Robert Chernomas

If They Get Sick, They are in Trouble: Health Care Restructuring, User Charges, and Equity in Vietnam:

The transition from a centrally planned economy in the 1980s and the implementation of a series of neoliberal health policy reform measures in 1989 affected the delivery and financing of Vietnams health care services. More specifically, legalization of private medical practice, liberalization of the pharmaceutical industry, and introduction of user charges at public health facilities have effectively transformed Vietnams near universal, publicly funded and provided health services into a highly unregulated private-public mix system, with serious consequences for Vietnams health system. Using Vietnams most recent household survey data and published facility-based data, this article examines some of the problems faced by Vietnams health sector, with particular reference to efficiency, access, and equity. The data reveal four important findings: self-treatment is the dominant mode of treatment for both the poor and nonpoor; there is little or no regulation to protect patients from financial abuse by private medical providers, pharmacies, and drug vendors; in the face of a dwindling share of the state health budget in public hospital revenues and low salaries, hospitals increasingly rely on user charges and insurance premiums to finance services, including generous staff bonuses; and health care costs, especially hospital costs, are substantial for many low- and middle-income households.

Who Paid for the Canadian Welfare State Between 1955-1988?

This paper attempts to examine the impact of state taxation and expenditure activities on Canadian labor and non-labor. Using state expenditure and revenue data for the period 1955-1986, the Canadian transfer ratio is estimated and then it is compared and contrasted with the transfer ratio for the United States. This inter-country comparison also enables us to isolate the influence of a crisis-induced rise in unemployment on the net transfer from arguments that the social wage grew because of the growing power of labor over capital and the state.

An economist's brief guide to the recent debate on the Canadian health care system.

The purported advantages of the Canadian system of health insurance over the U.S. health care system have recently been questioned by a number of economists. These criticisms have in turn engendered a response by other economists who believe that the evidence supports the cost and coverage advantages of the Canadian system. The authors provide an overview of this recent debate.

Is the Canadian health care system more effective at expenditure control than previously thought? A reply to Peter Coyte.

In an article published by the Journal of Public Health Policy (Summer 1990), Peter C. Coyte argues that it is not empirically valid to say that the introduction of universal medical insurance in Canada successfully contained the growth in the share of societys resources devoted to the health care industry. During the period under consideration, both Canada and the United States witnessed several major policy changes in the provision and regulation of health services. Coytes decision to apply a simple time trend to the data assumes away these changes, especially the introduction of universal medical insurance in Canada in 1971, whose influence on health expenditures is itself the primary subject of inquiry of his paper. We conclude that both the unadjusted and the adjusted data suggest that the Canadian universal health system has been a resounding success economically, once the appropriate periodization is applied to the data, reflecting the institutional and policy changes that took place. Finally, we propose suggestions for future research with respect to measuring resource usage in the Canadian and U.S. health care systems.

The Class Analysis of Poverty: Is the Underclass Living off the Socially Available Surplus?:

In a recent article Erik Olin Wright argues that the U.S. underclass is a drain on the socially available surplus and thus a hindrance to capital accumulation. Wrights argument is not supported by available evidence from the United States, Canada, and the United Kingdom on the states distributive activities. This evidence suggests that the social welfare necessary to sustain the underclass is provided by transfers from wage and salary earners rather than from profit.

Productive and Unproductive Labor and the Rate of Profit in Malthus, Ricardo, and Marx

A principal objective of Malthus, Ricardo, and Marx was to discover the laws that regulate and limit the growth of the wealth of nations and, in particular, the unprecedented growth of capitalism. The central theme of this paper is that their productive and unproductive labor concepts are critical to understanding their analyses of capitalist growth and the tendency for the rate of profit to fall which regulates and limits this growth. The way in which they identify productive and unproductive labor and how they apply this distinction is critical to understanding the common thread that runs through and marks the differences between them.

Profit Without Accumulation

The first depression of the twenty-first century appears to contain some unusual properties in the United States. In the midst of an economy in its fourth year of oscillating between stagnation and recession, the companies in the Standard & Poors 500 stock index were expected to report record profits in 2011, and corporate profit as a share of the economy is at a fifty-year high. Productivity growth in the past decade, at more than 2.5 percent, is higher than in the 1970s, 1980s, and 1990s. And yet there is little appetite or competitive drive to invest. Two questions come to mind: Why are profits high, and why not invest them? High rates of exploitation, low taxes, and speculation generate high profits in production, and rents captured from debt-laden households and commodity prices explain the high profitability. The divorce of the capitalist class from its domestic economy, the debts of which are so high as to make investments too uncertain, explains the low investment rate. The paper examines the theoretical implications of these developments, with particular attention to their implications for theorizing the capitalist drive to accumulate.

Further Refinements of Canadian/U.S. Health Cost Containment Measures

Critics of the Canadian health care system have argued that the lower health care share of gross national product (GNP) in Canada relative to the United States is more likely to be associated with a relatively more rapid growth in GNP in Canada than with the ability of the Canadian single-payer system to contain costs. In this article the authors use both the level and the average annual growth rate of health cares share of GNP to provide an assessment of cost containment for the United States and Canada. They conclude that the suggestion that the success of the Canadian system has been an illusion created by its more rapid growth in GNP is not supported once the appropriate adjustments are made to the data.

The Profit Doctrine: Economists of the Neoliberal Era

Cover -- Contents -- List of Boxes, Figures and Tables -- List of Abbreviations -- Acknowledgements -- 1. Prophets and Profits -- 2. The Contest of Economic Ideas: Survival of the Richest -- 3. The Consequences of Economic Ideas -- 4. Milton Friedman: The Godfather of the Age of Instability and Inequality -- 5. The Deregulationists: Public Choice and Private Gain -- 6. The Great Vacation: Rational Expectations and Real Business Cycles -- 7. Bursting Bubbles: Finance, Crisis and the Efficient Market Hypothesis -- 8. Economists Go to Washington: Ideas in Action -- 9. Conclusion: Dissenters and Victors -- Bibliography.

Kansas syndrome|[quest]|

This paper explores white working- and middle-class Americans’ paradoxical support for policies that have contributed to their thirty-year economic decline while benefitting the wealthiest people in the country. Their habit of identifying with the aggressor has caused them actively to be engaged in their own economic descent. In the words of Jesse Jackson, “They’re turkeys at their own Thanksgiving.”