The United States, unlike all other industrialized nations, does not have a comprehensive public system for financing health care. Nevertheless, the magnitude of America's public health care financing effort is remarkable. Of the one trillion dollars the United States spent on health care in 1996, almost half, $483.1 billion, was spent by public programs. In 1995, Medicare—our social insurance program for persons over sixty-five and the long-term disabled—overed 37.5 million Americans; Medicaid—our program for indigent elderly and disabled persons and indigent (...) children and their families—covered 36.3 million. In 1996, Medicare and Medicaid spent $203.1 and $147.7 billion, respectively. The payment policies of these massive public health care programs have a profound effect on the provision of health care.Many of the recipients of Medicare and Medicaid suffer pain. In 1994, 376,200 Americans over age sixty-five died of cancer. Virtually all of these would have been Medicare recipients, and as many as 70 percent of them died in unrelieved pain. Nearly four million Americans over sixty-five endured the pain of inpatient surgery in 1995, again nearly all of whom were Medicare recipients. (shrink)

We have just completed an exhausting nine‐month debate on the future of the Affordable Care Act. I see this debate as having ended—as of this writing—in a draw. After months of repeal efforts, Republicans in the House barely passed in early May, with a 217‐to‐213 margin, the American Health Care Act, which would have significantly amended the ACA. Republicans in the Senate spent the summer trying to arrive at amendments to the AHCA that could attract fifty of their fifty‐two votes, (...) but in the end, the clock ran out on their opportunity to enact an amendment without Democratic input. With this legislative failure, we appear to be in a stalemate. The Affordable Care Act remains in place as the law of the land, but the Trump administration seems committed to at best condemning the ACA to malign neglect and at worst actively undermining it at every opportunity. Given the political stalemate, the time is right to reassess the deeper issues at stake and ponder the prospects for a considered compromise on health reform. (shrink)

This “Legal Solutions in Health Reform” paper identifies and analyzes the legal issues raised by health insurance exchanges. Like all Legal Solutions papers, it does not purport to provide a concrete proposal as to how health insurance exchanges should be organized or even whether they should play a role in health care reform. Rather, it attempts simply to describe the legal issues that health insurance exchanges raise, and to propose alternative solutions to legal problems where useful. More specifically, it analyzes (...) and offers alternative solutions to the legal problems raised by proposals to establish insurance exchanges by the federal government, by state governments, and by private entities or associations. Because the focus of this project and paper is on legal issues, discussion of policy and design issues is attenuated. Nevertheless, some attention to policy issues is unavoidable because law is the realization of policy. (shrink)

The Affordable Care Act is an essential first step toward making health insurance more affordable for lower and moderate income Americans. It has accomplished historic reductions in the proportion of Americans who are uninsured. The number of Americans reporting delaying medical care for financial reasons has declined by approximately one-third since 2010. Medicaid expansions, in particular, have significantly reduced financial burdens and accompanying anxieties experienced by low-income Americans in states that have embraced this opportunity. Consistent with these finding, one recent (...) analysis of credit report data finds that Medicaid expansion was associated with between a $600 and $1000 decline in collection balances among individuals who gained coverage. Notwithstanding these gains, premiums and cost-sharing are still too high for many Americans. And cost-sharing has continued to edge higher for the majority of Americans who have coverage through employer-based plans. Measures to address these challenges must build on the ACA to provide greater protection to millions of Americans and to address continued dissatisfaction with our health care financing system among middle-income Americans. (shrink)

Even Americans who have only a vague knowledge of health policy know that the U.S. is different. We do not have “socialized medicine,” like our European or Canadian neighbors. We believe that health care is not rationed here, and that, unlike citizens of other nations, we do not have to wait in long queues when we need medical care. We believe that U.S. health care is the best in the world.At the same time, the U.S. spends more on health care (...) - both per capita and as percentage of gross domestic product - than other nations do. One in six non-elderly Americans has no health insurance, and voluminous studies show that lack of health insurance has a dramatic effect on both access to care and on health status. Furthermore, on many of the most important indicators of population health, such as infant mortality and life expectancy, the U.S. scores worse than do other nations. (shrink)

