Medicaid's Role in Moves Toward Universal Health Care

This paper considers the problems currently facing the Medical Assistance (Medicaid) program in light of the major problems confronting the American health care system. Actual and proposed Medicaid reforms are reviewed, their merits noted and their shortcomings detailed. It is argued that substantial Medicaid reform can take place only in the context of radical reform of the entire U.S. health care system. Similarly, Medicaid should be incorporated into any plan aimed at providing universal health care coverage.     

Health insurance coverage of the unemployed: COBRA and the potential effects of Kassebaum-Kennedy.

We use the April 1993 Current Population Survey to examine the health insurance coverage decisions of the unemployed and to simulate the potential effects of the new Kassebaum-Kennedy legislation. After controlling for demographic characteristics, COBRA eligibility raises the probability of health insurance coverage by 0.095, while eligibility for spouse employer insurance increases the likelihood of coverage by 0.318, and eligibility for both increases the likelihood of coverage by 0.341. In our simulations, we find that had Kassebaum-Kennedy been in effect in April 1993, 9.0 percent of the unemployed would be eligible to take up coverage, and the coverage rate of the unemployed would have been increased by 0.85 percent to 1.5 percent from 41.6 percent. Our estimates of the effect of Kassebaum-Kennedy on health insurance coverage are much lower than those reported by the Government Accounting Office prior to the passage of the legislation.     

Penology,economics, and the public: Toward an agreement

In this paper we confront the problem of why prisons are not a more effective tool for dealing with criminals. Several sources of this problem are suggested, and reasonably operational solutions are proposed. These solutions are motivated by basic principles of economics, and some broader consequences of this framework for dealing with criminal activity are briefly discussed.This article stems from general issues which arose while the author was at SUNY/Binghamton preparing a dissertation on somewhat more specific cost-benefit questions of prison management. He is indebted to Clifford Kern, A. G. Holtmann, and B. A. Weisbrod for lively comments on an earlier draft of this paper.     

Toward an informational dynamics of collective choice

In the following argument, it is suggested that the informational dimension of small-scale collective choice systems be introduced into the set of explanatory variables, be allowed to fluctuate while the ‘committee’ is in session and, finally, be permitted to “feed back” to the individual participants during the group decision process. It is suggested that consideration of the in-period or ‘in-committee’ shocks which this release and flow of information may be modeled to have on the participants’ round-to-round voting strategies might provide a supplementary explanation of some of the anomalous results (such as the relative rarity of observed cycling) encountered in observations of collectively controlled systems.     

Health insurance in a democracy: Why is it public and why are premiums income related?

Many democracies have public health insurance systems which combine redistribution from the rich to the poor and from the healthy to the sick. This paper shows that such systems can be in the interest of the poor and the rich from a constitutional perspective. Necessary conditions are that insurance markets are incomplete and that income inequality is neither too low nor too high. Then even the rich can prefer a public health insurance system financed by income-dependent contributions compared to a system financed by a flat fee or a private health insurance system.     

The committee assignment process as an optimal contracting problem

This paper adapts a simple model from the optimal contracting literature to explain the relationship between political parties and non-incumbent candidates. The model predicts that legislators with a higher opportunity cost of government service will receive better committee assignments. Using data that spans 12 Congresses (97th to 108th), I find that when the opportunity cost of Senate service is measured by previous occupation, freshmen senators with a high opportunity cost for serving (those who were lawyers) were given good committee assignments, while freshmen senators with a low opportunity cost for serving (professors, and those with relatives already in politics) were given worse committee assignments.     

Labour mobility and decision making on social insurance in an integrated market

In a two-country model the consequences of labour mobility on social insurance levels are studied. There are two groups of workers, one with a high risk and the other one with a low risk of being nonemployed. In both countries the decision-making function on social insurance is some weighted average of the expected utilities of both groups. In case low-risk workers are much more mobile than high-risk workers, it can be concluded that labour mobility does not necessarily have a downward effect on social insurance. In that case coordination of decision making would not improve the levels of social insurance.     

Toward Judicial Comity: Certification in the Courts

Certification is a procedure whereby federal courts may askstate courts of last resort to clarify an ambiguous provisionof state law. This increasingly popular device of deferenceoperates as an alternative to abstention and to the casual predictionof the meaning of state law. Certification is a permissive anddiscretionary mechanism; as such, it is neither universal inits usage nor uniform in its application. The thirty-eight statesthat authorize the procedure differ on which federal courtsmay participate and whether the answer to the certified questionmust determine, or resolve, the lawsuit. Our survey resultsindicate that federal and state judges alike praise certificationfor its contributions to intersystem harmony. It conserves judicialresources, advances litigant interests, minimizes interpretivemisguesses, and avoids repetitive litigation.     

Modeling health insurance expansions: effects of alternate approaches.

Estimates of the costs and consequences of many types of public policy proposals play an important role in the development and adoption of particular policy programs. Estimates of the same, or similar, policies that employ different modeling approaches can yield widely divergent results. Such divergence often undermines effective policymaking. These problems are particularly prominent for health insurance expansion programs. Concern focuses on predictions of the numbers of individuals who will be insured and the costs of the proposals. Several different simulation-modeling approaches are used to predict these effects, making the predictions difficult to compare. This paper categorizes and describes the different approaches used; explains the conceptual and theoretical relationships between the methods; demonstrates empirically an example of the (quite restrictive) conditions under which all approaches can yield quantitatively identical predictions; and empirically demonstrates conditions under which the approaches diverge and the quantitative extent of that divergence. All modeling approaches implicitly make assumptions about functional form that impose restrictions on unobservable heterogeneity. Those assumptions can dramatically affect the quantitative predictions made.     

National health insurance: Some lessons from the Canadian experience

In the current American debate over national health insurance an examination of the Canadian governmental experience is very instructive. Canada is enough like the United States to make the effects of Canadian health insurance policies rather like a large natural experiment. The Canadian experience—universal government health insurance administered by the ten provinces with some fiscal and policy variations—can be used to predict the impact in the United States of proposed national health insurance plans on the medical care system, and the reaction of mass publics and national policymakers to these effects.The central purpose of the Canadian national health insurance was to reduce and hopefully eliminate financial barriers to medical care. In this it succeeded. But it also produced results which Canadian policymakers never anticipated: essentially unexpected side-effects on cost, quality, organization, and manpower distribution of the particular national health insurance program adopted. It should be cause for concern, the article concludes, that most of the prominent American national health insurance proposals resemble the Canadian program in failing to provide a single level of government with both the means and incentives to curb the inflationary effects of national health insurance. The lesson from Canada is that unless the system has very strong anti-inflationary mechanisms and incentives built into it, national health insurance will feed the fires of medical inflation despite great formal governmental authority to control it.