforce.     

Comparable worth in the united states legal and administrative developments in the 1980's

During the 1980's, the concept of comparable worth has become closely identified with women's rights and sex discrimination concerns, and is now recognized by advocates and critics alike as one of the major affirmative action issues of the decade. Simply put, comparable worth refers to the idea of equal pay for dissimilar jobs of equal value to an organization.

According to comparable worth proponents, jobs traditionally associated with women have been systematically undervalued in the marketplace. The net result is a disparity in pay for women when compared with that for jobs largely held by men. It is also argued that this compensatory bias against women can be revealed and eliminated by assessing the economic value of disparate occupations through the use of objective standards of evaluation. For example, although secretarial and janitorial jobs are dissimilar in function, it is argued that pay equity can be achieved by assessing such factors as working conditions and the amount of training, responsibility and effort required for each job.

Critics of comparable worth take strong exception to these assertions. They argue that the wage differential between men and women is more the result of career choice and market forces than sex discrimination. Moreover, they contend that employers must often pay a higher wage for some occupations than others in order to remain competitive and to attract the best qualified personnel. Finally, critics of comparable worth maintain that job evaluation systems are inherently subjective. Therefore, any comparison of dissimilar jobs is at best arbitrary.

These conflicting points of view have formed the crux of the comparable worth debate during the past 10 years. The purpose of this review is to assess some of the outcomes and trends established by this debate as well as what those trends appear to indicate for the coming decade. To do so, we shall examine the comparable worth issue from legal, legislative and administrative perspectives.     

Implementing pay reform in the public sector: Different approaches to flexible pay in sweden and the united states

A set of implementation criteria drawn from the United States experience provide a framework for examining pay reform in the Swedish public sector. The study finds that the Swedish approach is quite distinct and this may be attributable to unique features in the Swedish labor market. The reform toward flexible or individualized pay in government agencies appears to be based on an assumption of greater cost efficiency in human resource management and a broad unwillingness to employ objective measures of individual or organizational productivity. Consequently the study calls into question the utility of an analytical framework based on the Anglo-American experience for examining the Swedish case.     

The united states naval blockade of Iraq: A foreign policy and international law analysis

The current Persian Gulf crisis may signal a new period in human history in which the United Nations is viewed as the forum of first resort for the resolution of international harms and disputes. This is particularly striking since the Security Council, because of east-west divisions, has been unable to act in a collective manner to addresses serious international breaches of the peace. This two part essay deals with the events leading up to the Iraqi invasion of Kuwait, the step-by-step reaction by the U.S. Government, the imposition of the U.S. Navy blockade of Kuwaiti shipping, and the legal justification for the introduction of forces. The reader is left to decide whether the Rule of Law and Charter ideals of collective security, are the real victors in the current conflict.

Part 1 of the essay examines the detailed economic and political causes for the Iraqi invasion. Even though some commentators have characterized Saddam Hussein's entry into Kuwait as “naked aggression” which was driven by Saddam Hussein's hamartia to become the new Nasser, OPEC production disputes, allegations of excessive Kuwaiti pumping of the Rumalia oil field (straddles both countries), the need for an Iraqi coastline, and large Iraqi debt to Kuwait are seen as “rational” reasons for the invasion. A historical examination of the Iran-Iraq conflict is grafted into part one to assist the reader in appreciating the fact that belligerent conduct is viewed in Iraq as a normative mode of conflict resolution and that in the context of all current and future military and diplomatic interchanges, the proven bellicosity of Iraq should figure prominently in the approaches which are taken.

The U.S. military presence in the Persian Gulf must be viewed in the context of the U.S.'s diplomatic and economic interests in the region. The essay concludes that the actions of the United States in the first forty days after the Iraqi invasion were masterful because of the skilled use of the U.N. security council (to build a broad political base) as well as the introduction of limited force (imposition of a naval blockade) to signal to Saddam Hussein that the international community was serious in its resolve. The shooting which is taking place is most unfortunate; but U.S. efforts were properly tailored to keep the world coalition intact and prevent a shooting war. Until approximately 3 weeks into the actual conflict, the level of anti-U.S. rhetoric was noticeably small- a triumph for U.S. foreign policy makers in forming a world-wide consensus and maintaining it and a triumph for international respect for law.