The last year, June 1992 through September 1993, has seen a great deal of ferment with respect to access to and financing of health care in the United States. The elections of 1992 portend dramatic changes in the American health care system, and vigorous debate regarding both expansion of access to health care and transformation of the health care financing system is taking place at the federal and the state levels. In fact, however, the time period covered here produced remarkably (...) few changes in the law, particularly at the federal level. The one piece of Medicare and Medicaid legislation passed by Congress in the fall of 1992, H.R. 11, was vetoed by President Bush immediately after the election. The Omnibus Budget Reconciliation Act of 1993 contained a host of minor adjustments to the Medicare and the Medicaid programs, but only the Medicaid asset transfer provisions and extensions to the self-referral provisions of the fraud and abuse laws, discussed below, are of import to us. (shrink)

In her classic 1993 article, “The Struggle for the Soul of Health Insurance,” Deborah Stone contrasted the principle of mutual aid—“the essence of community” in the face of sickness—and the principle of actuarial fairness, under which “each person should pay for his own risk.” Stone claimed that “in most societies sickness is widely accepted as a condition that should trigger mutual aid,” while in the United States, a competitive insurance industry fosters in people “a sense of their difference, rather than (...) their commonalities, and their responsibility for themselves only, rather than their interdependence,” leading to the fragmentation of “communities into ever‐smaller, more homogeneous groups” and “the destruction of mutual aid.” The United States has, as Stone observes, long been an outlier in its approach to financing care for sickness. Over the past half century, we have developed mutual aid‐based programs to care for some, but most Americans have had to pay the “actuarially fair” cost of their care, either as individuals or as employee groups. Mutual aid has existed only on a limited scale. The Affordable Care Act is the most comprehensive attempt to date to remedy this situation. (shrink)

Since the Supreme Court of New Jersey decided the Quinlan case a quarter of a century ago, three American Supreme Court decisions and a host of state appellate decisions have addressed end-of-life issues. These decisions, as well as legislation addressing the same issues, have prompted a torrent of law journal articles analyzing every aspect of end-of-life law. In recent years, moreover, a number of law review articles, many published in this journal, have also specifically addressed legal issues raised by palliative (...) care. Much less is known in the United States, however, as to how other countries address these issues. Reflection on the experience and analysis of other nations may give Americans a better understanding of their own experience, as well as suggest improvements to their present way of dealing with the difficult problems in this area.This article offers a conceptual and comparative analysis of major legal issues relating to end-of-life treatment and to the treatment of pain in a number of countries. In particular, it focuses on the law of Australia, Canada, the United Kingdom, Poland, France, the Netherlands, Germany, and Japan. (shrink)

As we write this paper in spring 2008, many are hopeful that November’s election will open the door to some form of comprehensive health care reform. In all likelihood, we will elect a president who has campaigned to a greater or lesser extent on promises of improving access to health care, improving quality, and reducing costs. Equally important, it seems likely that the 111th Congress is preparing to undertake meaningful health care reform. And perhaps most important, despite recent attention to (...) energy issues and the economy, opinion polls consistently show that the American public continues to rank health care as one of the two or three most important domestic issues in the fall elections and supports comprehensive health care reform. (shrink)

Originally edited by Timothy Stoltzfus Jost, this text examines how different countries around the world approach the same challenges in health care law and ethics: how to finance care for as many people as possible; how to ensure quality care; how to best secure patients' rights; how to regulate abortion, end of life decision making, and assisted reproduction; and how to manage infectious diseases, tobacco use, and human subject research. The new edition considers a broader array of countries, (...) particularly from Asia, Latin America, Africa, and the Middle East. (shrink)

1. As John Hawthorne and Maria Lasonen-Aarnio appreciate, some of the central issues raised in their ‘Knowledge and Objective Chance’ arise for all but the most extreme theories of knowledge. In a wide range of cases, according to very plausible everyday judgments, we know something about the future, even though, according to quantum mechanics, our belief has a small but nonzero chance (objective probability) of being untrue. In easily constructed examples, we are in that position simultaneously with respect to many (...) different propositions about the future that are equiprobable and probabilistically independent of each other, at least to a reasonable approximation. (shrink)

