Gregory J. Martin

Dividing the Dollar with Formulas

In advanced democracies, most government spending is allocated according to criteria approved by a legislature but implemented by the bureaucracy. I ask whether this fact imposes a binding constraint on the ability of legislators to engage in targeted redistribution, by constructing a model in which legislators are constrained to allocate spending by a formula of limited dimension—in contrast to benchmark models where proposers have the flexibility to manipulate the payoffs of individual members directly. The model predicts oversized winning coalitions, positive distributions outside of the winning coalition, and the emergence of persistent voting blocs. I then apply the model to a sample of 31 US federal spending bills, using new data connecting spending outcomes to authorizing legislation. I find that most allocation formulas for spending programs involve five or fewer factors. Formulaic allocation imposes a tight constraint on targeting, eliminating more than 90% of congressional proposers’ degrees of freedom.

Colloids for Sepsis: Effectiveness and Cost Issues

Severe sepsis, defined as acute organ dysfunction secondary to infection, and septic shock, defined as severe sepsis plus hypotension not reversed with fluid resuscitation, originate in the systemic inflammatory response following infection and lead to cardiovascular and organ dysfunction. Sepsis is a major cause of hospital mortality and a considerable economic burden [1]. Resuscitation in sepsis is initially based on goal-directed fluid therapy. This modality remains controversial [2] and a recent randomized trial indicated that bolus fluid therapy in a large population of children with sepsis in a resource-challenged environment [3] increased mortality irrespective of the type of fluid. Nevertheless, this remains an active area of clinical investigation, as evidenced by the large number of registered relevant trials on www.clinicaltrials.gov. The timing, rather than the type, of fluid therapy has been proposed as being crucial [4].