Consumer-sponsored prepaid group practice: restructuring the health care system

The traditional separation of health care delivery and financing systems is breaking down as various new types of health care facilities are established and as payment continues to be a major concern. Group Health Cooperative of Puget Sound (GHC) was organized as a prepaid group practice system responsive to consumers. Costs, methods of payment and delivery of care are interrelated and are all influenced by consumer ownership. GHC has been refining its benefit programs since 1945. Strategies for controlling use and costs focus on improved provider management and on flexibility. This article explains how the structure of GHC benefits the consumer.     

Assessing Civil-Military Relations and the January 6th Capitol Insurrection

The events of January 6, 2021, when violent rioters attacked the Capitol building in Washington in order to disrupt validation of the 2020 presidential election, forced an unprecedented reckoning with the state of American politics. Members of Congress struggled to account for the rhetoric that gave rise to the event; law enforcement grappled with the challenge of holding accountable those who perpetrated the violence; and journalistic outlets wrestled with reporting a complex web of conspiracy theories and disinformation that gave rise to the insurrection. But for senior military leaders, the question was how to explain the troubling presence of active duty servicemembers and veterans in the first attack on the American seat of government in two centuries. The result is a profound and urgent discussion in U.S. civil-military relations.     

The R and D contract and democratic theory

The purposes of this essay are to describe how federal research and development policy has altered authority relationships and to suggest a new concept of legitimacy in accord with the changed conditions. Research and development (R and D) creates an indeterminate future. Thus, the politics of research and development incorporates an apparent contradiction : political leadership demands that jobs be done which require creative and unpredictable actions on the part of private organizations, while it also demands that contractors be held responsible for fulfilling goals efficiently, avoiding deleterious secondary consequences, and refraining from abuses of power. The paradox can be resolved by creating norms of responsibility that allow for judgments on how a job is done rather than what is to be done. New institutions for technological assessment to check on unintended consequences of projects and citizen review boards to estimate the quality of life engendered by projects may provide such norms of responsibility.