Until recently, many philosophers took Causal Decision Theory to be more successful than its rival, Evidential Decision Theory. Things have changed, however, with a renewed concern that cases involving an extreme form of decision instability are counterexamples to CDT :392–403, 1984; Egan in Philos Rev 116:93–114, 2007). Most prominent among those cases of extreme decision instability is the Psychopath Button, due to Andy Egan; in that case, CDT recommends a seemingly absurd act that almost certainly results in your death. This (...) renewed attention to decision instability has spurned an array of modifications to and rejections of CDT. I argue, however, that the Psychopath Button and its ilk are no counterexamples to CDT. That is, given the causalist’s commitments in Newcomb Problems, they already have the tools to justify CDT’s verdict in Egan-style cases of extreme decision instability. I first argue that there is no reason to think the Psychopath Button is a counterexample to CDT; in particular, many philosophers have placed too much weight on pre-theoretic intuition in Egan-cases, and apart from pre-theoretic intuition, arguments against CDT in cases of extreme decision instability are flawed. My second claim is that the causalist can provide good reasons for following CDT in cases of extreme decision instability. I present a new case, the Two Button Defense, that highlights precisely why the causalist can reasonably follow CDT in even the Psychopath Button. CDT therefore stands as a viable decision theory, without need for modification, restriction, or rejection. (shrink)

Although Bastin et al. propose a useful model for thinking about the structure of memory and memory deficits, their distinction between entities and relational encoding is incompatible with data showing that even individual objects – prototypical “entities” – are made up of distinct features which require binding. Thus, “entity” and “relational” brain regions may need to solve fundamentally the same problems.

Over the past two decades, therule of law has emerged as a key priority within contemporary peacebuildingefforts. Drawing on examples from post-Dayton Bosnia, this article examines theimpact of rule of law reform efforts on broader patterns of power and politicalauthority in peacebuilding contexts. It suggests that in the case of Bosnia,the use of rule of law strategies to restructure political life has largelyfailed. Thus, despite some notable achievements on the rule of law front, thecore dynamics of Bosnia’s political conflict remain (...) intact, and country’s peaceprocess is as fragile as ever. The article concludes by noting that charting acourse between accepting the political status quo and fundamentallytransforming it requires more nuanced approaches that advance the rule of laweven while accepting its limits as an instrument of deep politicaltransformation. (shrink)

This response takes up some of the editorial comments for further clarification and critique. My point has been that ‘politics’ is as much a modern invention as ‘religion’. We cannot understand the rhetorical function of ‘religion’ if we treat it as a stand-alone category referring to some supposed object or objects in the world. I am especially concerned here to keep in view the oscillating binary categories of which ‘religion' forms one parasitic half, and ‘politics' or ‘science' the other. This (...) critical problematization of the liberal categories of the understanding opposes and challenges their current institutionalization in the liberal academy, where they now serve the Neoliberal agenda and the reproduction of the dominant, globalising imperatives of private property. (shrink)

Musical systems develop associations over time between aspects of musical form and concepts from outside of the music. Experienced listeners internalize these connotations, such that the formal elements bring to mind their extra-musical meanings. An example of musical form-meaning mapping is the association that Western listeners have between the major and minor modes and happiness and sadness, respectively. We revisit the emotional semantics of musical mode in a study of 44 American participants (musicians and non-musicians) who each evaluated the relatedness (...) of 96 melody-word pairs. Among the tonal melodies, we manipulated mode (major and minor) and timbre (clarinet and flute) while systematically controlling for other musical factors including pitch register and melodic contour. Similarly, among the English words, we manipulated word affect (happy and sad) while systematically controlling for other lexical factors including frequency and word length. Results demonstrated that participants provided a higher proportion of related responses for major melodies paired with happy words and minor melodies paired with sad words than for the reverse pairings. This interaction between mode and word affect was highly significant for both musicians and non-musicians, albeit with a larger effect for the former group. Further interactions with timbre suggested that while both clarinet and flute conveyed happiness when in the major mode, the clarinet was somewhat more successful than the flute at conveying sadness in the minor mode. Debriefing questionnaires suggested that the majority of the participants, including all of the non-musicians, had no awareness of the major-minor manipulation, and instead directed their attention to register and contour. We argue that the affective character of the major and minor modes is but one example of form-meaning mapping in music, and suggest further exploration of the roles of timbre, register, and contour in conveying musical emotions. (shrink)

The Communist Party USA's reputation for being in the forefront of the fight against African American oppression was forged in the 1930s as the result of the adoption of the Communist International's position that African Americans were an oppressed nationality. According to Marxist-Leninist doctrine, this entitled African Americans to the right to self-determination in that area of the country where they were a majority (the Black Belt South) and equal social and political rights throughout the country. The organizational internalization of (...) this position was accomplished through numerous articles in the Party's press, which were used as educational tools for the membership. The most sustained organizing work in the South occurred in Alabama with the organizing of the Share Croppers Union (SCU). A study of the Party and the SCU in Alabama during the 1930s helps demonstrate the significance of the self-determination position and its importance in shaping the work of the Party among African Americans. (shrink)

