Competitive pricing and the challenge of cost control in medicare

The Medicare program faces a serious challenge: it must find ways to control costs but must do so through a system of congressional oversight that necessarily limits its choices. We look at one approach to prudent purchasing - competitive pricing - that Medicare has attempted many times and in various ways since the beginning of the program, and in all but one case unsuccessfully due to the politics of provider opposition working through Congress and the courts. We look at some related efforts to change Medicare pricing to explore when the program has been successful in making dramatic changes in how it pays for health care. A set of recommendations emerges for ways to respond to the impediments of law and politics that have obstructed change to more efficient payment methods. Except in unusual cases, competitive pricing threatens too many stakeholders in too many ways for key political actors to support it. But an unusual case may arise in the coming Medicare fiscal crisis, a crisis related in part to the prices Medicare pays. At that point, competitive pricing may look less like a problem and more like a solution coming at a time when the system badly needs one.     

The effect of the election of prosecutors on criminal trials

We examine whether elections of public prosecutors influence the mix of cases taken to trial versus plea bargained. A theoretical model is constructed wherein voters use outcomes of the criminal justice system as a signal of prosecutors’ quality, leading to a distortion in the mix of cases taken to trial. Using data from North Carolina we test whether reelection pressures lead to (a) an increase in the number and proportion of convictions from jury trials and (b) a decrease in the average sanction obtained in both jury trials and pleas. Our empirical findings are consistent with our theoretical predictions.     

An Integrated Theory of Budgetary Politics and Some Empirical Tests: The U.S. National Budget, 1791–2010

We develop a general theory of budgetary politics and examine its implications on a new data set on U.S. government expenditures from 1791 to 2010. We draw on three major approaches to budgeting: decision‐making theories, primarily incrementalism and serial processing; policy process models; and path dependency. We show that the incrementalist budget model is recursive and that its solution is exponential growth, and isolate three periods in which it operates in pure form. The equilibrium periods are separated by critical junctures, associated with wars or economic collapse. We assess policy process dynamics by examining the deviations within equilibrium periods. We offer three takeaways: (1) exponential incrementalism is fundamental to a theory of budgeting; (2) disjoint shifts in the level of exponential incrementalism are caused only by critical moments; (3) temporally localized dynamics cause bends in the exponential path, longer returns to the path within budgetary eras, and annual punctuations in budget changes.     

Predictors of sexual aggression among male juvenile offenders

The purpose of this study was to conduct a longitudinal examination of predictors of sexual aggression among male juvenile offenders. Four hundred and four adolescent males between the ages of 14 and 17 years were recruited from juvenile probation offices to take part in a prospective study of substance use and sexual risk. At baseline, participants completed a series of questionnaires that assessed putative risk factors for sexual aggression. They then completed a measure of sexual aggression at the 6-month follow-up period. Correlational analyses revealed that participants who reported hard drug use, more frequent alcohol and marijuana use, and less severe offenses reported engaging in more severe sexual aggression. In addition, participants who reported higher impulsivity, sensation seeking, and externalizing behaviors also reported participating in more severe sexual aggression. When these variables were included in a regression analysis, only externalizing behaviors and severity of offense uniquely predicted severity of sexual aggression at the 6-month follow-up.     

Flag desecration in American culture: Offenses against civil religion and a consecrated symbol of nationalism

Adoration for the United States flag is emblematic of American nationalism and patriotism. Moreover, in extreme forms, its rigid orthodoxy also reflects civil religion — a non-sectarian faith in which secular objects are transformed into sacred icons. Ostensibly, elements of civil religion imbue reverence for the flag, and although the recent flag protection campaign has caught the attention of intellectuals from various academic disciplines, sociologists are conspicuously absent from such discourse. In light of its relevance to civil religion, the dearth of sociological analysis on flag desecration is especially disconcerting. This article offers several theoretical explanations for the social construction of flag desecration and its sociological significance to civil religion.     

Book reviews

Computer Law (4th edition) Colin Tapper Longman ISBN CSD 0 582 05932 1 £22.50 PPR 0 582 02491 1 £35.00

Further Computer Contracts M‐T Michèle Rennie Sweet and Maxwell 1989. ISBN 0 421 40330 6

Formalism in AI and Computer Science Philip Leith Ellis Horwood 1990. ISBN 1 3325549 2

Electronically Recorded Evidence ‐ A Guide to the Use of Tape and Video Recordings in Criminal and Civil Proceedings Sybil Sharpe Fourmat Publishing 1989. ISBN 1 85190 071 3

Computer Law Chris Reed(ed) Blackstone Press Limited 1990. ISBN 1 85 431037 2

EDI and American Law: A Practical Guide Benjamin Wright Electronic Data Interchange Association 1989. ISBN 0 96 238750 9

Computer Software Protection and Semiconductor Chips Dr Dirk Schroeder (Butterworth's Current EC Legal Developments Series) 1990. ISBN 0 406 04021 4

Computers and the Law David I Bainbridge (Pitman) 1990. ISBN 0 273 03170 8     

Abortion research: attitudes,sexual behavior,and problems in a community college population

One hundred fifty community college students, 95% Caucasian, were surveyed regarding their attitudes toward abortion, their sexual behavior, and their problems. Although 70% of the students were raised Catholic, 82% supported abortion choice. Eighty-six percent had engaged in premarital sex, 70% used contraception, and 26% had premarital pregnancies. When anti-abortion students were compared with pro-abortion students, they had more religiosity, believed that abortion was murder, were more punitive toward the woman and medical personnel involved, were less sexually active, and less likely to know someone who had an abortion. Many students had a history of, and were currently experiencing, serious problems, especially the females.Received Ph.D. in psychology from Tufts University. Research interests include gender development and abuse.Received C.A.S. in school psychology from Harvard University. Research interests include corporal punishment and battered wives.