Chromium‐Based Regulations Applicable to Metal Finishing Industries in the United States: A Policy Assessment

This article seeks to briefly evaluate the context behind the development of regulations related to chromium pollution control in metal finishing industries. The available evidence suggests the possibility of elevation of the issue to the agenda for agency rule‐making, and subsequent implementation can occur even in the absence of focusing events. Based on historical evidence, this article illustrates that gradual accumulation of knowledge of harmful effects of chromium over the period of decades has been instrumental in the formulation and implementation of standards and guidelines to regulate chromium in the environment under major statutes such as the Clean Air Act, the Clean Water Act, the Safe Drinking Water Act, and so on. The implementation of command and control regulations has resulted in appreciable reduction of chromium released into the environment, thereby minimizing the impact on human health and the environment. However, achieving full compliance from metal finishing industries is still an illusion. There are examples of violations committed by industries. In response to this realization, policy evolution in the chromium pollution control domain has occurred in two directions: (1) gradual replacement of existing standards with more stringent standards and guidelines and (2) emphasis on multimedia, voluntary, and participatory approaches to improve compliance. But the results from the latter are not as dramatic as previously envisioned. Borrowing from the experience of the Common Sense Initiative (CSI), this article argues that consensus‐based, multistakeholder collaboration can be a policy development tool.     

Evaluating essential health packages from a human rights perspective

Many countries at all levels of development have formulated an essential health package, sometimes also referred to as a health benefit plan or a health benefit basket. As defined by the World Health Organization (WHO), essential health packages (EHPs) are “health service interventions that are considered important and that society decides should be provided to everyone.” Although EHPs are not often formulated from an explicitly human rights perspective, since they are conceptualized as a guaranteed minimum of health services, much like core health obligations, they have obvious human rights import. This article evaluates the principles from which the plans are developed, the content of the packages, and the experience of countries seeking to implement them from a human rights perspective. In the process, it seeks to gain greater clarity about the health service requirements of the right to health.     

THE GOVERNMENT AND HOSPITAL COMMITTEES OF MANAGEMENT IN VICTORIA

Abstract: A new method has recently been introduced for selecting members of Victorian hospital committees of management: they are to be appointed by the Minister of Health, instead of being nominally elected by "contributors" to the hospitals. The 1977 Health Commission Act, which contains these new appointment provisions, gives the state government additional powers over the hospitals, and the power to appoint committees of management could contribute to this augmented control. The new method of selection, however, is expected to make little difference in practice to the committees. Neither the former Liberal state government, in framing the Health Commission Act, nor recent official inquiries have considered seriously the capacity of these committees as they are now constituted to maintain a high degree of hospital autonomy, despite the hospitals' heavy reliance on public funds. By leaving undisturbed these inheritors of the voluntary hospital tradition, the former Liberal government, though it has left its Labor successor with some new powers, has left it also with a potential obstacle to implementing the kinds of reforming measures recommended for the state's health services.     

The need for centres of health research excellence in the developing world

Pervasive ill health and overpopulation impede progress in most developing countries but in recent years, programs providing aid to these regions have de-emphasized health as a priority. Furthermore, support for building the health research capacity, so essential to the success of efforts to promote improved health, has been lacking. This paper examines these policies as they relate to one developing country, one global h ealth program and a major Canadian development agency. Much has been achieved in the past decade in one of the world's poorest countries, Bangladesh, but major health problems persist, particularly in maternal and child health. With the will to build effective health programs, Bangladesh lacks the resources and the research base needed for their development. The World Health Organization, (WHO) Diarrhoeal Disease Control (CDD) program, which addresses a major cause of child mortality in Bangladesh, promotes effective treatment but it contributes little to a permanent research establishment in that country. The Canadian International Development Agency (CIDA) which directs only a small portion of its $2.2 billion annual budget to health, lacks an influential level of technical expertise in health. This agency has no mandate to support health research in the developing world; research is the responsibility of the International Development Research Centre (IDRC), the Health Sciences Division of which closed in July, 1995. To upgrade the place of health and health research in development, the attitudes and policies of major donors must change and models of success are needed. Of the existing institutions or programs involved in health and health research in the developing world, the internationally funded health research centre, strategically sited in the developing world could provide the excellence around which relevant programs should flourish. An existing example of this rare species, the International Centre for Diarrhoeal Disease Research, Bangladesh, merits particular consideration in this regard.     

Conservative Constituency Parties' Funding and Spending in England and Wales, 2004–2005

Under new regulations established by the Political Parties, Elections and Referendums Act 2000 , data are now available—through the Electoral Commission—on the income, expenditure and financial health of constituency political parties. These cover all parties with an annual turnover of £25,000 or more. The returns from 263 Conservative constituency party units in England and Wales for 2004 and 2005 (the latter being a general election year) are analysed here, showing that not only are very few wealthy but that a majority implicitly operate with an annual turnover below the defined threshold. Sources of income and patterns of expenditure are analysed, as are the patterns of large donations (which have to be separately reported). In general, the greatest turnover is to be found in marginal constituencies.     

