Medicaid rationing in Oregon: political wolf in a philosopher's sheepskin

Although the details of the proposal have shifted since it was first described, the Oregon Medicaid waiver has had one consistent feature: it will reduce benefits to AFDC mothers and children who are currently covered by Medicaid in that state, in the hopes of increasing coverage for other individuals who are now uninsured. Because of the adverse consequences for the AFDC population, there should be strong evidence supporting the purported benefits of the proposal before proceeding with the waiver. One of the most intriguing aspects of the waiver proposal is the claim that the money currently being spent on AFDC beneficiaries could be redistributed to expand coverage to a substantial number of the uninsured. The concept is that far more people could receive the most valuable services if those now being served gave up their coverage of the least valuable services. Other purported benefits of the waiver include enhanced citizen participation in decisionmaking, cost-savings, and improved payment levels and delivery arrangements. Remarkably, this analysis of the proposal reveals that the waiver is likely to achieve none of its stated objectives, and instead will have adverse consequences not identified by its proponents. What the proposal would do is to insulate politicians from visible responsibility for limiting benefits for AFDC children and adults. Finally, the proposal undermines 25 years of Medicaid as an entitlement program. As such, it would establish as a social ethic the principle that the poor can be relegated to inadequate care. Such an extreme measure is not justified by the fiscal situation in Oregon, which is not extraordinarily poor or overtaxed, and does not have a particularly generous or unusually expensive Medicaid program.     

Child witnesses and the confrontation clause

InMaryland v. Craig, the United States Supreme Court relied heavily on a brief prepared by a committee of the American Psychology-Law Society on behalf of the American Psychological Association (APA). The APA brief concluded that sexually abused children may be particularly vulnerable to distress in the legal process, especially when forced to confront the defendant face to face, and that such acute distress may be inconsistent with the state's interests in promotion of reliable testimony and child welfare. APA also argued that psychological theory and research provide foundations for individualized determination of the need for measures to protect children from face-to-face confrontation. *** DIRECT SUPPORT *** AFE06051 00002     

The relationship of abuse and witnessing violence on the Child Abuse Potential Inventory with black adolescents

A number of social and psychological factors present in most adolescent parents place them at high risk for abusive behavior toward their children. However, current child abuse potential measures do not include adolescent samples as part of the psychometric data base. Consequently, the purpose of this study was twofold: (1) to investigate whether a Black adolescent sample would perform differently than an adult nonabusing sample on the Child Abuse Potential Inventory (CAP), and (2) to examine the relationship between history of abuse or witnessing violence to scores on the CAP. Results revealed that Black adolescents scored significantly higher than the adult normative sample on the CAP; consequently, cutoff scores need to be empirically established for adolescents. Additional analyses indicated that a history of abuse, as well as a history of witnessing violence, are associated with a high potential for abuse.     

The emergence of maternal-fetal conflict policies

George Washington University Medical Center's Policy on decisionmaking by pregnant patients is being widely circulated by the ACLU; copies of the Policy can be obtained by calling the American Civil Liberties Union Reproductive Freedom Project. There is, of course, much disagreement over the details of the Policy; not everyone will agree with its underlying philosophy favoring maternal rights. Nevertheless, there does seem to be a consensus that wherever possible these conflicts should be resolved in accordance with previously adopted policies rather than by the courts on an ad hoc basis. Had the Policy been in place in 1987, the Carder case would probably not have been submitted to a judge in the first place, nor would Angela Carder have been forced to undergo a Caesarean section. All hospitals should consider adopting a maternal-fetal conflict policy, and those that do so should be aware of the George Washington University Medical Center Policy, whether or not they agree with its provisions. Whatever policy each hospital ultimately develops should be integrated with decisionmaking and informed consent policies already in place. The formulation and implementation of such a policy, reflecting the hospital's legal and ethical obligations to its pregnant patients, will go a long way towards preventing unnecessary resort to the courts.     

Circumventing formal structure through commitment: Presidential influence and agenda control

Although the formal institutional structure that defines the temporal order of play in a policy game between the Congress and President ought to provide Congress with agenda power, the President is traditionally treated as the dominant player in this relationship. We show that if the President can make clear-cut commitments, presidential commitment can counter the dominance hierarchy and the complexion of equilibrium outcomes. Thus, the details of political interactions (in particular, the possibilities for commitment) may be as important as the formal specification of institutional structure.We thank Peter Aranson, David Austen-Smith, Ed Campos, Gerry Faulhaber, Art Frank, Ken Koford, William Riker, Janet Pack, the anonymous referees, and seminar participants at the University of Delaware, the University of Pennsylvania, and the University of Rochester for helpful comments, subject to the usual caveat. We also thank Joel Friedlander and Harold Dichter for research assistance.     

Competition in political and economic markets

Prepared as a response to Frey and Eichenberger's Anomalies in Political Economy. We thank Gordon Tullock for helpful discussions. This work was partially supported by the Taylor Experimental Laboratory at Washington University.     

Elections and government spending

It is widely believed that electoral pressures cause legislators to favor government spending programs. This electoral theory of spending is shown to encompass two core hypotheses: (1) the electoral consequences hypothesis, which states that support for spending programs improves the representative's electoral showing; and (2) the legislator insecurity hypothesis, which states that greater electoral insecurity leads representatives to be more in favor of spending programs. A test of these ideas using spending scores for U.S. representatives in 1986 finds that neither hypothesis is supported by the data.     

Attitudes of Canadians toward affirmative action: Opposition,value pluralism,and nonattitudes

Set against a backdrop of current public policy and case law, this study investigates Canadian attitudes toward affirmative action among both citizens and decision makers. We find low levels of support for such programs across a variety of contexts and intended beneficiaries, but we also discover that opinion on both sides of the issue is rather soft, for large portions of those taking positions on the matter are willing to reconsider their views when prompted. We interpret this finding as an indication of what Philip Converse has called nonattitudes. Thus, a substantial portion of Canadians appear to hold no genuine attitudes on the question of affirmative action and are relatively open to persuasion. In contrast, the preferences of those with stable attitudes are rooted in the tradeoff between values of equality and merit. Implications for policy activists in this issue area are discussed.The research reported here is part of a large project supported by the Social Sciences and Humanities Research Council (Grant No. 411-85-001). The Centre of Criminology at the University of Toronto has provided a home, and indispensable support, for the Charter Project. This research was also facilitated by a contribution from the Solicitor General of Canada to the Centre of Criminology, University of Toronto. Our thanks also go to Robert Vipond for his help in clarifying our concepts.     

Last rights. In sickness and in health, more people are taking life's biggest decision away from doctors and into their own hands

When dying is all that awaits them, more and more people are choosing certain death now rather than uncertain life on medical support systems. But the decision seldom comes easy, as a Newsweek reporter discovers during three weeks with the doctors, nurses, patients and families in an intensive-care ward. A best-selling guide to suicide fires debate over when it is right to let life go--and who should make that choice when the patient no longer can.     

Money madness. Are private psychiatric hospitals resorting to kidnapping in their quest for paying patients?

In their zeal for lucrative insurance reimbursement, some private psychiatric hospitals seem to have gone over the edge themselves. A number of these institutions, critics charge, use outright coercion to commit and retain patients. Now some formerly abducted "recruits" are fighting back with lawsuits.