An Integrated Theory of Budgetary Politics and Some Empirical Tests: The U.S. National Budget, 1791–2010

We develop a general theory of budgetary politics and examine its implications on a new data set on U.S. government expenditures from 1791 to 2010. We draw on three major approaches to budgeting: decision‐making theories, primarily incrementalism and serial processing; policy process models; and path dependency. We show that the incrementalist budget model is recursive and that its solution is exponential growth, and isolate three periods in which it operates in pure form. The equilibrium periods are separated by critical junctures, associated with wars or economic collapse. We assess policy process dynamics by examining the deviations within equilibrium periods. We offer three takeaways: (1) exponential incrementalism is fundamental to a theory of budgeting; (2) disjoint shifts in the level of exponential incrementalism are caused only by critical moments; (3) temporally localized dynamics cause bends in the exponential path, longer returns to the path within budgetary eras, and annual punctuations in budget changes.     

Competitive pricing and the challenge of cost control in medicare

The Medicare program faces a serious challenge: it must find ways to control costs but must do so through a system of congressional oversight that necessarily limits its choices. We look at one approach to prudent purchasing - competitive pricing - that Medicare has attempted many times and in various ways since the beginning of the program, and in all but one case unsuccessfully due to the politics of provider opposition working through Congress and the courts. We look at some related efforts to change Medicare pricing to explore when the program has been successful in making dramatic changes in how it pays for health care. A set of recommendations emerges for ways to respond to the impediments of law and politics that have obstructed change to more efficient payment methods. Except in unusual cases, competitive pricing threatens too many stakeholders in too many ways for key political actors to support it. But an unusual case may arise in the coming Medicare fiscal crisis, a crisis related in part to the prices Medicare pays. At that point, competitive pricing may look less like a problem and more like a solution coming at a time when the system badly needs one.     

OxyContin and a Regulation Deficiency of the Pharmaceutical Industry: Rethinking State-Corporate Crime

On May 10, 2007, three executives of the pharmaceutical company Purdue Pharma pled guilty in federal court to misleading doctors and patients about the risk of addiction and potential for abuse of OxyContin. Additionally, Purdue Pharma paid over $600 million in fines and other payments to the United States government and the Commonwealth of Virginia. The drug OxyContin was first introduced to the market in December of 1995. Warning signs of the drug’s potential for abuse were almost immediate, and there were reports of copious amounts of the drug being diverted into the black market for recreational use. In some cases, criminologists have argued that if the government fails to protect its citizens from the harm of a corporation then such behavior should be considered state-corporate crime. We critically evaluate the case of OxyContin to see if it falls under the state-corporate crime paradigm. Further, we argue the state-corporate crime paradigm can benefit from an increased focus on the organizational structures of regulation agencies.