Previous studies conducted in the United States indicate that people associate numbers with gender, such that odd numbers are more likely to be considered male and even numbers considered female. It has been argued that this number gendering phenomenon is acquired through social learning and conditioning, and that male-odd/female-even associations reflect a general, cross-cultural human consensus on gender roles relating to agency and communion. However, the incidence and pattern of number gendering in cultures outside the United States remains to be (...) established. Against this background, the purpose of this study was to determine whether people from a culture and country very different from the United States also associate numbers with gender, and, if they do, whether the pattern of these associations is the male-odd/female-even associations previously observed. To investigate this issue, we adopted the Implicit Association Test used frequently in previous research, where associations between numbers and gender were examined using male and female Arabic participants native to, and resident in, the United Arab Emirates. The findings indicated that the association of numbers with gender does occur in Arabic culture. But while Arabic females associated odd numbers with male faces and even numbers with female faces, Arabic males showed the reversed pattern of gender associations, associating even numbers with male faces and odd numbers with female faces. These findings support the view that number gendering is indeed a cross-cultural phenomenon and show that the phenomenon occurs across very different countries and cultures. But the findings also suggest that the pattern with which numbers are associated with gender is not universal and, instead, reflects culture-specific views on gender roles which may change across cultures and gender. Further implications for understanding the association of numbers with gender across human societies are discussed. (shrink)

We show that any partial order with a Σ3 enumeration can be effectively embedded into any partial order obtained by imposing a strong reducibility such as ≤tt on the c. e. sets. As a consequence, we obtain that the partial orders that result from imposing a strong reducibility on the sets in a level of the Ershov hiearchy below ω + 1 are co-embeddable.

ABSTRACTAxel Honneth’s theory of recognition has been criticised for presenting a deficient concept of work and the normative significance of work. In recent years Jean-Philippe Deranty, among others, has suggested that Honneth could overcome this deficiency by reintroducing into his mature theory the critical concept of work that first appeared in his 1977–1985 writings. My paper critically reconstructs and assesses Deranty’s position. I argue that Deranty has understated the extent to which his research direction diverges from Honneth’s. Rather than simply (...) nuancing Honneth’s existing philosophical system, Deranty’s work exposes some of its conceptual limits and points beyond it. (shrink)

Le déréglement climatique est sans doute l’exemple le plus dramatique d’« hyperobjet », à savoir d’entités de dimensions temporelles et spatiales si disproportionnées à nos habitudes de perception que nos cadres de pensée et de compréhension s’en trouvent déjoués. Cet article explique ce que sont les hyperobjets et évoque leur impact sur nos modes de pensée ainsi que sur les façons dont nous devons apprendre à coexister. Les hyperobjets nous forcent à prendre en compte l’inséparé.

We report the results of an experiment designed to determine the effects of psychological proximity—proxied by awareness of pain and friendship—on moral reasoning. Our study tests the hypotheses that a moral agent’s emphasis on justice decreases with proximity, while his/her emphasis on care increases. Our study further examines how personality, gender, and managerial status affect the importance of care and justice in moral reasoning. We find support for the main hypotheses. We also find that care should be split into two (...) components, one related to protection and the other to the preservation of relationships. Although gender does not affect moral reasoning directly, we find that it does so indirectly via personality, controlling for age, professional status, and professional background. We do not find a significant effect of managerial status on ethics of justice, but do find that holding a managerial position has a negative impact on ethics of care. Regarding personality, we detect significant positive effects of conscientiousness on ethics of justice and of neuroticism on ethics of care. (shrink)

This book provides a novel reevaluation of Jacques Derrida’s deconstructive account of writing. Derrida’s various essays on writing's materiality in books, scrolls, typewriters and digital displays, briefly touched on the question of religion. At times he directed his attention to the mediatic nature of Christianity. However, such comments have rarely been applied to formal aspects of religious texts. In response, this book investigates the rise of the Christian codex in its second-to-fifth-century-CE Jewish and Greco-Roman contexts. By better understanding the religious (...) nature of this technical development, it becomes possible to reframe writing's coincidence with faith. (shrink)