Medicaid in the 1990s: Trends, Innovations, and the Future of the "PAC-Man" of State Budgets

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.     

Special report on liability and insurance. An update on assignment of patient benefits under ERISA

While the holdings in Davidowitz and Arkansas Blue Cross & Blue Shield arose in different contexts, they both reflect the courts' increasing willingness to consider the importance of cost containment in the health insurance arena, even though patient accessibility to health care may be restricted as a result. If the holding in Davidowitz is not successfully appealed, providers may need legislative relief in order to retain their ability to take valid assignments of patient claims for payment from ERISA plans. It is uncertain whether such legislation can be sought at the state level or must instead come from Congress due to ERISA preemption of state legislation. Clearly, the district court decision on remand in Arkansas Blue Cross & Blue Shield will be closely watched for any light it may shed on this question. On a pragmatic note, providers who have not entered into "participation" agreements with insurers or other private payors may now have a greater incentive to do so, and "nonparticipating" providers who continue to obtain assignments from patients in order to collect directly from insurers or other private payors should determine on a case-by-case basis whether the source of the patient's benefits is a group health plan--which is likely to fall under ERISA and may contain nonassignment provisions--or some other form of coverage. For an additional perspective on insurers' responses to copayment waivers, see Newsletter, Vol. 6, No. 10, October 1991, at 7.     

The development of drug trade and drug control in the Netherlands: a historical perspective

Drug trade is widely seen as a phenomenon rather new to the Netherlands. However, at the beginning of the 20th century the Dutch pharmaceutical industries were already extensively involved in the production of both opiates and cocaine, and they went on exporting large quantities of these drugs after the Opium Act (1919) took force. Until the 1960s, arrests were not at all common, and these largely affected minority groups like Chinese opium smokers and black marijuana users. Since then, drug control efforts have increased by leaps and bounds. At first, cannabis was the main target; then the focus turned to heroin, and that was later joined by cocaine. This paper traces the history of the drug trade and drug control in the Netherlands, with emphasis on their development in Amsterdam. The conclusion is reached that, in spite of drastic changes in both drug trade and drug control, certain ideologies, constructs and strategies have remained remarkably stable.     

From coercion to deception: the changing nature of police interrogation in America

Our police, with no legal sanction whatever, employ duress, threat, bullying, a vast amount of moderate physical abuse and a certain degree of outright torture; and their inquisitions customarily begin with the demand: If you know what's good for you, you'll confess. (Ernest Jerome Hopkins, 1931)¹ Today, Ness Said, interrogation is not a matter of forcing suspects to confess but of conning them. Really, what we do is just to bullshit them (William Hart, 1981)² There is an interesting irony at work here: restrict police use of coercion, and the use of deception increases. (Gary Marx, 1988)³ In both popular discourse and academic scholarship one continually encounters references to the tradition-bound police who are resistant to change. Nothing could be further from the truth. The history of the American police over the past 100 years is the history of drastic, if not radical, change. (Samuel Walker, 1977)⁴ A longer version of this paper was presented at the Annual Meeting of the American Society of Criminology in November, 1991.     

Human rights safeguards and international cooperation in extradition: Striking the balance

Conclusion It is necessary to strike the correct balance between safeguarding the rights of the individual and engendering mutually beneficial cooperation between states in extradition matters. In the absence of effective global international human rights enforcement mechanisms, many of the traditional safeguards still have a real role to play in extradition. This article reviewed five such safeguards and found that all but the nationality exception should be retained to ensure that international cooperation and individual protection are both safeguarded for the common good of society.This is a revised version of a paper presented at an international workshop on Principles and Procedures for a New Transnational Criminal Law, organized jointly by the Society for the Reform of Criminal Law and the Max Planck Institute for Foreign and International Criminal Law, Freiburg, Germany, May 21–25, 1991.LL.B., University of Exeter 1973; LL.M., Osgoode Hall Law School 1974; D. Jur., Osgoode Hall Law School 1976.     

Comprehensively Advance Reform of the Urban Housing System Opinion. [Summary 1991

On 31 December 1991, the Chinese State Council Housing System Reform Leading Group announced this Opinion, setting out targets, principles, and policies for the reform of the system of provisional housing in urban areas. Section 1 of the Opinion provides that the long-term goal of reform is to convert the distribution of housing from a system based on welfare allocation to one based on commodity exchange either by purchase or rental. Section 2 sets the following targets for reform: a) within the period of the Eighth Five-Year Plan, the system will be converted from one of low rent to one in which the calculation of rent will be based on cost of upkeep, administration costs, and depreciation; b) by 2000, the calculation of rent will be based on the above factors, as well as interest on investment and property taxes; and c) in the long term, the calculation of rent will be based on all of the above factors, as well as land rent, insurance premiums, and profit. Section 4 deals with policies for managing various problems such as rent increases and subsidies, sales of housing, financing for housing, the system of investment in and construction of housing, and administration of housing. This Section provides that a three-level housing investment fund based on municipalities, work units, and individuals will be established.     

Facing the powers that be

Lobbyists, entrenched forces in congress and self-interested friends will try to stymie Clinton's efforts. A look at four key arenas of combat.     

Project USA: American competitiveness and what must be done to restore it

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.