National health insurance: Some lessons from the Canadian experience

In the current American debate over national health insurance an examination of the Canadian governmental experience is very instructive. Canada is enough like the United States to make the effects of Canadian health insurance policies rather like a large natural experiment. The Canadian experience—universal government health insurance administered by the ten provinces with some fiscal and policy variations—can be used to predict the impact in the United States of proposed national health insurance plans on the medical care system, and the reaction of mass publics and national policymakers to these effects.The central purpose of the Canadian national health insurance was to reduce and hopefully eliminate financial barriers to medical care. In this it succeeded. But it also produced results which Canadian policymakers never anticipated: essentially unexpected side-effects on cost, quality, organization, and manpower distribution of the particular national health insurance program adopted. It should be cause for concern, the article concludes, that most of the prominent American national health insurance proposals resemble the Canadian program in failing to provide a single level of government with both the means and incentives to curb the inflationary effects of national health insurance. The lesson from Canada is that unless the system has very strong anti-inflationary mechanisms and incentives built into it, national health insurance will feed the fires of medical inflation despite great formal governmental authority to control it.     

THE DETERMINATION OF ANTITRUST LIABILITY IN UNITED STATES v. MICROSOFT: THE EMPIRICAL EVIDENCE THE DEPARTMENT OF JUSTICE USED TO PROVE ITS CASE

This paper considers the empirical evidence used by the Departmentof Justice in the U.S. v. Microsoft antitrust case to provethat Microsoft engaged in exclusionary (and anticompetitive)actions in the browser market as part of its efforts to maintainits dominance of the personal computer operating system market.This evidence deserves special consideration because the DistrictCourt made the unusual decision to rely on the empirical evidencepresented by the Department of Justice rather than the empiricalevidence presented by Microsoft. This decision was unusual becauseMicrosoft's evidence had a strong presumption of validity asit was based on data that Microsoft collected and used in theordinary course of its business. Furthermore, no market participantsused the Department of Justice-sponsored data in any meaningfulway. Although it is impossible to determine with any certaintywhy the District Court ruled the way it did, I conclude thatthere were two driving forces in the court's decision. The Departmentof Justice identified serious flaws in Microsoft's data, makingit unreliable for the purposes for which Microsoft was usingit in the trial. The Department of Justice was also able toshow that no such flaws affected the data it sponsored and indeed,on many points, that data was more consistent with the testimonyof Microsoft executives than the data sponsored by Microsoft.     

Overcoming Challenges to Using Evidence-Based Interventions in Schools

The Center for School Mental Health Assistance at the University of Maryland recently completed a review of evidence-based prevention and treatment programs that can be used by school mental health clinicians. Based on the review, a school-based program operating in 22 Baltimore City schools has purchased and trained clinicians in a number of protocols for evidence-based interventions. We present findings from this review and make pragmatic recommendations for school mental health programs to overcome the challenges associated with the use of evidence-based interventions.She received her doctorate in childclinical psychology from the University of Missouri-Columbia. Her research interests are in the area of the development, prevention, and treatment of juvenile delinquency and youth externalizing disorders.who does research in the area of childrens mental health services and the implementation of wraparound services in real-world settings.University of Maryland School of Medicine. His research is in the area of testing the effectiveness of School Mental Health Programs and the effects of community violence on youth mental health.involved in research related to school mental health, school-based health centers, and prevention of risky behavior among adolescents.Postdoctoral fellow at the time of the study.Postdoctoral fellow at the time of the study.