Illusions of necessity: evading responsibility for choice in health care

Discretionary power is commonly defended by denial of its existence, the allegation of inevitability. Objective external conditions and forces are claimed to dictate policy decisions with tangible distributional effects. In health policy, such forces include the aging of the population, the extension of technology, and the demands of ethical standards. Taken together, these forces create relentless upward pressure on costs, to levels which society "cannot afford," necessitating sacrifice of the interests of the "less eligible." Yet quantitative analysis of these forces does not sustain the argument; in each case the source of cost escalation is not external pressure but the way in which the health care system itself reacts. Less costly and equally effective options are demonstrably available, but would threaten provider interests and broader ideologies. A spurious cloak of inevitability serves to promote and justify political choices.     

Winning by Co-Opeting in Strategic Government-University-Industry R&D Partnerships: The Power of Complex, Dynamic Knowledge Networks

There is increasing consensus among academic scholars, policy makers, and industry practitioners alike that the present and future secret of business survival and prosperity lies in strategic partnering and co-opeting successfully rather than outright competition. This is particularly so in knowledge-intensive, highly complex, and dynamic environments such as all high technology industries (semiconductors, aerospace, software, telecommunications, etc.), where collaborating to compete in knowledge generation and exchange has become so pervasive it is often hard to notice having become the standard modus operandi (from cross-licensing agreements to strategic complementarity in products and services). For example, witness the case of the Microsoft/Intel collaboration or “Wintel” alliance. We propose a dynamic, learning-driven framework which uses the game theoretic perspective, drawing principally from the notion of “co-opetition” (coined by Ray Noorda, former CEO of Novell, and developed by Brandenburger and Nalebuff [1996]), to examine how a knowledge generating and leveraging value-maximizing organization (not just a for-profit firm), should position itself in relation to the range of players with whom the organization interacts (in terms of market relationships, generating and pooling of strategic knowledge assets including intellectual property rights and human capital, and other dimensions) to maximize shareholder value in the long term. Select case studies focusing on government-university-industry strategic partnerships for research and technological development (GUISP RTDs), such as the NSF Engineering Research Centers, provide empirical validation of our concepts and especially on how to architect intelligent organizational interfaces across the spectrum of strategic R&D collaborations.     

From Chaos To Patterns Of Understanding: Reflections On The Dynamics Of Effective Government Decision Making

Like other liberal-democratic governments, Australia has been going through a process of dramatic change in political and administrative structures and processes. There has been the well-documented shift from controlling inputs to managing for results which has resulted in the desired enhancement of executive government's responsibility and accountability for outcomes. A clear understanding of the evolving process of cabinet decision making points the way ahead to the next phase of reform. What lies ahead could, indeed, be more revolutionary than what has been achieved to date. Weber's dynamic concept of authority and domination, when understood as Weber himself used it, can tell one much about change and future possible evolution. It helps, heuristically, to indicate that government decision-making processes have already evolved to a sophisticated level. However, there is still much development that should be undertaken to maintain the quality of decision making. For instance, the move to small policy-advising departments and separated administrative programme-delivery agencies could be seen as a natural evolution and quite predictable. Good governance relies much on attaining a balance, in Weber's terms, between the ethics of intention (means) and the ethics of responsibility (ends). Together, they make the 'true man' who can have a 'vocation of politics' says Weber – but the 'true man' is hard to find. What is needed, therefore, are decision-making processes that are good at drawing out this balance. Well-established patterns of social action, encapsulated in Weber's sociology and typographically oriented hermeneutics, can help identify how this could be achieved. For instance, when one understands Weber's ideal types of authority structure as the core of a comprehensive conceptual model with constant interplay and movement over time, one can get a hint of how government decision making could be further enhanced.     

Reviews

Big Men, Small Boys and Politics in Ghana: Power, Ideology and the Burden of History, 1982–1994 by Paul Nugent. Pinter Publishing Limited (London and New York). 1995. xiv plus 306pp. including bibliography and index. £35 or $63 hardback.

Understanding Contemporary Africa (2nd edition) edited by April A. Gordon and Donald L. Gordon. Lynne Rienner Publishers, Boulder and London. 1996. xiv plus 432pp. including maps, illustrations, notes, bibliographies, appendices and index.

The Politics of Difference: Ethnic Premises in a World of Power edited by Edwin N. Wilmsen and Patrick McAllister. University of Chicago Press: Chicago and London. 1996. ix plus 210pp.

The Multilateral Development Banks. Volume 1. The African Development Bank by E. Philip English and Harris M. Mule. The North‐South Institute. Ottawa. 1996. xvi plus 213pp.

Brothers at War: Dissidence and Rebellion in Southern Africa by Abiodun Alao. British Academic Press, London and New York. 1994. xiii plus 201pp. including notes, bibliography, index. £39.50. Hardback.

Now that We are Free: Coloured Communities in Democratic South Africa edited by Wilmot James, Daria Caliguire and Kerry Cullinan. Lynne Rienner Publishing, Boulder (Colorado) and London. 1996. 142pp.

Imperialism or Solidarity? International Labour and South African Trade Unions by Roger Southall. University of Cape Town Press, Cape Town. 1995. 398pp.

The Aid Relationship in Zambia: A Conflict Scenario by Oliver Saasa and Jerker Carlsson. Institute for African Studies, Lusaka (Zambia) and Nordic Africa Institute, Uppsala (Sweden). 1996. 170pp. including figures, tables, notes, bibliography and index. Paperback.