Lawrence D. Brown

The Medically Uninsured: Problems, Policies, and Politics

The ranks of the medically uninsured have grown significantly in recent years, but no consensus on a policy solution has emerged. After summarizing the characteristics of the uninsured population, this paper reviews diverse policy responses and their troubled political prospects.

A Consideration of User Financial Incentives to Address Health Inequalities

Health inequalities and user financial incentives to encourage health-related behavior change are two topical issues in the health policy discourse, and this article attempts to combine the two; namely, we try to address whether the latter can be used to reduce the former in the contexts of the United Kingdom and the United States. Payments for some aspects of medical adherence may offer a promising way to address, to some extent, inequalities in health and health care in both countries. However, payments for more sustained behavior change, such as that associated with smoking cessation and weight loss, have thus far shown little long-term effect, although more research that tests the effectiveness of different incentive mechanism designs, informed by the findings of behavioral economics, ought to be undertaken. Many practical, political, ethical, and ideological objections can be waged against user financial incentives in health, and this article reviews a number of them, but the justifiability of and limits to these incentives require more academic and public discourse so as to gain a better understanding of the circumstances in which they can legitimately be used.

Dogmatic Slumbers: American Business and Health Policy

For more than a decade students of health policy have predicted a revolution waged by corporate purchasers of health care who would rise in demand of public policy cures for increasing and burdensome health care costs. This forecast has been largely disappointed, however, as the business sector has remained oddly diffident in its demands for health policy reform. There are three reasons for businesss reticence--the economic stakes of the corporate sector in health reform are uncertain, organizational encumbrances hamper business activism in this arena, and ideological convictions make business wary of governmental solutions. Although business is sometimes said to manipulate the policy process for its own material ends, in the health sphere the most likely road to reform may reverse this image: a newly activist federal government may have to mobilize business support for reforms that advance both corporate interests and larger social goals.

The elements of surprise: how health reform happened.

By enacting health care reform in March 2010, President Barack Obama and the congressional Democrats electrified the national air almost as dramatically as did the playoff home run by Bobby Thompson that inspired Red Smith’s eloquence in 1951. Against huge historical and situational odds, the president and Congress steered into law new provisions and programs that, if they survive, will (among many other things) bring health care coverage to roughly 95 percent of the U.S. population and greatly modify the rules by which private insurers enroll subscribers and price products. That the measures that go beyond health insurance reform are largely contingent and speculative does nothing to diminish the magnitude of the achievement. As that American thought leader Miss Piggy might say, however, “Enough about the public interest, what about me?” After many years of teaching health politics, I can now no longer make do with perfunctory annual emendations in the margins of my yellowing lecture notes and must entertain seriously revisionist notions of the arts and limits of the possible in the U.S. system. March 2010 delivered at least five political surprises that have sent me back to the drawing board.

Capture and Culture: Organizational Identity in New York Blue Cross

This article explores the changing corporate culture of New Yorks Blue Cross and Blue Shield plan in its first fifty years. As the plan grew, corporate culture evolved over four sequential phases: the plan first had the character of an experiment, then that of a movement, a business, and, most recently, a corporate agglomerate. Accompanying this evolution has been an identity crisis, as the need to adapt to a turbulent environment has challenged the plans settled understanding of its core values, namely, voluntarism, community, and cooperation.

Path dependency: a dialogue.

Hi Larry! I can’t tell you how honored I am to be invited by the JHPPL editor to engage in this dialogue with you. We read your work in graduate school! And as I surely expected, you render a powerful critique of me and others who use path dependency to illuminate the properties of policy change as it unfolds over time — linear or not. But let’s start at the most general level of difference between us. Let’s face it, Larry. I believe in the science part of social science, and you do not. This means that my whole view of the analytical task in looking at health policy over time is about the search for generalizable properties across cases, all the while trying to distinguish systematically what parts of each case are quite particular to it, otherwise known as unique. Your views, on the other hand, stress the futility of searching for theories to explain over time or across cases why we get what we get — which in the United States is a lamentably atrocious health care system compared to those of other OECD countries, which do a pretty good job at it. In sum, you believe in analysis but not in science. What’s the “it” in question? Well, it’s doing a reasonably good job at reconciling the irreconcilable, the iron triangle I refer to: cost, access,

The Democratic Wish: Popular Participation and the Limits of American Government

Thats it, a book to wait for in this month. Even you have wanted for long time for releasing this book democratic wish popular participation and the limits of american government; you may not be able to get in some stress. Should you go around and seek fro the book until you really get it? Are you sure? Are you that free? This condition will force you to always end up to get a book. But now, we are coming to give you excellent solution.