Consumer-sponsored prepaid group practice: restructuring the health care system

The traditional separation of health care delivery and financing systems is breaking down as various new types of health care facilities are established and as payment continues to be a major concern. Group Health Cooperative of Puget Sound (GHC) was organized as a prepaid group practice system responsive to consumers. Costs, methods of payment and delivery of care are interrelated and are all influenced by consumer ownership. GHC has been refining its benefit programs since 1945. Strategies for controlling use and costs focus on improved provider management and on flexibility. This article explains how the structure of GHC benefits the consumer.     

Fresh Thinking on U.S. Engagement with Africa: Probing the Limits of Engagement

The Biden administration faces the opportunity to reset U.S. policy towards Africa and possesses a variety of tools to use in doing so, including traditional diplomacy, economic statecraft, development assistance, and military engagement. With the increased militarization of U.S. foreign policy over the past few decades, there is an unfortunate tendency to default to military engagement when confronted with even remote threats to U.S. national security interests, and Africa is no exception. With vital security interests in Africa, it can be argued that military engagement should be limited in its application and targeted to those situations that do not lend themselves to solution through traditional diplomacy or development assistance.     

The R and D contract and democratic theory

The purposes of this essay are to describe how federal research and development policy has altered authority relationships and to suggest a new concept of legitimacy in accord with the changed conditions. Research and development (R and D) creates an indeterminate future. Thus, the politics of research and development incorporates an apparent contradiction : political leadership demands that jobs be done which require creative and unpredictable actions on the part of private organizations, while it also demands that contractors be held responsible for fulfilling goals efficiently, avoiding deleterious secondary consequences, and refraining from abuses of power. The paradox can be resolved by creating norms of responsibility that allow for judgments on how a job is done rather than what is to be done. New institutions for technological assessment to check on unintended consequences of projects and citizen review boards to estimate the quality of life engendered by projects may provide such norms of responsibility.