Playing With a Stacked Deck: Why Was a Single Payer Plan Dealt Such Bad Cards?

The final report of the Maine Health Care Reform Commission (MHCRC) was submitted to Governor Amgus King in November, 1995. Given the complexity of what we call the healthcare system as well as the moving targets of federal and state incentives for reform, the report accomplished a great deal in a short period of time. Commission members were mandated to offer a single payer universal coverage bill, a multiple payer universal coverage bill, and a bill to achieve reform through incremental changes to the existing system, emphasizing cost containment, managed care, and improved access. The commission was also mandated to cost out its recommendations Reactions to the MHCRC report were invited from individuals who represent constituencies which often have an influential role in healthcare. Five commentaries address pros and cons of particular elements of the commission’s report. This second commentary provides perspectives from three practicing physicians in Maine

Can Green Be Lean?

Introduction: In the past, efforts to improve the environment almost always led to increased production costs. In fact, some economists have attributed a significant part of the slowdown in productivity growth of the 1970s to increased attention to environmental issues (Gray, 1987; Conrad and Morrison, 1989). This result is in accordance with neoclassical economic theory, which holds that firms maximize profits subject to given constraints. If a constraint (such as keeping emissions below a certain level) is added, then profits cannot be higher than they were before. However, in practice there are numerous examples of firms which have both reduced their emissions and increased their profits and/or their efficiency. (See for example Porter and van der Linde, 1995.) Concomitantly, a central tenet of strategic management theory is that firms need to focus on only a few distinctive competencies if they wish to be profitable (Hamel and Prahalad, 1990). However, Florida (forthcoming) has found a significant number of firms that are leaders in adopting new forms of both production management and environmental management. This paper explores these paradoxes: how firms can be both profitable and environmentally conscious, how they can be both innovators in manufacturing and leaders in emissions reduction. The contribution of this paper is to present detailed examples of conditions under which these types of superior performance go together, and to begin to develop a theoretical framework which explains the examples. The theoretical framework is based on Nathan Rosenberg's (1976) concept of 'focussing devices'. His argument is that because managers are only boundedly rational, they cannot explore all possible sources of efficiency improvement at once. Instead, they develop worldviews which give them ideas about where might be fruitful places to look. In Rosenberg?s example, nineteenth-century US firms developed many labor-saving innovations because of the salience of high labor costs in this country. Many of these practices increased efficiency and profitability in Europe as well, and were adopted there; however, they were not thought of there because labor costs did not stand out so clearly as a key element of costs. This paper argues that the recent diffusion of the principles behind the Toyota Production System gives managers a new focusing device, one which allows them to be simultaneously 'lean' and 'green'

Pollution Prevention Assistance in the Automotive Supply Chain: A Study of Northeast Ohio

No Abstract Provided, see paper for executive summar

Immunization with the C-domain of α-toxin prevents lethal infection, localizes tissue injury, and promotes host response to challenge with Clostridium perfringens

© 2004 by the Infectious Diseases Society of America. All rights reserved.Clostridium perfringens gas gangrene is characterized by rapid tissue destruction, impaired host response, and, often, death. Phospholipase C (α-toxin) is the virulence factor most responsible for these pathologies. The present study investigated the efficacy of active immunization with the C-terminal domain of α-toxin (Cpa247–370) in a murine model of gas gangrene. Primary end points of the study were survival, progression of infection, and tissue perfusion. Secondary end points, which were based on findings of histologic evaluation of tissues, included the extent of tissue destruction and microvascular thrombosis, as well as the magnitude of the tissue inflammatory response. Survival among C-domain–immunized animals was significantly greater than that among sham-immunized control animals. Furthermore, immunization with the C-domain localized the infection and prevented ischemia of the feet. Histopathologic findings demonstrated limited muscle necrosis, reduced microvascular thrombosis, and enhanced granulocytic influx in C-domain–immunized mice. We conclude that immunization with the C-domain of phospholipase C is a viable strategy for the prevention of morbidity and mortality associated with C. perfringens gas gangrene