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251. Optimal Contracting with Altruistic Agents: A Structural Model of Medicare Payments for Dialysis Drugs

Author:
Martin Gaynor, Nirav Mehta, and Seth Richards-Shubik
Publication Date:
05-2020
Content Type:
Working Paper
Institution:
Centre for Human Capital and Productivity (CHCP), Western University
Abstract:
We study physician agency and optimal payment policy in the context of an expensive medication used in dialysis care. Using Medicare claims data we estimate a structural model of treatment decisions, in which physicians differ in their altruism and marginal costs, and this heterogeneity is unobservable to the government. In a novel application of nonlinear pricing methods, we theoretically characterize the optimal unrestricted contract in this screening environment with multidimensional heterogeneity. We combine these results with the estimated model to construct the optimal contract and simulate counterfactual outcomes. The optimal contract is a flexible fee-for-service contract, which pays for reported treatments but uses variable marginal payments instead of constant reimbursement rates, resulting in substantial health improvements and reductions in costs. Our structural approach also yields important qualitative findings, such as rejecting the optimality of any linear contract, and may be employed more broadly to analyze a variety of applications.
Topic:
Economics, Government, Health, Health Care Policy, Human Capital, Productivity, and Medicare
Political Geography:
United States

252. Timebomb at the Port: How Institutional Failure, Political Squabbling and Greed Set the Stage for Blowing up Beirut

Author:
Reinound Leenders
Publication Date:
09-2020
Content Type:
Working Paper
Institution:
Arab Reform Initiative (ARI)
Abstract:
The institutional set-up of the Port of Beirut is emblematic of Lebanon’s post-war corruption and sectarian clientelism. Any investigation into the 4 August explosion needs to take into account the port’s dismal institutional record and how the current political class ensured its governance remained opaque and messy. This paper provides critical insights into the port’s set-up over the last 30 years highlighting the failing political system, a greedy political class, and entrenched mismanagement and corruption. It demonstrates how the bickering of key actors over the port’s control and the port’s institutional failures set the stage for the blast, pointing to an urgent need to build an accountable port authority as part of any reform effort.
Topic:
Government, Governance, Accountability, and Institutions
Political Geography:
Middle East and Lebanon

253. Powering Through the Pandemic

Author:
Ashwini K. Swain
Publication Date:
07-2020
Content Type:
Special Report
Institution:
Centre for Policy Research, India
Abstract:
The disruption caused by the Covid-19 pandemic are consequential for India’s long-term electricity goals. While exacerbating the existing weaknesses in the sector, the pandemic could also affect the trend toward an electricity transition. This report is an attempt to understand the impact of the pandemic on India’s electricity, government responses, and thus, suggest a structural approach to building a resilient electricity future. We find that the Covid-19 caused disruptions in the electricity sector are pervasive and have alarming secondary effects and long-term consequences. While the Central and state governments have been swift to recognise the disruptions, the band-aid approach, focused on fixing existing patterns in the sector, appears inadequate to challenges. Ironically, the long-term electricity reform agenda – proposed in major legislative and policy amendment proposals – shaped in times of a pandemic has failed to internalise the challenges thrown-up and insights gained from the Covid-19 experience. The combination of Covid-19 disruptions, technological driven cost reductions in renewable energy, and the longstanding financial and governance problems of the sector combine to create a ‘critical juncture’ for the sector- a moment to envision a new and alternative configuration of technology, institutions and politics that could transform Indian electricity. While this a long-term and complex conversation, the report suggests illustrative pathways toward these goals.
Topic:
Government, Electricity, Pandemic, and COVID-19
Political Geography:
South Asia and India

254. Financing Nutrition in India: Cost Implications of the Nutrition Policy Landscape 2019-20

Author:
Avani Kapur, Ritwik Shukla, Manan Thakkar, and Purnima Menon
Publication Date:
07-2020
Content Type:
Case Study
Institution:
Centre for Policy Research, India
Abstract:
India should have spent at least ₹38,571 crore in 2019-20, across Union government ministries and State government departments to fully finance a set of core direct nutrition interventions (DNIs), at scale. In this study, you will find information on nutrition costing. It carries forward critical studies that costed for nutrition interventions.
Topic:
Government, Food, and Finance
Political Geography:
South Asia and India

255. A Crisis of Hunger: a ground report on the repercussions of COVID-19 related lockdown on Delhi’s vulnerable populations

Author:
Ashwin Parulkar and Mukta Naik
Publication Date:
03-2020
Content Type:
Special Report
Institution:
Centre for Policy Research, India
Abstract:
The lock-down in response to COVID-19 has created an unprecedented food crisis in Delhi. While monthly-wage earning households may have a few days food supply on hand, daily wage labourers – now without work - have no income and, therefore, no ability to buy food. Even those with means to buy food face local access barriers because vendors and street markets are no longer operational. The Delhi government recently announced relief measures for such vulnerable people. But we find these have serious lacuna that must be identified and addressed to respond to the unfolding crisis of hunger at hand. This report draws on conversations with civil society organisations with deep networks on ground to highlight key issues and possible solutions. We discuss three key Delhi government announcements: the deployment of homeless shelters for provision of food, the use of the construction workers cess for direct benefit transfers, and the increase in PDS allocations. Additionally, we draw attention to measures under the ICDS and on the specific and acute distress among residents of violence affected north-east Delhi. Last, we discuss the plight of migrants trapped inside Delhi who want to return home.
Topic:
Disaster Relief, Government, Labor Issues, Hunger, and COVID-19
Political Geography:
South Asia and India

