Comments on Enthoven’s “The U.S. Experience with Managed Care and Managed Competition”

This session will provide an overview of the U.S. health care system with an emphasis on trends observed since the reforms of the early 1990s. ; How has the health care system adjusted to the introduction of market-oriented medicine? And what have been the consequences for access to care, health care costs (public and private), and the quality of care over the past decade? How does the U.S. health care system measure up in international comparisons, for instance? Does managed care work as its advocates expected or have inappropriate consumer and provider incentives undermined this experiment? What are the implications for reform?Health care reform

Why the Future of Marijuana Legalization is Still Uncertain

The purpose of this paper is to examine the future of the marijuana legalization movement and the prospects of recreational marijuana legalization at the national level. While the marijuana movement has made tremendous strides at the state level over a very short period of time, there remains a debate over whether or not this progress will translate into success federally. First, this paper reviews the literature from the field, the majority of which focuses on whether marijuana ought to be legalized for recreational use in the first place. Despite extensive research, the evidence from the field is far from definitive. It remains unclear whether recreational legalization of marijuana raises teenage usage, whether the harmful side effects of marijuana are offset by its medical benefits, and whether the social costs of marijuana prohibition outweigh the social costs associated with its increased use. This paper also details political obstacles obstructing federal legalization of marijuana. Even if state-based evidence for recreational legalization was overwhelmingly favorable, there would still be significant obstacles to federal legalization of marijuana. These obstacles include a backward drug classification system, an anti-marijuana Attorney General, and key constituencies that oppose marijuana legalization. This paper concludes that despite the liberalization of marijuana policies at the state level, the future of federal legalization is still hazy at best

In Defense of Milgram Experiments

In the early 1960s, social psychologist Stanley Milgram conducted a series of studies at Yale University in which he measured the willingness of subjects to obey an authority figure (the experimenter) who instructed them to administer electrical shocks to a confederate under the guise that the experiment was testing the effects of punishment on learning. Although the electrical shocks were fake, these famous obedience experiments are, to this day, recognized as some of the most controversial psychology experiments of all time. While Milgram\u27s experiments yielded seemingly profound insight about human obedience to authority, many in his field were quick to criticize his work for violating research ethics. Over the past fifty years, not much has changed. The consensus amongst the philosophical community is still that Milgram\u27s obedience experiments were largely unethical, and that his procedure would never be approved by an IRB today. This paper, however, challenges this popular notion. To do so, it reexamines the criticism of some of Milgram\u27s sharpest detractors, namely Diana Baumrind, Steven Pattern, and Steve Clarke. In addressing these critiques, I incorporate both arguments that Milgram made in his own defense, as well as my own arguments. Ultimately, I show that none of the arguments accusing Milgram of harming his subjects purport definitive evidence that they subjects were actually considerably harmed

Quality and Employers' Choice of Health Plan

We seek to understand the relationship between employer decisions regarding which health plans firms choose to offer to their employees and the performance of those plans. We measure performance using data from the Health Plan Employer Data Information Set (HEDIS) and the Consumer Assessment of Health Plan Survey (CAHPS). We use a unique data set that lists the Health Maintenance Organizations (HMOs) available to, and offered by, large employers across markets in the year 2000, and examine the relationship between plan offerings, performance measures and other plan characteristics. We estimate two sets of specifications that differ in whether they model plan choice as a function of absolute plan performance or plan performance relative to competitors. We find that employers are more likely to offer plans with strong absolute and relative HEDIS and CAHPS performance measures. Our results are consistent with the view that large employers are responsive to the interests of their employees.

A New Medicare End-of-Life Benefit for Nursing Home Residents

A new Medicare benefit is needed to support end-of-life care for those spending their final days in a nursing home, say the authors of this article. Arguing that the current hospice benefit is a poor fit with the nursing home setting, the authors recommend a new benefit that would enable nursing home residents to receive individualized palliative and psychosocial services in addition to rehabilitative services

Value‐Based Insurance Design: More Health at Any Price

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90286/1/hesr1358.pd

Insurance loss coverage under restricted risk classification: The case of iso-elastic demand

This paper investigates equilibrium in an insurance market where risk classification is restricted. Insurance demand is characterised by an iso-elastic function with a single elasticity parameter. We characterise the equilibrium by three quantities: equilibrium premium; level of adverse selection (in the economist’s sense); and “loss coverage”, defined as the expected population losses compensated by insurance. We consider both equal elasticities for high and low risk-groups, and then different elasticities. In the equal elasticities case, adverse selection is always higher under pooling than under risk-differentiated premiums, while loss coverage first increases and then decreases with demand elasticity. We argue that loss coverage represents the efficacy of insurance for the whole population; and therefore that if demand elasticity is sufficiently low, adverse selection is not always a bad thing