Harvey M. Sapolsky

Restructuring the U.S. Defense Industry

The end of the Cold War produced major changes in the U.S. defense sector. More than 2 million defense workers, military personnel, and civil servants have lost their jobs. Thousands of arms have left the industry. More than one hundred military bases have closed, and the production of weapons is down considerably. As signiacant as these changes are, they do not address the key issues in restructuring the post–Cold War defense sector. The Reagan-era defense buildup led contractors to invest in huge production capacity that no longer is needed. This capacity overhang includes too many open factories, each of which produces a “legacy” system that was designed for the Cold War. Many individual defense plants are also too large to produce efaciently at post–Cold War levels of demand. Until this excess capacity is eliminated, the United States will continue to spend too much on defense. The politics of jobs and congressional districts that many analysts thought governed the Cold War have triumphed in its aftermath. Today, years after the collapse of the Soviet Union, not one Cold War weapon platform line has closed in the United States. 1 The same factories still produce the same aircraft, ships, and armored vehicles (or their incremental descendants). During the Cold War, the high level of perceived security threat increased U.S. policymakers’ respect for military advice on weapons procurement and research and development (R&D) decisions. The military services’ expert knowledge checked Congress’s pork barrel instincts, and failed or unneeded weapon systems were often canceled. Today, however, contractors and congres

Corporate Attitudes toward Health Care Costs

WITH THE GOVERNMENT STRAINING TO MEET its health benefit obligations to the poor and the elderly, it is not surprising that some policy analysts see the development of an alliance between business and government as the only effective means to control inflation in the health sector. Most Americans receive health benefits from their employers rather than from government (Carroll and Arnett, 1979). Rising health care costs, however, affect all purchasers of health care services. Government action alone has been unable to limit the growth in these costs. An aroused business community could make the difference if it added its purchasing power to that of government in an effort to discipline the utilization and pricing of health care services. Businesses are certainly important purchasers of health care services, buying annually tens of billions of dollars worth of care on behalf of their employees. Many observers believe that firms, because of these expenditures, are a potential force for health sector reform (Council on Wage and Price Stability, 1976; Havighurst, 1978; Altman, 1978). The view they offer is that firms, especially the largest, are concerned about increases in health care costs; are seeking to improve

THE FLUORIDATION CONTROVERSY: AN ALTERNATIVE EXPLANATION

Fluoridation, the addition of fluoride compounds to the public water supply in order to reduce tooth decay, is a health innovation that appears to have considerable benefits and only modest costs. It is also, however, an innovation that has produced a protracted public controversy which has not been fully understood. Here, Sapolsky examines proposed explanations of the controversy and offers an alternative more nearly compatible with the evidence available. The author is Assistant Professor of Political Science at the Massachusetts Institute of Technology.

Terminating federal research and development programs

The barriers to terminating federal research and development vary with the type of program (manpower resource creation, basic or applied research, hardware development) and the functional sector in which it is lodged (defense or civilian). Each has a public/private constituency of sponsors and performers. Some constituencies are much more potent than others. Hence, to kill an R&D program, one must weaken the constituency behind it. Useful strategies for would-be terminators include decremental funding and the amalgamation of competing R&D programs within the same agency.

Prospective Payment in Perspective

Prospective payment promises improvement for a health care system plagued by inefficiency and rising costs, but is likely to disappoint. Serious efforts to control costs threaten the systems access and quality objectives and will be resisted. Moreover, serious cost containment, whether the result of all-payer regulation or competition, requires a stronger civil service than America seems capable of providing. A comparison with the experience in defense demonstrates the important limitations in applying incentive-based models in policy areas with conflicting goals. The search for panaceas will go on, but there are none.

The Political Obstacles to the Control of Cigarette Smoking in the United States

The opportunity to affect significantly the consumption of cigarettes in the United States through government action appears quite limited. Fifty million Americans smoke cigarettes. The United States is a leading producer of tobacco leaf and utilizes a price support system which is designed to protect tobacco growers. The industry is profitable and politicaly well connected. Several states are important producers of tobacco while others benefit from the excise tax imposed on cigarettes. The opposition to smoking is relatively weak and divided. Nevertheless, the tobacco industry worries about the future market for cigarettes.

Restraining Order: For Strategic Modesty

Even in an era of globalization, when information, people, goods, services, and, yes, weapons, armies, and terrorists may travel much more efficiently than in the past, geography still matters. At the start of the Cold War, the United States chose to relinquish the protection given by wide ocean buffers and relatively unthreatening neighbors to protect poor and depleted European and Asian allies whose own geography made them vulnerable to Soviet expansion. Today, however, the Cold War is long over, these allies have grown prosperous, and its time for America to reclaim its strategic depth. The Cold War left a legacy that has been difficult for Americans to transcend. The global network of American bases and military commands is ready for use, and many U.S. allies, despite their posturing complaints about U.S. policy, often encourage our interventionism as a way of ducking responsibility for maintaining their own security. It is also true that post-Cold War conflicts that developed in or near the collapsed Soviet empire, and the violent ethnic rivalries and failed states of Africa and Asia, have tempted U.S. intervention. When President Obama and other policymakers claim that security is indivisible?that instability anywhere

The Future of the Veterans' Health Care System

The probable adoption of a national health insurance system in the near future makes the Veterans Administrations health care program vulnerable to change. The last major turning point in the program occurred at the end of World War II when a decision was made to link VA hospitals to medical schools. This linkage in large measure has been responsible for the programs focus on acute care. The VA professional staff prefers an even greater interaction of the program with medical education. Others suggest its termination. The authors propose instead that the VA become a model system for the care of the chronically ill, the alcoholic, and the aged whose needs tend to be neglected by the overall health system.

Equipping the Armed Forces

Since World War II we have felt compelled for the first time in our history to maintain large standing forces. It is technology though, not numbers, that provides our edge in the continuing military competition with the Soviet Union. Acquiring advanced weapons is a complex process greatly complicated by our governmental system, which intentionally fragments political power. Mechanisms for improving the efficiency of the weapons acquisition process, however, threaten the very values that we seek to protect with our military power.

Writing the regulations for health

The development of regulations in health is much more than a purely technical procedure. Rather, it involves decisionmaking and bargaining processes that engage a wide range of individuals and organizations with diverse interests and varied resources. Attempts at statutory precision and goal clarification may improve, but will not fundamentally alter the regulation writing experience. The dynamics of regulations development are revealed in three cases. The primary case, The Health Maintenance Organization Act of 1973, suggests that despite the efforts of the regulations writers themselves, there are limits to the extent to which basic interest conflicts and questions of health policy can be resolved in the process. Other cases examined are the Professional Standards Review Organization Act of 1972 and the National Health Planning and Resources Development Act of 1974.