256. Limits of the Conservative Revolution in the States

Author:
Matt Grossmann
Publication Date:
09-2020
Content Type:
Journal Article
Journal:
Political Science Quarterly
Institution:
Academy of Political Science
Abstract:
Matt Grossmann analyzes the policy consequences of increasing Republican control of U.S. state governments since the 1990s. He finds that Republican states have enacted some new conservative policies, but many other liberal policy revolutions have continued unabated. He argues that conservative policymaking is difficult because federal policy and electoral incentives incentivize continued government expansion.
Topic:
Government, Politics, Conservatism, and Political Science
Political Geography:
North America and United States of America

257. Do Global Publics View Human Rights Organizations as Handmaidens of the United States?

Author:
David Crow and James Ron
Publication Date:
03-2020
Content Type:
Journal Article
Journal:
Political Science Quarterly
Institution:
Academy of Political Science
Abstract:
David Crow and James Ron look at how global publics view the relationship between human rights organizations and the U.S. government. They argue that ordinary people across various world regions do not perceive human rights groups as “handmaidens” of U.S. foreign policy.
Topic:
Foreign Policy, Government, Human Rights, Non-Governmental Organization, and Public Opinion
Political Geography:
Global Focus and United States of America

258. Toppling Foreign Governments: The Logic of Regime Change, Melissa Willard-Foster

Author:
Alexander B. Downes
Publication Date:
03-2020
Content Type:
Journal Article
Journal:
Political Science Quarterly
Institution:
Academy of Political Science
Abstract:
The rapid-fire overthrow of the theocratic Taliban regime in Afghanistan (2001) and Saddam Hussein’s Baathist dictatorship in Iraq (2003) by the United States—and the disastrous aftermaths of those and other recent interventions (such as the ouster of Libya’s Muammar el-Qaddafi in 2011)— has sparked popular and scholarly interest in the causes and consequences of foreign-imposed regime change (FIRC). One of the enduring puzzles about FIRCs is that, as highlighted in Melissa Willard-Foster’s terrific book Toppling Foreign Governments, three-quarters of them are carried out by great powers against minor powers in situations of extreme power asymmetry. “Though this asymmetry of power makes an imposed change feasible,” writes Willard-Foster, a political scientist at the University of Vermont, “it should also make that change unnecessary” because “militarily weak leaders who are bereft of allies should back down when confronted by stronger states” (pp. 2–3). The 133 regime changes in Willard-Foster’s study, however, testify that the weak regularly defy the strong—and pay the price for it.
Topic:
Foreign Policy, Government, Regime Change, and Political Science
Political Geography:
Afghanistan, Iraq, and United States of America

259. Changing Cultures in Congress: From Fair Play to Power Plays, Donald R. Wolfensberger

Author:
Ryan D. Williamson
Publication Date:
01-2020
Content Type:
Journal Article
Journal:
Political Science Quarterly
Institution:
Academy of Political Science
Abstract:
In 2017, then Speaker of the House Paul Ryan broke the record for most closed rules in a single session. Ironically, this feat came only two years after vowing to lead the House in a more open and inclusive manner than his recent predecessors had. This about-face was not new or unique to Ryan, though. Indeed, he was simply the next in a string of Speakers over the previous few decades to promise greater debate, only to renege shortly thereafter. Chronicling this decline of deliberation in Congress is the focus of Donald R. Wolfensberger’s work. The former Republican staff director for the House Rules Committee offers a detailed yet accessible insight into how Congress has evolved in recent history. Beginning with a brief discussion of the history of majoritarian politics in Congress, Wolfensberger specifically looks at a litany of case studies from the last two decades. Topics cover a wide range, including health care reform, budgets and deficits, and the Iran nuclear deal, to name a few. Within each, a common theme pervades—the majority party must “rely on extraordinary consultation, pressures, and compromises within its own ranks, as well as on a creative use of the rules, to eke out a victory on contentious legislation” (p. 57).
Topic:
Government, Book Review, and Political Science
Political Geography:
North America and United States of America

260. Turkmenistan, Now With Soviet-Style Deficits, on Brink of Explosion

Author:
Paul A. Goble
Publication Date:
12-2020
Content Type:
Working Paper
Institution:
The Jamestown Foundation
Abstract:
Turkmenistan, far and away the most closed country in the former Soviet space, seldom receives much attention except as the butt of dismissive jokes or, more recently, when its leaders tried to deny that COVID-19 is present in their country even as they took measures intended to hinder its spread (see EDM, July 21). But multiple reports over the last few days suggest Turkmenistan is fast descending into an economic crisis that makes its continued socio-political stability ever less likely. Moreover, this Central Asian country now has an opposition based abroad that is increasingly capable of providing leadership to local Turkmenistanis infuriated by the domestic situation they find themselves in as a result of the authorities’ oppressive policies.
Topic:
Government, Crisis Management, and Domestic Policy
Political Geography:
Central Asia and Turkmenistan