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Rapidly escalating health-care inflation and congressionallymandated expansions have led to large increases in spendingfor Medicaid, the federal-state program of health care for thepoor. These increases came at a time when state budgets werealready under recession-induced stresses. In addition, 1991brought new pressures for Medicaid spending from the courtsand closer federal scrutiny and control over revenues used forthe program's state "match." Yet the Medicaid picture is farfrom bleak. Diversity, innovation, and an emerging stale policyrole also characterize the program in ways that epitomize thestrengths and weaknesses of the American intergovernmental system. 相似文献
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Peter Atkins Greg Bagley Jim Bartoo Michael Bayer David Beatty David Brown Terry Cook Reggie Fairchild David Foster Bruno Gentil Gordon Goetzmann Michael Green Jim Hamann Rustom Irani Greg Lee Lynn Little Jim Mariani Tom McGuire Doug Merrill Gentaro Murakami Todd Naiven Taisuke Nomura Doug Paul Joe Rodriguez Stephen Silver Howard Suskind Mitsuhiro Tsuchiya Mike Wais Jeff Wright Jonathan Zaremski 《The Journal of Technology Transfer》1992,17(1):58-67
The United States today faces a loss of influence as a world power, a reduction in American independence as a policymaker, and a decline in the standard of living on which Americans have come to depend. History teaches that nations weaker and less productive than the United States can rise to become economic powerhouses and rapidly increase their standards of living. History also teaches that nations failing to recognize their fundamental problems will inevitably decline. American politicians must face what is abundantly clear: the United States is losing ground and must act quickly to reverse its course. This White Paper outlines what must be done. Information about the nation's current status must be analyzed and communicated. Incentives to improve the level of competence in government must be provided and maintained. The emphasis of government policy must be changed to reflect broad economic and technological interests as opposed to special interests. Savings must be encouraged and increased. Infrastructure must be improved Tax laws must be modified to help bring these changes about. Economic and technological issues must be elevated to the importance they require. American thinking must reflect the new realities: that the age of leadership through military power is over, that the requirements for success in the world of the 1990s and beyond require a sound and growing economy that is internationally competitive. The US can accomplish these goals only through foundation-shaking, comprehensive, fundamental changealong the lines we propose herein.This paper is the executive summary (with minor editing modifications) of a white paper that is available from Cornell University's Johnson Graduate School of Management. 相似文献
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Federalism enjoyed political and popular salience during theperiod 19961997 as the so-called "Devolution Revolution"began to be implemented and analyzed in the United States. Whilethere were a few examples of important Revolutionary efforts,the federal government continued to hold much of the power andsignificance it has achieved over the past sixty years. Evenin the area of welfare policy, where in 1996 there were historicreforms enacted to end the federal entitlement, the federalgovernment maintained a significant presence that made the ideaof devolution of welfare policy responsibility some what questionable.Nevertheless, states continued to lead in policy innovationin areas ranging from education to health, and the U.S. SupremeCourt continued to question the limits of federal power. Thepast year illustrated, once again, the complexity of our federalsystem and how difficult it is to reform federalismparticularlywhen it involves a shift in power and creates the perceptionof winners and losers. 相似文献
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