Does Spending More Get More? Health Care Delivery and Fiscal Implications From a Medicare Fee Bump

While salient features of the Affordable Care Act include insurance expansions and private coverage reforms, various other provisions are embedded within the law. We focus on a temporary 10 percent fee increase for primary care visits supplied to publicly insured (Medicare) beneficiaries. Using administrative and survey data, we assess the price shock's impact on service volume, physician labor supply, and quality of care. Primary care physicians (PCPs) in independent practices demonstrate, at most, a marginal 2 percent increase in new patient visits while horizontally and vertically integrated PCPs show no change. Both PCP organizational types witness declines in established patient visits, on average, but there is marked heterogeneity: established patient visits increase by 1 to 2 percent among PCPs with fewer Medicare claims in the pre‐period. The Medicare fee bump did not observably impact other labor supply outcomes and quality of care margins. We estimate that the policy introduced a $1.5 billion transfer from taxpayers to providers during the initiative's first three years.     

Crowdsourcing and Self-Instruction: Turning the Production of Teaching Materials Into a Learning Objective

This article describes a lesson plan that harnessed students’ abilities to generate new teaching material by constructing country timelines. This involved crowdsourcing, or the reliance upon task inputs from a large number of people to acquire information. The plan was motivated by an approach that conceives of learning as deriving from the joint activity of individuals with shared tools, and was geared toward promoting self-instruction alongside traditional lectures and exams. By relying on independent research and individual contributions to create a new teaching resource, the course facilitated strategic reading and peer learning and promoted a research-active learning environment. The experience encourages instructors to consider ways to use distributed learning in the classroom to make students both the producers and consumers of innovative content.     

Reform of the United Nations Security Council: equity and efficiency

Rents and political motives are present in many aspects of public policy. This article considers the role of rents, rent seeking, and the political choice of environmental policy. Rents are introduced into the political choice of price and quantity regulation under conditions of uncertainty. The model shows how political-economy aspects affect the choice between price and quantity regulation. The contesting of rents associated with different policies affects the regulatory structure and influences the political choice of an environmental policy target. The primary conclusion is that the political choice of environmental policy depends on the interaction between the efficiency of rent transfer and the size of rent-seeking groups within the economy.     

Clean Air Federalism: Do States Race to the Bottom?

Proponents of federal environmental standards argue that competition for industrial development creates a “race to the bottom” in which states relax their own environmental standards to avoid losing businesses to states with more “business‐friendly” regulations. This article presents results from a unique survey of state clean air programs that show—contrary to the race to the bottom—a substantial number of states exceed federal EPA standards in a broad variety of clean air programs. Multivariate analyses of these state policies indicate that states strengthen their environmental programs in response to citizen demands rather than weaken their programs in deference to economic pressures.     

Communication and competition in environmental studies

College-bound students and graduate students interested in environmental studies and environmental science have hundreds of programs to choose from, and potential suitors in the academy are eager to be noticed. This article considers how purveyors of environment-related degree programs and majors use branding and other communication strategies as they compete for students and other coveted resources. Departmental and degree nomenclature is examined so as to discern how academic institutions respond to changing intellectual fashions and popular interest in environmental affairs. This analysis is aided by Harold D. Lasswell’s insights into the politics of communication.