The ongoing debate over Medicare: understanding the philosophical and policy divides

This Article examines the evolution and status of Medicare, as well as the myriad current efforts to reform this longstanding entitlement. The author analyzes why healthcare financing for the elderly follows an administered pricing, fee-for-service model, while the working population generally obtains its insurance under a competitive market model. As a non-means-tested program modeled after Social Security, Medicare embraces both a universal entitlement philosophy of government-provided basic health services, and a need-based entitlement philosophy of caring for the Medicare-eligible elderly.     

Objective and Self-Perceived Resources as Predictors of Depression Among Urban and Non-Urban Adolescent Mothers

Pregnant and parenting adolescents often cope with a lack of resources as they struggle to negotiate the tasks of motherhood and adolescence. Previous research has determined that young mothers have an increased rate of depression when compared to older mothers. In this study, self-perceived resource adequacy, education, income, age, and environment (urban vs. non-urban) were investigated as predictors of depression at approximately 14 and 36 months after birth in adolescent mothers (N=523). Self-perceived resources accounted for significant variance in depression at 14 and 36 months while controlling for education and income. However, education and income were not significant predictors while controlling for self-perceived resources. Age and environment did not predict depression. Researchers would be wise to focus on a young woman’s view of her situation, as it appears that self-perceived resources play an important role in predicting depression.Post-Doctoral Research Associate at Juniper Gardens Children’s Project, University of Kansas. She received her Ph.D. from Iowa State University in 2005. Her major research interests are adolescent parenthood, mental health, and parenting interventions.Professor at Iowa State University. He received his Ph.D. from the University of Minnesota in 1976. His major research interests are stress and coping, mental health, and adolescence.Assistant Professor at Iowa State University. She received her Ph.D. from Iowa State University in 1997. Her major research interests are assessment and program planning for children with disabilities and early literacy.     

Beyond Ethical Codes: The Management of Integrity in the Netherlands Tax and Customs Administration

Trust in government is foundering. Ethics codes have limited utility in bolstering public trust, and a clear correlation between such codes and changed behavior must still be established. They are a means for external oversight, but they do nothing in terms of providing an internal moral compass. To rebuild trust in government, employees must also act with integrity. Actions that are both ethical and carried out with integrity are necessary—neither is sufficient. Acknowledging this, the Dutch Tax Administration undertook a two-pronged approach focused on the management of integrity as a means to codify the operational ethics of the organization, as well as to foster shared values and behaviors. This approach is noteworthy because it guides behaviors while retaining street-level discretion. It also is the first step toward creating a bureaucracy of mutual relationships that creates an ongoing moral consciousness serving both democracy and efficiency not only through control, but also through self-reflection, interaction, and association.     

Perceived Sibling Relationships and Adolescent Development

Utilizing longitudinal, 3-wave data collected from multiple informants (fathers, mothers, and target children) in 374 families, the potential effects of sibling relationships on adolescent development across early and middle adolescence were investigated. Adolescents who perceived their sibling relationships more positively at Time 1 tended to have better friendships and higher self-esteem at Time 2, which, in turn, were associated with less loneliness, less depression, and fewer delinquent behaviors and less substance use at Time 3. Moreover, a bidirectional relationship was found between adolescent self-esteem and the quality of their sibling relationships, suggesting that a more positive sibling relationship helps to enhance adolescent self-esteem, and that higher adolescent self-esteem predicts a more positive sibling relationship. A bidirectional relationship was also found between adolescent sibling relationships and adolescent friendships. However, a much stronger association between adolescent sibling relationships at Time 1 and adolescent friendships at Time 2, than between adolescent friendships at Time 1 and adolescent sibling relationships at Time 2, may suggest that the quality of an earlier sibling relationship is more predictive of the quality of a later friendship for adolescents rather than the other way around.