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211. Massachusetts Miracle or Massachusetts Miserable: What the Failure of the "Massachusetts Model" Tells Us about Health Care Reform

Author:
Michael Tanner
Publication Date:
06-2009
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
When Massachusetts passed its pioneering health care reforms in 2006, critics warned that they would result in a slow but steady spiral downward toward a government-run health care system. Three years later, those predictions appear to be coming true: Although the state has reduced the number of residents without health insurance, 200,000people remain uninsured. Moreover, the increase in the number of insured is primarily due to the state's generous subsidies, not the celebrated individual mandate. Health care costs continue to rise much faster than the national average. Since 2006, total state health care spending has increased by28 percent. Insurance premiums have increased by 8–10 percent per year, nearly double the national average. New regulations and bureaucracy are limiting consumer choice and adding to healthcare costs. Program costs have skyrocketed. Despite tax increases, the program faces huge deficits. The state is considering caps on insurance premiums, cuts in reimbursements to providers, and even the possibility of a “global budget” on health care spending—with its attendant rationing. A shortage of providers, combined with increased demand, is increasing waiting times to see a physician. With the “Massachusetts model” frequently cited as a blueprint for health care reform, it is important to recognize that giving the government greater control over our health care system will have grave consequences for taxpayers, providers, and health care consumers. That is the lesson of the Massachusetts model.
Topic:
Health, Human Welfare, Markets, and Governance
Political Geography:
United States

212. Darfur: In Search of Peace

Author:
George Shepherd and Peter Van Arsdale
Publication Date:
01-2009
Content Type:
Working Paper
Institution:
Human Rights Human Welfare (University of Denver)
Abstract:
Darfur is located in the Western part of Sudan and borders Libya to the north, and Chad and CentralAfrican Republic to the West. It had an estimated population of seven million (prior to refugee and IDPdisplacements), representing more than 70 tribes, and is potentially rich in natural resources includingoil, copper, and uranium, as well as reservoirs of subsurface "Pleistocene water."
Topic:
Conflict Resolution, Civil War, Human Rights, Human Welfare, Humanitarian Aid, Poverty, and War
Political Geography:
Africa and Libya

213. The uncertain legitimacy of occupational health policies

Author:
Emmanuel Henry
Publication Date:
01-2009
Content Type:
Working Paper
Institution:
Centre for European Political Sociology
Abstract:
Because they deal with issues of bodily integrity and health, the policies managing occupational risks reveal the contradictions of public action in the field of occupational relationships, and the fragile compromises to which they lead. This paper sets out to question the difficulties related to the legitimisation of public policies in the field of workplace health. We analyse the reasons why these policies are difficult to legitimate and present an overview of the solutions that have been elaborated to answer this problem. The recent evolutions of public health policies, notably the arrival of new actors in traditional arenas of negotiation tend to weaken these compromises and force actors to elaborate new modes of action. These evolutions should then be analysed by taking into account other public policies, in order to determine to what extent the management of occupational risks is undergoing the same transformations or if this field remains unaffected.
Topic:
Health, Human Welfare, and Politics
Political Geography:
Europe

214. Using Indicators to Encourage Development? Lessons from the Millennium Development Goals

Author:
Richard Manning
Publication Date:
01-2009
Content Type:
Working Paper
Institution:
Danish Institute for International Studies
Abstract:
The Millennium Declaration included a highly significant innovation – universal, support by the world's governments for a short list of development results to be, achieved by a set date. As the target year of 2015 approaches, the paper compares the, MDG framework that emerged from the Declaration with other ways of measuring, and incentivising progress, sets out some initial hypotheses about its impact and addresses issues about its structure and coverage. This leads to proposals about how to, get the best value from the MDGs over the years to 2015 and five hypotheses about, how the world might approach the issue of what framework, if any, to put in place, to measure and incentivise development progress after 2015.
Topic:
Development, Health, Human Welfare, Humanitarian Aid, International Cooperation, International Political Economy, Third World, and United Nations

215. Pricing and Access: Lessons from Randomized Evaluations in Education and Health

Author:
Michael Kremer and Alaka Holla
Publication Date:
01-2009
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper surveys evidence from recent randomized evaluations in developing countries on the impact of price on access to health and education. The debate on user fees has been contentious, but until recently much of the evidence was anecdotal. Randomized evaluations across a variety of settings suggest prices have a large impact on take-up of education and health products and services. While the sign of this effect is consistent with standard theories of human capital investment, a more detailed examination of the data suggests that it may be important to go beyond these models. There is some evidence for peer effects, which implies that for some goods the aggregate response to price will exceed the individual response. Time-inconsistent preferences could potentially help explain the apparently disproportionate effect of small short-run costs and benefits on decisions with long-run consequences.
Topic:
Development, Economics, Education, Health, Human Welfare, and Markets

216. Does the Doctor Need a Boss?

Author:
Michael F. Cannon and Arnold Kling
Publication Date:
01-2009
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
The traditional model of medical delivery, in which the doctor is trained, respected, and compensated as an independent craftsman, is anachronistic. When a patient has multiple ailments, there is no longer a simple doctor patient or doctor-patient-specialist relationship. Instead, there are multiple specialists who have an impact on the patient, each with a set of interdependencies and difficult coordination issues that increase exponentially with the number of ailments involved.
Topic:
Economics, Health, and Human Welfare
Political Geography:
United States

