Getting the Haves to Come out Behind: Fixing the Distributive Injustices of American Health Care

Hyman criticizes an article by Havighurst and Richman regarding the distributive injustices of US health care. Hyman also offers a guide for implementing policy reforms based on the analysis by Havighurst and Richman

The Massachusetts Health Plan: The Good, the Bad, and the Ugly

In spring 2006, Massachusetts enacted legislation to ensure universal health insurance coverage to all residents. The legislation was a hybrid of ideas from across the political spectrum, promoted by a moderately conservative Republican governor with national political aspirations, and passed by a liberal Democratic state House and Senate. Groups from across the political spectrum supported the plan, from the Heritage Foundation on the right to Families USA on the left, although the plan had detractors from across the political spectrum as well. This study briefly describes the basic structure of the Massachusetts plan and identifies the good, the bad, and the ugly. Although the legislation, as Stuart Altman put it, "is not a typical Massachusetts -- Taxachusetts, oh -- just -- crazy -- liberal plan," there is enough "bad" and "ugly" in the mix to raise serious concerns, particularly when the desire to overregulate the health insurance market appears to be hard -- wired into Massachusetts policymakers' DNA. If we want to make health insurance more affordable and avoid the "bad" and the "ugly" of the Massachusetts plan, Congress -- or, barring that, individual states -- should consider a "regulatory federalism" approach. Under such an approach, insurers and insurance purchasers would be required to subject themselves to the laws and regulations of a single state but allowed to select the state. As with corporate charters, this system would allow employers and insurers to select the regulatory regime that most efficiently and cost -- effectively matches the needs of their risk pools. The ability of purchasers and insurers to exit from the state's regulatory oversight (taking their premium taxes with them) would temper opportunistic behavior by legislators and regulators, including the temptation to impose inefficient mandates and otherwise overregulate

Implementing Privacy Policy: Who Should Do What?

Academic scholarship on privacy has focused on the substantive rules and policies governing the protection of personal data. An extensive literature has debated alternative approaches for defining how private and public institutions can collect and use information about individuals. But, the attention given to the what of U.S. privacy regulation has overshadowed consideration of how and by whom privacy policy should be formulated and implemented. U.S. privacy policy is an amalgam of activity by a myriad of federal, state, and local government agencies. But, the quality of substantive privacy law depends greatly on which agency or agencies are running the show. Unfortunately, such implementation-related matters have been discounted or ignored— with the clear implication that they only need to be addressed after the “real” work of developing substantive privacy rules is completed. As things stand, the development and implementation of U.S. privacy policy is compromised by the murky allocation of responsibilities and authority among federal, state, and local governmental entities—compounded by the inevitable tensions associated with the large number of entities that are active in this regulatory space. These deficiencies have had major adverse consequences, both domestically and internationally. Without substantial upgrades of institutions and infrastructure, privacy law and policy will continue to fall short of what it could (and should) achieve