Tension, compression, and shear: directions, stresses, and outcomes of health care cost control

"Control" of health care costs is often portrayed as a struggle between external, "natural" forces pushing costs up and individuals, groups, and societies trying to resist the inevitable. This picture is false. Control includes strenuous efforts by some to raise costs, and by others to resist those increases, and/or to transfer costs to someone else. But all such forces originate in the purposes and interests of individuals and groups. Health care cost control is a struggle among conflicting interests over the priorities of a society, and claims of "inevitability" are simply part of the political rhetoric of that struggle. International experience supports certain conclusions. First, there is no basis for the claim that limits on expenditure growth must threaten the health of (some members of) a society. Second, there is a substantial variety of experience with cost control. Failure in the United States is often presented as evidence of the impossibility of control, but most other countries have succeeded. Finally, control requires the direct confrontation of interests, with substantial build-up of stress. Advocates of expansion are more successful if they can transform compressive forces into efforts to shift the burden onto someone else. Pressures from providers in every country for "privatization" and/or payment by users reflect this recognition of economic interest.     

The metropolitan character of urbanization in Mexico, 1900-1988

The author analyzes trends in urbanization in Mexico during the twentieth century, with a focus on the impact of rapid industrialization since 1982. Sections are included on the interrelations among economic development, industrialization, and urbanization; stages, levels, and measures of urbanization; the development of the city system in Mexico; and stages in the growth of Mexico City. (SUMMARY IN ENG)     

Explaining political sophistication

Debates over the political sophistication of mass publics smolder on. The more fundamental question, however, is why people become as politically sophisticated or unsophisticated as they do. This paper develops a nonlinear simultaneous equation model to weigh explanations of three general sorts: the politicalinformation to which people are exposed, theirability to assimilate and organize such information, and theirmotivation to do so. The estimates suggest that interest and intelligence, representing motivation and ability, have major effects, but that education and media exposure, the big informational variables, do not. I consider the reasons and sketch some implications for the sophistication of mass publics, for the study of sophistication and other variables of extent, and for democratic theory.An earlier version of this paper was presented at the annual meeting of the Midwest Political Science Association, Chicago, IL, April 9–11, 1987. The data were made available by the Inter-University Consortium for Political and Social Research. Douglas Arnold, John Bolland, Thad Brown, Carol Cassel, Philip Converse, George Kateb, Jan Kmenta, Kathleen Knight, James Kuklinski, Kenneth Langton, Melvin Manis, Diana Owen, Thomas Rochon, Marianne Stewart, Paul Sniderman, James Stimson, and Herbert Weisberg have provided feedback and encouragement. James Gibson relayed his results on the intelligence measures, even as they came off the printer. Mary Lee Luskin helped in many ways. If errors remain, they are mine.     

Are you ready for the cure?

The Clinton health-care plan will soon be unveiled. Here is an inside look at what it contains so far.     

The struggle over retiree medical benefits: who's on top?

Over the past decade, there has been an explosion of litigation addressing an employer's right to unilaterally amend or terminate medical benefits provided to retirees. The sheer volume of these cases and the variety of facts and legal theories have combined to obscure the patterns and trends that actually are emerging from this litigation. This article will describe the context of the struggle over retiree benefits and discuss those leading decisions in which the federal courts of appeals have established their rules for deciding retiree benefits cases.