Toward a 21st-century health care system: Recommendations for health care reform

The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during which physicians, health policy experts, health insurance executives, business leaders, hospital administrators, economists, and others who represent diverse perspectives came together. This group agreed that the following 8 recommendations are fundamental to successful reform: 1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment. 2. Establish a securely funded, independent agency to sponsor and evaluate research on the comparative effectiveness of drugs, devices, and other medical interventions. 3. Simplify and rationalize federal and state laws and regulations to facilitate organizational innovation, support care coordination, and streamline financial and administrative functions. 4. Develop a health information technology infrastructure with national standards of interoperability to promote data exchange. 5. Create a national health database with the participation of all payers, delivery systems, and others who own health care data. Agree on methods to make de-identified information from this database on clinical interventions, patient outcomes, and costs available to researchers. 6. Identify revenue sources, including a cap on the tax exclusion of employer-based health insurance, to subsidize health care coverage with the goal of insuring all Americans. 7. Create state or regional insurance exchanges to pool risk, so that Americans without access to employer-based or other group insurance could obtain a standard benefits package through these exchanges. Employers should also be allowed to participate in these exchanges for their employees' coverage. 8. Create a health coverage board with broad stakeholder representation to determine and periodically update the affordable standard benefit package available through state or regional insurance exchanges

Collateral damage: the impact of optimised TCP variants on real-time traffic latency in consumer broadband environments

In recent years a number of TCP variants have emerged to optimise some aspect of data transport where high delay-bandwidth product paths are common. We evaluate a different scenario - latency-sensitive UDP-based traffic sharing a consumer-grade 'broadband' link with one or more TCP flows. In particular we compare Linux implementations of NewReno, H-TCP and CUBIC. We find that dynamic latency fluctuations induced by each TCP variant is a more significant differentiator than 'goodput' (useful throughput), and that CUBIC induces far more latency than either H-TCP or NewReno when multiple TCP flows are active concurrently. This potential for 'collateral damage' should influence future efforts to re-design TCP for widespread deployment

Relational nouns, pronouns, and resumption

This paper presents a variable-free analysis of relational nouns in Glue Semantics, within a Lexical Functional Grammar (LFG) architecture. Relational nouns and resumptive pronouns are bound using the usual binding mechanisms of LFG. Special attention is paid to the bound readings of relational nouns, how these interact with genitives and obliques, and their behaviour with respect to scope, crossover and reconstruction. I consider a puzzle that arises regarding relational nouns and resumptive pronouns, given that relational nouns can have bound readings and resumptive pronouns are just a specific instance of bound pronouns. The puzzle is why is it impossible for bound implicit arguments of relational nouns to be resumptive? The puzzle is highlighted by a well-known variety of variable-free semantics, where pronouns and relational noun phrases are identical both in category and (base) type. I show that the puzzle also arises for an established variable-based theory. I present an analysis of resumptive pronouns that crucially treats resumptives in terms of the resource logic linear logic that underlies Glue Semantics: a resumptive pronoun is a perfectly ordinary pronoun that constitutes a surplus resource; this surplus resource requires the presence of a resumptive-licensing resource consumer, a manager resource. Manager resources properly distinguish between resumptive pronouns and bound relational nouns based on differences between them at the level of semantic structure. The resumptive puzzle is thus solved. The paper closes by considering the solution in light of the hypothesis of direct compositionality. It is argued that a directly compositional version of the theory is possible, although perhaps not desirable. The implications for direct compositionality are considered. © Springer 2005