The final portion of Part 1 deals with the history of blockades before and after the 1945 U.N. Charter. Blockade actions have been used since the Middle Ages but the 1856 Pact of Paris and the 1909 Declaration of London are the modern sources for the Law of Blockade. Becuase of the sheer intensity of conflict in the First and Second World Wars, the normative rules contained in the two written sources of law fell into disuse. Even so, most of the substantive provisions from the 19th and early 20th century doctrines are incorporated into contemporary law and policy. Commander Rosen argues strenuously for a modernization of the international conventions to codify the rules of blockade since, given the utter destructiveness of modern warfare, blockades remain a relatively benign use of force in those situations in which use of force is legally justified. But, however laudable the U.N. Charter ideals are to sharply restrict the use of force to exceptionally limited circumstances and make state aggression illegal, situations will arise in which use of force will be necessary to respond to illegal aggression. Resurrection of the old concept of pacific blockade (similar to the naval action taken in connection with the Cuban Missile Crisis) is urged because unanimity in the U.N. is transitory and nations, particularly superpowers, need the legal flexibility to react to illegal aggression with limited uses of force--below the threshold uses of force authorized by the U.N. Charter.     

T2 Transfer of high technology from the united states to the soviet bloc: A public policy issue

The Union of Soviet Socialist Republics and the Soviet-bloc states are engaged in an extensive effort in the legal as well as illegal acquisition of United States high technology. This study examines the importance to the U. S. of such losses; the manner in which the Soviets acquire our high technology; benefits of such acquisitions to the Soviet Union; steps being taken by the U. S. to reduce its loss of high technology; and the author's recommended course of action to reduce high-technology transfer.

The transfer of U. S. high technology to the Soviet Union is recognized as one of our most serious national security problems. This problem is complicated, however, when considering our free enterprise system and the need to promote free trade. On the one hand high technology represents a substantial share of our current exports, while on the other, the United States has relied on technological superiority to offset the Soviet-bloc edge in military might. An equilibrium must be established to ensure protection of both economic and national defense interests of the United States.

The Soviet effort to acquire U. S. high technology is broad based, supported by the Military-Industrial Commission and State Committee for Science and Technology (in legal acquisitions), as well as the Soviet Intelligence Service (in illegal acquisitions). Such techniques as review of U. S. publications, U. S.-Soviet exchange programs, as well as extensive clandestine intelligence operations, are utilized by the Soviets in obtaining our high technology.

The Soviet acquisition of U. S. high technology has greatly benefited the USSR. This is clearly seen in U. S. Government estimates that the Soviets may have saved as much as $100 million in research and development of advanced microcircuitry. Several examples of savings to the Soviet defense industry as a result of high-technology transfer are elucidated in this work. In short, the Soviets have been able to save billions of defense dollars by utilizing proven U. S. designs with none of the risks experienced in the research and development of this technology.

Because of the paradoxical nature of this question of high-technology transfer, U. S. Congressional reaction to renewal of the Export Administration Act of 1979 has been mixed. On one side of the aisle, there has been support of looser controls on high-technology exports to promote free trade. On the other side of the aisle, tighter controls on such exports have been supported to protect critical U. S. high technology. At the same time, the U. S. Government has undertaken steps to strengthen its agreement with the COCOM nations. Another effort undertaken by the U. S. and other Western governments is the expulsion of accused Soviet spies from various Soviet diplomatic establishments (at least 67 Soviets from January to May, 1983). Additionally, the U. S. Department of State, Defense, Commerce, and Customs, as well as the American Intelligence Community, have undertaken efforts to reduce high-technology transfer to the Soviet Union. U. S. industry has attempted to increase security of high-technology; however, because of the Defense Investigative Service's workload, the quality of background investigations on individuals, working in firms handling defense contracts, has suffered.

The author recommends establishment of an ad-hoc matrix organization to integrate the resources and efforts of all of the federal agencies, as well as industry, in controlling the transfer of U. S. high technology to the Soviet Union and Soviet-bloc states. The author also includes recommendations as contained in various Congressional bills. The author's suggestions are made with a view toward creating a balance necessary to the protection of our free market system and protection of the national defense of the United States.     

Privatization,efficiency and market failure : transforming ecuador's public sector

Much of the privatization that is occurring in Latin America is leading to improved efficiency. However, privatization in areas where markets do not yield efficient solutions, for example of public goods, like light houses, natural monopolies, mainly utilities, and goods with externalities, like education, can lead to lower output and higher costs in the long run. This paper first presents an outline of the shift in development theory with respect to the role of the public sector. It then examines the growth of Ecuador's public sector and its current debate on how privatization should proceed. It concludes that while careful privatization can be positive, privatizing natural monopolies like the electric utility and/or quasi-public goods, like highways are likely to be detrimental to long run economic development. In order for Ecuador's economy to continue to develop, the public sector still needs to play a significant role in developing human capital and physical infrastructure.