Jump-Starting Collaboration: The ABCD Initiative and the Provision of Child Development Services through Medicaid and Collaborators

Many policy problems require governmental leaders to forge vast networks beyond their own hierarchical institutions. This essay explores the challenges of implementation in a networked institutional setting and incentives to induce coordination between agencies and promote quality implementation. It describes the national evaluation of the Assuring Better Child Health and Development program, a state-based program intended to increase and enhance the delivery of child development services for low-income children through the health care sector, using Medicaid as its primary vehicle. Using qualitative evaluation methods, the authors found that all states implemented programs that addressed their stated goals and made changes in Medicaid policies, regulations, or reimbursement mechanisms. The program catalyzed interagency cooperation and coordination. The authors conclude that even a modest level of external support and technical assistance can stimulate significant programmatic change and interorganizational linkages within public agencies to enhance provision of child development services.     

Immigrant Health Care Access and the Affordable Care Act

In spite of major coverage expansions under the Patient Protection and Affordable Care Act (ACA), a large proportion of immigrants will continue to remain outside the scope of coverage. Because various provisions of the ACA seek to enhance access, advancing knowledge about immigrant access to health care is necessary. The authors apply the well‐known Andersen model on health care access to two measures—one focusing on perceptions of unmet health care needs and the other on physician visits during the last year. Using data from the New Jersey Family Health Survey, the authors find that prior to implementation of the ACA coverage expansions, immigrants in New Jersey reported lower levels of unmet health care needs despite poorer self‐rated health compared with U.S.‐born residents. The article concludes with a discussion of the use of Andersen model for studying immigrant health care access and the broader implications of the findings.     

The Long Road to Flexicurity: The Development of Job Security Regulations in Denmark and Sweden

Flexicurity has become a prominent policy recommendation in recent years. However, little is known about the actual development of flexicurity in the country most often associated with it – namely Denmark. This is particularly the case for one of the three ‘pillars’ of flexicurity: low levels of job security regulations. This article fills this gap in the scholarly literature. It demonstrates that regime attributes are often not the result of policy making by wise policy designers, but unintended consequences of contingent choices made with the purpose of winning short‐term political gains. Comparing the development of job security regulations in Denmark and Sweden, the article shows that the two countries followed a similar path until the late 1960s. In both, job regulations were part of collective agreements. However, in the 1960s the labour movement started to demand more restrictions, which resulted in the 1974 Employment Protection Act in Sweden. No such change happened in Denmark. Two crucial differences can explain this unequal development. First, societal pressure for regulation was larger in Sweden than in Denmark. And second, the Swedish labour movement was stronger and more unified. When the Danish trade union movement could have turned to the political arena, the 1973 ‘earthquake’ election and the resulting fragmentation of the party system closed the window for all‐left majority governments in Denmark. Without reliable partners to the left and no majority of their own, Danish Social Democrats were not able to pass restrictive job security regulations against the will of employers' associations.     

Public Health and the Regulatory State

Public health has moved from the public good component of health to everything related to health and, then, to everything related to society. If we take public health in its wide, total, social sense, it presumably explains or justifies much of the regulatory state. Virtually all state activities contribute directly or indirectly to some citizens’ “physical, mental and social well-being” (as the World Health Organization’s definition says). Public health requires social engineering, which cannot be achieved without controlling the lifestyles that the Philosopher King doesn’t like. Controlling lifestyles cannot be done without regulating the businesses that would allow people to satisfy their sinful preferences, and without preventing these people from circumventing the controls through black markets or other violations of government regulation.     

The Impact of Converting Categorical into Block Grants: The Lessons from the 314(d) Block Grant in the Partnership for Health Act

Section 314(d) of P. L. 89–749, (1966), the Partnershipfor Health Act, combined nine categorical health grants intoone block grant for health. The impact of section 314(d), according to data gathered forthis study, can be summarized as follows: the block grant increasedthe administrative flexibility of state health officials; statehealth planning agencies generally did not have a major influenceon the block grant; state health planning agencies located ingovernors' offices had less influence over the block grant thanthose located in state health departments; Congress did notsignificantly increase expenditures for the block grant; nationalinfluence was increased by creating health programs that couldpotentially have been made part of the block grant; and theblock grant did not generally result in a reordering of spendingpriorities. The best explanation for the unspectacular effect of combiningseveral categorical grants into one block grant was that, withoutnew resources, the substantial (and welcome) new administrativeflexibility given state officials was insufficient to producean important substantive reordering of program priorities.     

Chronic Illness and health insurance-related job lock.