217. Halfway to Where? Answering the Key Questions of Health Care Reform

Author:
Michael Tanner
Publication Date:
09-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
Although neither the House nor the Senate passed a health care bill by President Obama's August deadline, various pieces of legislation have made it through committee, and they provide a concrete basis for analyzing what the proposed health care reform would and would not do. Looking at the various bills that are moving on Capitol Hill, we can determine the following: Contrary to the Obama administration's repeated assurances, millions of Americans who are happy with their current health insurance will not be able to keep it. As many as 89.5 million people may be dumped into a government-run plan. Some Americans may find themselves forced into a new insurance plan that no longer includes their current doctor. Americans will pay more than $820 billion in additional taxes over the next 10 years, and could see their insurance premiums rise as much as 95 percent. The current health care bills will increase the budget deficit by at least $239 billion over the next 10 years, and far more in the years beyond that. If the new health care entitlement were subject to the same 75-year actuarial standards as Social Security or Medicare, its unfunded liabilities would exceed $9.2 trillion. While the bills contain no direct provisions for rationing care, they nonetheless increase the likelihood of government rationing and interference with how doctors practice medicine. Contrary to assertions of some opponents, the bills contain no provision for euthanasia or mandatory end-of-life counseling. The bills' provisions on abortion coverage are far murkier.
Topic:
Government, Health, Human Welfare, and Markets
Political Geography:
United States and America

218. Missing pieces? Assessing the impact of humanitarian reform in Pakistan

Author:
Nicki Bennett
Publication Date:
10-2009
Content Type:
Policy Brief
Institution:
Oxfam Publishing
Abstract:
In May 2009, Pakistan's North-West Frontier Province became the site of the world's biggest and fastest human displacement in over a decade – and the largest internal displacement ever witnessed in Pakistan's history. Within the space of only a few weeks, an estimated three million Pakistanis fled their homes to escape their army's military offensive against armed insurgents.
Topic:
Human Welfare and Foreign Aid
Political Geography:
Pakistan and South Asia

219. Countering Drug Resistance in the Developing World: An Assessment of Incentives across the Value Chain and Recommendations for Policy Interventions

Author:
Prashant Yadav
Publication Date:
09-2009
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
The emergence and spread of drug resistance is draining available resources and threatening our ability to treat infectious diseases in developing countries. Countering drug resistance requires pharmaceutical companies, government regulators, doctors, and patients to make difficult choices about drug treatment in order to balance efficacy, cost, safety, and sustainability of drugs. These complex tradeoffs are faced along the drug supply chain from the development of new products, procurement of drugs for donor and government distribution, distribution steps to ensure treatment heterogeneity along with quality and availability, and dispensing and use that requires affordability, patient adherence and rational use of drugs and diagnostics. An analysis of the incentives and risks in the drug supply chain reflects that many stakeholders who can influence optimal prescribing of existing drugs; affect higher patient compliance; and ensure the quality of drugs have weak incentives to carry out these activities optimally. This implies a high potential for drug resistance to accelerate. This paper recommends specific measures to better align the incentives of these stakeholders with resistance- countering activities.
Topic:
Development, Health, Human Welfare, and Third World

220. Making Markets for Merit Goods: The Political Economy of Antiretrovirals

Author:
Ethan Kapstein and Josh Busby
Publication Date:
08-2009
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper examines the role of policy entrepreneurs and global activists in shaping the international market for antiretroviral drugs to combat HIV/AIDS. When ARVs first came on the market in the 1990s they were exceedingly expensive; the cost of treatment was upwards of $10,000 per year. These drugs were thus accessible only to those patients who had high incomes. But in 2006, the “international community,” meeting at a United Nations General Assembly Special Session (UNGASS), made an astonishing pledge to those who were infected with HIV. It proclaimed that there should be universal access to ARV treatment. This UNGASS, following up on an earlier historic UN special session devoted entirely to AIDS in 2001, marked the first time in history that the international community pledged itself to chronic care for the ill, which in this case includes the approximately 30 million people around the world estimated to be HIV positive. How do we explain the transformation of ARVs from private goods, which only a few could afford, into merit goods that were (at least declaratively) to be made available to everyone? In other words, how does a norm of “universal access to treatment”—that no person should be denied these life-extending drugs—become the ethical basis for global public policy with respect to pharmaceutical allocation? What are the lessons of the ARV story for other global issues? These are the primary questions we explore in this paper. Briefly, we argue that the policy entrepreneurs and activists who promoted the creation of a universal access to treatment regime—of the transformation of ARVs into global merit goods—relied on a combination of moral arguments and ideas with favorable material circumstances. From the ethical perspective, the task of these entrepreneurs was to convince the “international community” that access to ARVs was a “human right,” or conversely to convince decision-makers that it was morally wrong to allocate these life-enhancing drugs solely on the basis of ability to pay. But from a material standpoint, these arguments were greatly facilitated by the lowering prices of ARVs caused by a combination of differential pricing (that is, lower prices for drugs in the developing world than in the advanced welfare states) and competition from generics producers, coupled with increases in foreign aid spending devoted to HIV/AIDS and other diseases.
Topic:
Health, Human Welfare, Humanitarian Aid, and Political Economy