Halfway competitive markets and ineffective regulation: the American health care system

Since the late 1960s the U.S. has attempted to develop a strategy for controlling the rate of growth of health care spending. During the 1970s this strategy relied heavily on various forms of regulation. Some regulatory programs were partially successful in moderating spending increases, but they generated significant opposition--particularly from powerful provider groups, who successfully convinced Congress and the states to dismantle most of the regulatory structure and to substitute various forms of competitive approaches to controlling spending. Some of these competitive strategies have been successful in increasing the efficiency of subsections of our health system. But they too have produced "losers," and the government has been pressured to enter the system to minimize their losses. The net result has been a political stalemate between halfway competitive markets and ineffective regulation. With the rate of health care spending growth near historic levels, it is likely that the 1990s will bring a return to a stronger role for government regulation. But it is unlikely that we are any more willing to tolerate the negative fallout from regulation today than we were in the 1970s, and therefore we predict that the proportion of GNP going to health care will continue to grow throughout the remainder of this century.     

The Psychology of Coercion Failure: How Reactance Explains Resistance to Threats

When confronted with coercive threats, targets often stand firm rather than back down. We identify one important yet unrecognized factor that causes actors to resist threats: psychological reactance. Reactance theory explains that when someone perceives a threat to their freedom to make choices, they attempt to restore their autonomy by refusing to capitulate. The result is unwillingness to concede to coercion that extends beyond rational incentives. We test for reactance as a cause of coercion failure with two novel experiments. Each experiment pairs a coercive threat treatment with a matched “natural costs” counterpart that imposes the same choice on the target without intentional action by a coercer. Controlling for prominent alternative explanations, including costs, benefits, power, credibility, and reputation, we find that the targets of threats capitulate less frequently and more often support aggression against their opponents.     

Reinterpreting the Right to an Open Future: From Autonomy to Authenticity

This paper reinterprets a child’s right to an open future as justified by authenticity rather than autonomy. It argues that authenticity can be recognized as valuable by people whose conceptions of the good do not value autonomy. As a running example, the paper considers ultra-Orthodox Jews who lead separatist lives and who deny their sons secular education beyond an elementary school level. If their adult sons want to have careers and participate in life outside the religious enclave, they cannot easily do so. The parents see no reason to protect their child’s autonomy (which they do not value) or to prepare their child for a life that conflicts with their values. This paper provides one response to their concerns. Following a political-liberal project of seeking overlapping consensus, it tries to base demands that children be prepared for varied futures on values that reasonable religious people can embrace.     

Quality of Social Relationships and the Development of Depression in Parentally-Bereaved Youth

Fear of abandonment has been found to be associated with mental health problems for youth who have experienced a parent’s death. This article examines how youth’s fears of abandonment following the death of a parent lead to later depressive symptoms by influencing relationships with caregivers, peers, and romantic partners. Participants were 109 youth ages 7–16 (50% male), assessed 4 times over a 6-year period. The ethnic composition of the sample was non-Hispanic Caucasian (67%), Hispanic (16%), African American (7%), Native American (3%), Asian (1%), and Other (6%). Youth’s fears of abandonment by their surviving caregiver during the first year of data collection were related to their anxiety in romantic relationships 6 years later, which, in turn, was associated with depressive symptoms measured at 6 years. Youth’s caregiver, peer, and romantic relationships at the 6-year follow-up were related to their concurrent depressive symptoms. The relationship between youth’s attachment to their surviving caregiver and their depressive symptoms was stronger for younger participants. Implications of these findings for understanding the development of mental health problems following parental bereavement are discussed.     

Toward a stakeholder-based policy process: An application of the social marketing perspective to environmental policy development

This article suggests that the application of social marketing principles to the public policy process can facilitate the efforts of governmental policy-makers and non-governmental stakeholders to articulate their policy desires and to encourage the adoption and acceptance of particular environmental policies. A conceptual framework is presented, emphasizing both the influence of stakeholders on environmental policy development and the education of stakeholders as to the potential effects of the policy. The purpose of such a conceptualization is to show how social marketing principles can be applied to the public policy process in order to enhance the likelihood of successful policy development and implementation.     

Analysis of artificially degraded DNA using STRs and SNPs--results of a collaborative European (EDNAP) exercise

Recently, there has been much debate about what kinds of genetic markers should be implemented as new core loci that constitute national DNA databases. The choices lie between conventional STRs, ranging in size from 100 to 450 bp; mini-STRs, with amplicon sizes less than 200 bp; and single nucleotide polymorphisms (SNPs). There is general agreement by the European DNA Profiling Group (EDNAP) and the European Network of Forensic Science Institutes (ENFSI) that the reason to implement new markers is to increase the chance of amplifying highly degraded DNA rather than to increase the discriminating power of the current techniques. A collaborative study between nine European and US laboratories was organised under the auspices of EDNAP. Each laboratory was supplied with a SNP multiplex kit (Foren-SNPs) provided by the Forensic Science Service, two mini-STR kits provided by the National Institute of Standards and Technology (NIST) and a set of degraded DNA stains (blood and saliva). Laboratories tested all three multiplex kits, along with their own existing DNA profiling technique, on the same sets of degraded samples. Results were collated and analysed and, in general, mini-STR systems were shown to be the most effective. Accordingly, the EDNAP and ENFSI working groups have recommended that existing STR loci are reengineered to provide smaller amplicons, and the adoption of three new European core loci has been agreed.     

Statistical analysis of barefoot impressions

Comparison of the shapes of barefoot impressions from an individual with footprints or shoes linked to a crime may be useful as a means of including or excluding that individual as possibly being at the scene of a crime. The question of the distinguishability of a person's barefoot print arises frequently. This study indicates that measurements taken from the outlines of inked footprint impressions show a great degree of variability between donors and a great degree of similarity for multiple impressions taken from the same donor. The normality of the set of measurements on footprint outlines that we have selected for this study is confirmed. A statistical justification for the use of the product rule on individual statistical precisions is developed.     

The effect of routine income withholding of child support collections

Recent federal legislation requires states to make substantial improvements in paternity establishment, enact numeric child support standards for determining child support awards, update those awards at least every three years, and adopt routine income withholding of all child support obligations. Data gathered for the purpose of evaluating the Wisconsin Child Support Assurance System make it possible to examine the effects of routine income withholding on the size and regularity of child support payments. The data consisted of court records of child support cases that entered the court system in 20 Wisconsin counties between 1980 and 1986. Our estimates suggest routine income withholding increases child support payments by between 11 and 30 percent.