Job duration patterns are examined for evidence of health insurance-related job lock among chronically ill workers or workers whose family member is chronically ill. Using Cox proportional hazard models to indicate the effect of health insurance and health status on workers' job duration we allow for more general insurance effects than that shown in the existing literature. Data for workers in Indiana predating the Health Insurance Portability and Accountability Act (HIPAA) are used to examine the potential effect of HIPAA on job mobility. Among the workers in this sample who relied on their employer for coverage, chronic illness reduced job mobility by about 40 percent as compared with otherwise similar workers who did not rely on their employer for coverage. Results reported here identify previously under-appreciated job lock among chronically ill workers and workers whose family member is chronically ill, clarify how one best researches job lock, and indicate the potential effect of policies aimed at alleviating job lock and promoting inter-employer worker mobility.     

Strengthening the Political Safeguards of Federalism: The Fate of Recent Federalism Legislation in the U.S. Congress

Although a number of measures have been proposed during thepast decade to require the U. S. Congress to take more accountof state and local interests, whether in regard to mandates,preemptions, regulations, or grants-in-aid, the only major successhas been passage of the Unfunded Mandates Reform Act of 1995(UMRA). This article examines the fate of the dozen bills thatprogressed far enough to be the subject of a committee hearingor receive a vote in the House or Senate. Only a few of thesemeasures, most of them rather modest in scope, were enacted,while the most significant measures were rejected, largely becausestate and local governments have experienced a number of difficultiesin reproducing the conditions that were present for the passageof UMRA. Health, labor, and environmental groups were able toblock a number of these bills. Business groups occasionallyparted company with state and local governments and worked todefeat federalism legislation. Finally, state and local governmentgroups have not always been united in support of these measures.     

From Coercion to Partnership in Federal Partial Preemption: SMCRA, RCRA, and OSH Act

This article examines the experiences of three important partial-preemptionprograms—the Surface Mining Control and Reclamation Actof 1977 (SMCRA), the Occupational Safety and Health Act of 1970(OSH Act), and the Resource Conservation and Recovery Act of1976 (RCRA)—over the last two decades to improve our understandingof how federal-state interactions have shaped the regulatorypartnership. The evidence we gather suggests that the controlof regulatory programs has shifted over time back and forthbetween the federal government and the states. In the initialyears of these programs, what the Congress intended to be aregulatory partnership was, in effect, almost total federalpreemption of state authority. Under the Ronald Reagan administration,the opposite occurred; federal regulation in many cases becamede facto state regulation as federal officials essentially abdicatedtheir oversight responsibility. By the end of the 1980s, thefederal government began again to assert greater control overintergovernmental regulatory programs. The regulatory relationshipthat emerged is one in which the federal government and thestates share responsibility and authority for the implementationof these programs.     

Presidential priorities,congressional control,and the quality of regulatory analysis: an application to healthcare and homeland security

Elected leaders delegate rulemaking to federal agencies, then seek to influence rulemaking through top-down directives and statutory deadlines. This paper documents an unintended consequence of these control strategies: they reduce regulatory agencies’ ability and incentive to conduct high-quality economic analysis to inform their decisions. Using scoring data that measure the quality of regulatory impact analysis, we find that hastily adopted “interim final” regulations reflecting signature policy priorities of the two most recent presidential administrations were accompanied by significantly lower quality economic analysis. Interim final homeland security regulations adopted during the G.W. Bush administration and interim final regulations implementing the Affordable Care Act in the Obama administration were accompanied by less thorough analysis than other “economically significant” regulations (regulations with benefits, costs, or other economic impacts exceeding $100 million annually). The lower quality analysis apparently stems from the confluence of presidential priorities and very tight statutory deadlines associated with interim final regulations, rather than either factor alone.     

Health Insurance in Transition: The Health Insurance Portability and Accountability Act of 1996

The Health Insurance Portability and Accountability Act (HIPAA)of 1996 (PL. 104–191) brings the federal government fullyinto insurance regulation for the first time. Despite the Republicanmajority's rhetoric about state control, election-year politicstrumped federalism. HIPAA's immediate impact oncoverage maybe modest, but its ultimate significance is great because itcreates a template for more farreaching federal involvementin regulating insurance. HIPAA amends the Employee RetirementIncome Security Act (ERISA), the Public Health Service Act,and the Internal Revenue Code, creating a complicatedstructuredictated by efforts to avoid an unfunded mandate. The historyof insurance regulation and the activity surrounding the enactmentof PL. 104–191 suggest that HIPAA continues an incrementalprocess of transition between state insurance regulation andfederal oversight driven by recent and accelerating changesin the structure of the health-care marketplace.     

