Project USA: American competitiveness and what must be done to restore it

The United States today faces a loss of influence as a world power, a reduction in American independence as a policymaker, and a decline in the standard of living on which Americans have come to depend. History teaches that nations weaker and less productive than the United States can rise to become economic powerhouses and rapidly increase their standards of living. History also teaches that nations failing to recognize their fundamental problems will inevitably decline. American politicians must face what is abundantly clear: the United States is losing ground and must act quickly to reverse its course. This White Paper outlines what must be done. Information about the nation's current status must be analyzed and communicated. Incentives to improve the level of competence in government must be provided and maintained. The emphasis of government policy must be changed to reflect broad economic and technological interests as opposed to special interests. Savings must be encouraged and increased. Infrastructure must be improved Tax laws must be modified to help bring these changes about. Economic and technological issues must be elevated to the importance they require. American thinking must reflect the new realities: that the age of leadership through military power is over, that the requirements for success in the world of the 1990s and beyond require a sound and growing economy that is internationally competitive. The US can accomplish these goals only through foundation-shaking, comprehensive, fundamental changealong the lines we propose herein.This paper is the executive summary (with minor editing modifications) of a white paper that is available from Cornell University's Johnson Graduate School of Management.     

On the waves: a new kind of surf in Rio de Janeiro

Surfmen are thus called young daredevils who climb to the roof of suburban trains in Rio de Janeiro, Brazil and vie with each other in agility and prowess, some of them often falling on the railway tracks and being killed. The practice started as a need to hang on anything outside the crowded train and became a sport of sorts. Even though repressed by the railway authorities and punished by fines and imprisonment, the practice has been going on since the eighties and developed into a competition with rules, code of honour, grading of achievement. It became a means of improving self-esteem as well as securing leadership and social prestige by people who otherwise carry on lives devoid of any charm or ludic stimulus. A substitute behavior, it results from processes of cultural elaboration at work in the youth culture of our cities.     

“Comorbidity” of behavioral, emotional, and cognitive problems in adolescence

The purpose of this study was to examine in a sample of 11,516 secondary school students the extent to which different behavioral, emotional and cognitive problems (a) reflected one or more underlying common factors; (b) actually cooccurred; and (c) were single problems. Principal Component Analyses were performed and percentagewise techniques were used. PCA demonstrated that one or more general syndromes could not by far account for all of the variance of the variables. The results suggest the existence of adolescent subgroups with divergent comorbidity patterns: those who primarily report one single symptom; those who report concurrent symptoms either exclusively in the category of behavioral problems or exclusively in the category of emotional and cognitive problems; and those who report concurrent symptoms in both categories. This distinction between different subgroups has important theoretical, diagnostic, and treatment implications.     

State Medicaid reform under Section 1115 demonstration authority

Given the complexity of federal Medicaid law and the limitations it imposes on state flexibility, it is likely that states will continue to ask the Secretary to grant waivers under Section 1115 to allow them to pursue new approaches to health care reform. The results of currently operational Section 1115 projects involving statewide managed care systems will be useful in evaluating the Medicaid reform measures currently under discussion in other states and at the federal level. In particular, the ability of the states to control Medicaid and indigent care costs and to utilize federal dollars more efficiently should prove important in evaluating a block grant approach to federal Medicaid funding. Moreover, Section 1115 project results that bear on the sufficiency of various Medicaid capitation rate methodologies will also be of value as more states expand the use of managed care arrangements for their Medicaid populations.     

The Department of Health and Human Services issues proposed regulations on physician incentive payments by hospitals

Hospitals tempted to operate their own physician incentive plans are reminded that, under OBRA 1986, they are precluded from paying physician incentives of any kind to reduce or limit Medicare or Medicaid covered services. In light of the proposed regulations and the guidance of the preamble, hospitals should review their incentive plans to determine whether physicians providing direct patient care are receiving prohibited payments. Further, supervising physicians who are receiving incentives for certain hospital departments may not influence direct care over patients served by those departments, even through other physicians. Some risk may also exist if incentives are based on a formula that considers patients of the supervising physician's medical group. Finally, it may be useful to develop a utilization and quality of care review program specifically designed to assure that patient undertreatment does not occur as a result of any supervising physician incentive program.