New Conundrums: Public Policy and the Emerging Health Care Marketplace. 8th annual Herbert Lourie Memorial Lecture on Health Policy

There is a fundamentally new dynamic in American health care, one that has yet to be fully experienced but that threatens to leave a large portion of the American population without access to the quality health care they have received in the past. While the federal government has not completely abandoned the goal of assuring universal health care, a goal that dates back to the creation of Medicare and Medicaid in the 1960s and even earlier, the mechanisms to pursue that goal have changed. The implicit contract between government and health care providers--mostly doctors and not-for-profit hospitals--under which subsidized care was provided to those unable to pay has been broken in favor of more market-driven forces that promise a more cost-effective system, but a system that fails to protect a growing uninsured population. This new purchaser-driven system--in which costs increasingly determine the services that are provided--is likely to fall short of providing quality care to all who need it. Health care is different from other services, and unless this difference is recognized we are in danger of permanently denying quality health care to a significant minority of our population. Regulation of the emerging "free market" in health care is needed and government must assure that role.

Fairness under Uncertainty

Ever since its introduction by Foley (1967) and Varian (1974), the notion of fairness has been one of the most extensively used notion to evaluate allocations on an ethical basis. Whereas thereis an extensive literature on the efficiency properties of allocations in economies with uncertainty the concept of an envy-free allocation has not been widely studied in economies with uncertainty. We introduce two very natural notions of equity in an economy under uncertainty, namely ex ante and ex post equity, show they can contradict efficiency requirements. In particular, the set of ex ante efficient and ex post envy-free allocations may be empty. We nevertheless show that, under special circumstances, one may prove the existence of allocations that are both ex ante efficient and ex post envy-free. Such is the case, in particular, in an economy with individual risk and no aggregate risk.

Effects of Zn on the grain boundary properties of La2-xSrxCu1-yZnyO4 superconductors

The properties of the grain boundaries (GBs) are of significant importance in high-Tc cuprates. Most large scale applications of cuprate superconductors involve usage of sintered compounds. The critical current density and the ability to trap high magnetic flux inside the sample depend largely on the quality of the GBs. Zn has the ability to pin vortices but it also degrades superconductivity. In this study we have investigated the effect of Zn impurity on the intergrain coupling properties in high-quality La2-xSrxCu1-yZnyO4 sintered samples with different hole concentrations, p (\equiv x), over a wide range of Zn contents (y) using field-dependent ac susceptibility (ACS) measurements. The ACS results enabled us to determine the superconducting transition temperature Tc, and the temperature Tgcp, at which the randomly oriented superconducting grains become coupled as a function of hole and disorder contents. We have analyzed the behavior of the GBs from the systematic evolution of the values of Tgcp(p, y), Tc(p, y), and from the contribution to the field-dependent ACS signal coming from the intergrain shielding current. Zn suppresses both Tc and Tgcp in a similar fashion. The hole content and the carrier localization due to Zn substitution seem to have significant effect on the coupling properties of the GBs. We have discussed the possible implications of these findings in detail in this article. PACS: 74.72.Dn; 74.62.Dh; 74.25.Sv Keywords: Zn doped La214; Critical current density; Grain boundaryComment: To appear in Physica

Diversification, Convex Preferences and Non-Empty Core

We show, in the Choquet expected utility model, that preference for diversification, that is, convex preferences, is equivalent to a concave utility index and a convex capacity. We then introduce a weaker notion of diversification, namely ``sure diversification.'' We show that this implies that the core of the capacity is non-empty. The converse holds under concavity of the utility index. This property is shown to be equivalent to the notion of comonotone diversification\,; notion that we introduce in the paper. Finally, in the expected utility model, all these notions of diversification are equivalent and are represented by the concavity of the utility index.

Low-temperature critical current of Y1-xCaxBa2Cu3O7-delta thin films as a function of hole content and oxygen deficiency

The effects of hole content (p) and oxygen deficiency (delta) on the zero-field critical current density, Jc0, were investigated for high-quality c-axis oriented Y1-xCaxBa2Cu3O7-delta (x = 0, 0.05, 0.10, and 0.20) thin films. Ca was used to introduce hole carriers in the CuO2 planes, independent of the oxygen deficiency in the CuO1-delta chains. Low-temperature Jc0(16K) of these films above the optimum doping were found to be high (> 10^7 Amp/cm^2) and were primarily determined by the hole concentration, reaching a maximum at p ~ 0.185+/-0.005, irrespective of oxygen deficiency. This implies that oxygen disorder plays only a secondary role and the intrinsic Jc0 is mainly governed by the carrier concentration and consequently by the superconducting condensation energy which also peaks at p ~ 0.19 where the pseudogap correlation vanishes

Are Beliefs a Matter of Taste ? A case for Objective Imprecise Information

We argue, in the spirit of some of Jean-Yves Jaffray's work, that explicitly incorporating the information, however imprecise, available to the decision marker is relevant, feasible and fruitful. In particular, we show that it can lead us to know whether the decision maker has wrong beliefs and whether it matters or not, that it makes it possible to better model and analyze how the decision maker takes into account new information, even when this information is not an event and finally that it is crucial when attempting to identify and measure the decision maker's attitude toward imprecise information.Beliefs, imprecision, information.

Ambiguity Aversion and Incompleteness of Financial Markets

It is widely thought that incomes risks can be shared by trading infinancial assets. But financial assets typically carry some riskidiosyncratic to them, hence, disposing incomes risk using financial assetswill involve buying into the inherent idiosyncratic risk. However, standardtheory argues that diversification would reduce the inconvenience ofidiosyncratic risk to arbitrarily low levels. This argument is less robustthan what standard theory leads us to believe: ambiguity aversion canexacerbate the tension between the two kinds of risks to the point thatclasses of agents may not want to trade some financial assets. Thus,theoretically, the effect of ambiguity aversion on financial markets is tomake the risk sharing opportunities offered by financial markets lesscomplete than it would be otherwise.incomplete markets; ambiguity aversion

Fairness under Uncertainty

Ever since its introduction by Foley [1967] and Varian [1974], the notion of fairness has been one of the most extensively used notion to evaluate allocations on an ethical basis. Whereas there is an extensive literature on the efficiency properties of allocations in economies with uncertainty the concept of an envy-free allocation has not been widely studied in economies with uncertainty. We introduce two very natural notions of equity in an economy under uncertainty, namely ex ante and ex post equity, show they can contradict efficiency requirements. In particular, the set of ex ante efficient and ex post envy-free allocations may be empty. We nevertheless show that, under special circumstances, one may prove the existence of allocations that are both ex ante efficient and ex post envy-free. Such is the case, in particular, in an economy with individual risk and no aggregate risk.Fairness, uncerainty, envy

Thermodynamic properties of Bi2Sr2CaCu2O8 calculated from the electronic dispersion

The electronic dispersion for Bi2Sr2CaCu2O(8+d) has been determined from angle-resolved photoelectron spectroscopy (ARPES). From this dispersion we calculate the entropy and superfluid density. Even with no adjustable parameters we obtain an exceptional match with experimental data across the entire phase diagram, thus indirectly confirming both the ARPES and thermodynamic data. The van Hove singularity is crossed in the overdoped region giving a distinctive linear-in-T temperature dependence in the superfluid density there.Comment: 5 pages, 4 figures, submitted to Physical Review Letter