When Governments Regulate Governments

This article advances a political theory of regulation that accounts for the choices of regulators and regulated entities when both are governments. Leading theories of regulation assume that governments regulate profit‐maximizing firms: Governments set rules, to which firms respond rationally in ways that constrain their behavior. But often the entities that governments regulate are other governments. We argue that government agencies and private firms often face different compliance costs, and that agencies have greater incentives than firms to appeal regulations through political channels. Simultaneously, the typical enforcement instruments that regulators use to influence firm behavior may be less effective against governments. Our empirical subjects are public and private entities’ compliance with the U.S. Clean Air Act and Safe Drinking Water Act. We find that, compared with private firms, governments violate these laws significantly more frequently and are less likely to be penalized for violations.     

‘Back Regions’ and ‘Dark Secrets’ in Singapore: The Politics of Censorship and Liberalisation

The political transition from Lee Kuan Yew to Goh Chok Tong to Lee Hsien Loong has generally been interpreted as a trajectory of gradual liberalisation in Singapore. This discourse of liberalisation is encouraged by a variety of factors such as policy changes over censorship regulations, a younger and more cosmopolitan polity, the government's global city ambition and desire to turn the city-state into a creative hub. Such factors, however, often obscure the contemporary policing dynamics of the People's Action Party (PAP) state. Using Erving Goffman's concepts of the ‘back’ and ‘front’ regions, this paper will demonstrate how the PAP state operates in different social spaces and how it engages in the different politics of these spaces. Using specific cases from the theatre community, this paper argues that the discourse of liberalisation has grown because the PAP state has, in recent times, exercised its censorship powers in the ‘back regions’ of theatre, away from the media and public. Finally, it will examine recent amendments to the Films Act and the Public Order Act which clamps down on acts of civil disobedience, and show that this is consistent with what Goffman calls ‘dark secrets’—that is, facts that are incompatible with an individual's or institution's public image.     

Avian influenza, ‘viral sovereignty’, and the politics of health security in Indonesia

Abstract

In December 2006, Indonesian Health Minister, Siti Fadilah Supari, shocked the world when announcing her government would no longer be sharing samples of the H5N1 avian flu virus, collected from Indonesian patients, with the World Health Organization, at a time when global fears of a deadly influenza pandemic were running high. For observers of Southeast Asian politics, the decision reinforced the view of the region as made up of states determined to protect their national sovereignty, at almost all costs. This established view of the region, however, generally neglects the variable and selective manner in which sovereignty has been invoked by Southeast Asian governments, or parts thereof, and fails to identify the conditions shaping the deployment of sovereignty. In this paper, it is argued that Siti's action was designed to harness claims of sovereignty to a domestic political struggle. It was a response to the growing fragmentation and, in some cases, denationalisation of the governance apparatus dealing with public health in Indonesia, along with the ‘securitisation’ of H5N1 internationally. The examination of the virus-sharing dispute demonstrates that in Southeast Asia sovereignty is not so much the ends of government action, but the means utilised by government actors for advancing particular political goals.     

Personalizing solidarity? The role of self-tracking in health insurance pricing

Can data-driven innovations, working across an internet of connected things, personalize health insurance prices? The emergence of self-tracking technologies and their adoption and promotion in health insurance products has been characterized as a threat to solidaristic models of healthcare provision. If individual behaviour rather than group membership were to become the basis of risk assessment, the social, economic and political consequences would be far-reaching. It would disrupt the distributive, solidaristic character that is expressed within all health insurance schemes, even in those nominally designated as private or commercial. Personalized risk pricing is at odds with the infrastructures that presently define, regulate and deliver health insurance. Self-tracking can be readily imagined as an element in an ongoing bio-political redistribution of the burden of responsibility from the state to citizens but it is not clear that such a scenario could be delivered within existing individual private health insurance operational and regulatory infrastructures. In what can be gleaned from publicly available sources discussing pricing experience in the individual markets established by the Patient Protection and Affordable Care Act 2010 (ACA), widely known as ‘Obamacare’, it appears unlikely that it can provide the means to personalize price. Using the case of Oscar Health, a technology driven start-up trading in the ACA marketplaces, I explore the concepts, politics and infrastructures at work in health insurance markets.     

Pollution control innovations and the Clean Air Act of 1990

One advantage often cited for market‐based environmental policies is that they are more likely to promote technological innovation than are command and control regulations. This paper uses patent data to study innovation in flue gas desulfurization units (“scrubbers”) across these policy regimes. Plant level data indicate that the effect of these patents on pollution control changed after passage of the 1990 Clean Air Act, which instituted a market for sulfur dioxide (SO₂) permits. Previous regulations requiring plants constructed before 1990 to install scrubbers created incentives for innovation that lowered the costs of operating scrubbers, but did little to improve the environmental effectiveness of the technology. In comparison, innovations occurring since 1990 do serve to improve the removal efficiency of scrubbers. © 2003 by the Association for Public Policy Analysis and Management.