Standard Errors: How Budget Rules Distort Lawmaking

The article argues that the Congress’s budget process has invisibly influenced its legislative activities and structurally skewed its policy choices. The budgetary structure and tools as they affect lawmaking are largely unanalyzed. Until they are widely appreciated, they may often be random, inefficient, unrepresentative, and even deceptive. Review, critique, and change are overdue in any case. Inasmuch as the Congress is now, after a period of budget anarchy, debating how to refocus on the budget, this is a particularly good time for such activities. The article also argues that additional structures are needed to “counter-balance” both the skewing that results from the current rules and the sheer centrality of the budget in policymaking. In a fundamental way, Congress should review its simplistic focus on the restraint of monetary deficits alone. In the long run, future generations may be equally or better served by the creation of budget-like restraints on non-monetary deficits, such as increased disability, diminished public health, or permanent environmental damage. The structures that have shaped financial decisions in the past may offer solutions to these problems in the future. The article is laid out in four parts. Part One provides a brief historical background of the Congressional budget process, including its roots in Public Choice Theory. Part Two consists of an explanation of four non-obvious concepts essential to understanding the basics of the budget process. Part Three is a series of observations of some serious effects of the process in lawmaking. Part Four lays out suggestions for “counter-balancing” the budget process, including extension some of the Public-Choice remedies to non-monetary measures

Following the Money: The ACA’s Fiscal-Political Economy and Lessons for Future Health Care Reform

It is no exaggeration to say that American health policy is frequently subordinated to budgetary policies and procedures. The Affordable Care Act (ACA) was undeniably ambitious, reaching health care services and underlying health as well as health insurance. Yet fiscal politics determined the ACA’s design and guided its implementation, as well as sometimes assisting and sometimes constraining efforts to repeal or replace it. In particular, the ACA’s vulnerability to litigation has been the price its drafters paid in exchange for fiscal-political acceptability. Future health care reformers should consider whether the nation is well served by perpetuating such an artificial relationship between financial commitments and health returns

Executive Action to Expand Health Services in the Biden Administration

President Biden’s health platform is ambitious, encompassing a public insurance option, a reduced age of eligibility for Medicare, and expanded tax credits to subsidize premiums. Yet, with divided government, he may be unable to achieve bold health reforms. However, his administration can substantially improve health care access through executive action. In this Viewpoint, we propose a series of measures that could increase access to insurance coverage and health care that are achievable under the Affordable Care Act (ACA) and Medicaid

Biogeography of the Intestinal Mucosal and Lumenal Microbiome in the Rhesus Macaque

SummaryThe gut microbiome is widely studied by fecal sampling, but the extent to which stool reflects the commensal composition at intestinal sites is poorly understood. We investigated this relationship in rhesus macaques by 16S sequencing feces and paired lumenal and mucosal samples from ten sites distal to the jejunum. Stool composition correlated highly with the colonic lumen and mucosa and moderately with the distal small intestine. The mucosal microbiota varied most based on location and was enriched in oxygen-tolerant taxa (e.g., Helicobacter and Treponema), while the lumenal microbiota showed inter-individual variation and obligate anaerobe enrichment (e.g., Firmicutes). This mucosal and lumenal community variability corresponded to functional differences, such as nutrient availability. Additionally, Helicobacter, Faecalibacterium, and Lactobacillus levels in stool were highly predictive of their abundance at most other gut sites. These results quantify the composition and biogeographic relationships between gut microbial communities in macaques and support fecal sampling for translational studies