Bad debts and hospital rate-setting

This paper examines the economic foundations for mandatory discounts for insurers based on differences in bad debts experience. It considers critically the arguments Blue Cross plans use in several states. On both equity and efficiency grounds, discounts for actual bad debts are shown to be inappropriate. In contrast, it is shown that there are equity and efficiency reasons to grant a discount for insurance policies which avert bad debt, but that the appropriate discount is less than the amount of bad debt averted. The appropriate discount depends on the size of the subsidy needed to bring about purchase of debt-averting coverage. In some circumstances, this subsidy equals the underwriting loss on the coverage minus any tax subsidy the insurer receives.     

Preservation of human tissue immersed for five years in fresh water of known temperature

Two human bodies were recovered from the waters of the Duluth, Minnesota harbor. Extensive adipocere formation resulted in remarkable preservation of gross anatomic features of internal organs. Total time of immersion could be precisely estimated at five years. Water temperature during those five years could also be accurately estimated by direct measurements taken during the year following recovery of the bodies and from information supplied by a local electric power generating company. Immersion occurred at the time of the year when water temperature was highest (70 degrees F [21 degrees C]) facilitating the rapid formation of adipocere. A proposed mechanism for formation of adipocere is described.     

Sudden, unexpected death due to massive, nontraumatic intra-abdominal hemorrhage in association with cirrhosis of the liver

Hemoperitoneum is usually due to rupture, laceration, or perforation of a blood vessel or organ. The author describes three deaths due to massive intra-abdominal hemorrhage, all in alcoholics with cirrhosis of the liver, in which no source for the bleeding was found. One of the three individuals, who was briefly hospitalized, showed evidence of a disseminated intravascular coagulopathy (DIC). In the author's opinion, this is the most likely cause of the intra-abdominal hemorrhage in the two other cases and is related to the cirrhosis of the liver.     

The administrative legacy of ancient India

Marx and Weber considered ancient Asian bureaucracies as irrelevant for the modern world. But one important element of the Indian bureaucratic legacy namely, the district overlord or collector, was taken over by the British and instituted all over their Asian and African possessions. It still forms the foundation of field administration in all these countries after independence. This paper traces the textual origins of centralized Indian bureaucracy in Kautilya's Arthasastra, its dilution over the centuries due to the failure of imperial integration in India, compared to its success in China and the survival of the district overlord institution which the British resuscitated and modernized. The paper also speculates about the reasons for the failure of Marx and Weber to interpret or predict Indian development.