Rationing psychosocial treatments in the United States

This paper briefly reviews the recent history of psychosocial treatment for adults with severe mental illnesses in the United States. It examines the current sources and financing of such care, revealing the planned and unplanned reclassification of entitled beneficiaries and eligible patients, appropriate treatment, acceptable outcomes, and levels and sources of payment. One illustration of this phenomenon is seen in current efforts to identify and deliver only those public services that are covered by Medicaid, so as to allocate state resources only when they can be matched by federal monies. Another is the reliance on private health insurance, tied in the U.S. almost exclusively to employment, for medical care delivered under an acute, rather than a chronic care model. These analyses conclude with a discussion of the implicit and explicit mechanisms used to ration access to psychosocial treatment in the United States. The implications for individuals with serious mental illnesses, their families, and the general public are placed in historical and current policy contexts, recognizing the economic, social, and clinical variables that can moderate outcomes.     

A: Reviews: general

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Revisiting the role of distributive justice in Tyler’s legitimacy theory

Objectives

Tyler’s theory of legitimacy identified procedural justice and distributive justice as antecedents of legitimacy, but placed distributive justice in a relatively minor position compared with procedural justice. This has led to researchers paying less attention to distributive justice in the development of theory, despite consistent findings that distributive justice is important to a number of outcomes for criminal justice authorities. This report uses uncertainty management theory to revisit Tyler’s legitimacy model and gain a more nuanced understanding of distributive justice.

Methods

The proposed model is tested using a series of latent variable analyses conducted on a sample of 2169 adults and a factorial vignette design. The vignette design randomly manipulates outcome favorability and officer behavior during a hypothetical traffic stop. Multiple indicator multiple cause (MIMIC) models are then utilized to test the impact of these manipulations on perceptions of procedural justice and distributive justice. This is followed by a structural equation model that tests the relationships between procedural justice, distributive justice, and legitimacy.

Results

Officer behavior is a primary predictor of both procedural justice and distributive justice. Furthermore, the results demonstrate that distributive justice judgments are shaped by perceptions of procedural justice. Accordingly, distributive justice mediates the relationship between procedural justice and legitimacy.

Conclusions

Distributive justice should not be treated as a competing explanation for legitimacy evaluations, but as a concept that contextualizes why procedural justice is important.

     

Does microtargeting matter? Campaign contact strategies and young voters

In recent elections, campaigns have based their contact decisions on individual microtargeted propensity scores generated using “Big Data” rather than the more traditional geographic-based contacting. Shifts in campaign strategy have implications for who is contacted and ultimately who participates in elections. As campaigns focus more of their outreach towards individuals who the data indicate are more likely to turn out and more likely to vote for their candidate, some groups may be systematically excluded from contact. We investigate this using voter files and survey data from the 2012 US elections to compare who the Republicans identified for campaign contact using microtargeted propensity scores and who would have been identified for contact if they used a strictly geographic-based approach. Our findings suggest that young people are much less likely to be designated for contact when campaigns rely on microtargeted data than older individuals, the latter of whom are more likely to be contacted under both geographic and microtargeting strategies.     

Donald Trump,contempt, and the 2016 GOP Iowa Caucuses

ABSTRACT

Theories of discrete emotions distinguish contempt from other negative emotions, and recent evidence shows that contempt toward candidates played a major role in two US Senate races in 2014. Contempt felt by respondents was the most significant emotion predicting voting against three of the four major party candidates, and had effects independent of other emotions, such as anger, anxiety, and hope. In the present paper, the 2016 Republican Iowa Caucus provides the opportunity to examine contempt in a different context: an intra-party primary campaign, where candidates share the important characteristic of party affiliation. We find that while voters perceived all leading GOP candidates as expressing at least some contempt, Donald Trump was seen as expressing the most contempt by far. Voters also felt contempt for at least some candidates of their own party. When they did so, it predicts significantly lowered probabilities of voting for Cruz, Trump, and Rubio, and increased probabilities of voting for one or more of their opponents. Implications of these findings for theory and research on the role of contempt and other specific emotions in voting behavior are discussed.     

Taxpayer governmentality: governing government in Metro Vancouver’s transit tax debate

In a 2015 plebiscite, voters in Metro Vancouver, British Columbia rejected a proposed sales tax dedicated to funding a regional transportation plan. Opposition was spearheaded by a taxpayer group that focused on the perceived incompetence and wastefulness of the region’s transportation authority. Exercising a liberal imperative of ‘permanent critique of government’, the taxpayer group assembled evidence addressed to ‘taxpayers’. Developing a theoretical account of ‘taxpayer governmentality’, the paper analyses how people are addressed and fashioned as taxpayer subjects, empowered and responsibilized to govern government, and their own political conduct, as sceptical, calculating, non-political, economic actors. The paper concludes by suggesting that this taxpayer subject may be productive for understanding the practice of liberal critique and limitations of the state.