Health Care: What's Next?

Table of Contents

In Essence

"Bad Contribution" by Norman Ornstein, in The New Republic (June 10, 1996), 1220 19th St. N.W., Washington, D.C. 20036.

"Dueling as Politics: Reinterpreting the Burr-Hamilton Duel" by Joanne B. Freeman, in The William and Mary Quarterly (Apr. 1996), Box 8781, Williamsburg, Va. 23187-8781.

"Hollywood Goes to Congress" by Tom Rosenstiel, in Media Studies Journal (Winter 1996), Columbia Univ., 2950 Broadway, New York, N.Y. 10027.

"Distant Compassion" by Clifford Orwin, in The National Interest (Spring 1996), 1112 16th St. N.W., Ste. 540, Washington, D.C. 20036.

"The Interservice Competition Solution" by Harvey M. Sapolsky, in Breakthroughs (Spring 1996), Defense and Arms Control Studies Program, Center for International Studies, Massachusetts Institute of Technology, 292 Main St. (E38-603), Cambridge, Mass. 02139.

"Mortgage Lending in Boston: Interpreting HMDA Data" by Alicia H. Munnell, Geoffrey M. B. Tootell, Lynn E. Browne, and James McEneaney, in The American Economic Review (Mar. 1996), American Economic Assn., 2014 Broadway, Ste. 305, Nashville, Tenn. 37203.

"The Crusade That’s Killing Prosperity" by Lester Thurow, in The American Prospect (Mar.–Apr. 1996), New Prospect Inc., P.O. Box 383080, Cambridge, Mass. 02238.

"The Poverty of Impoverishment Theory: The Economic Well-Being of the Elderly, 1890–1950" by Brian Gratton, and "Myth of the Industrial Scrap Heap: A Revisionist View of Turn-of-the-Century American Retirement" by Susan B. Carter and Richard Sutch, in The Journal of Economic History (Mar. 1996), 302 Thayer St., Box 1981, Brown Univ., Providence, R.I. 02912.

"Toward a New Conception of the Environment-Competitiveness Relationship" by Michael E. Porter and Claas van der Linde, and "Tightening Environmental Standards: The Benefit-Cost or the No-Cost Paradigm?" by Karen Palmer, Wallace E. Oates, and Paul R. Portney, in The Journal of Economic Perspectives (Fall 1995), American Economic Assn., 2014 Broadway, Ste. 305, Nashville, Tenn. 37203–2418.

"A Re-evaluation of the Economic Consequences of Divorce" by Richard R. Peterson, "The Economic Consequences of Divorce Are Still Unequal" by Lenore J. Weitzman, and "Statistical Errors, Faulty Conclusions, Misguided Policy: Reply to Weitzman" by Peterson, in American Sociological Review (June 1996), Dept. of Sociology, Univ. of Arizona, Tucson, Ariz. 85721.

"The Future of Baseball" by Shannon Dortch, in American Demographics (Apr. 1996), 127 W. State St., Ithaca, N.Y. 14850.

"The Rise and Demise of the American Orphanage" by Dale Keiger, in Johns Hopkins Magazine (Apr. 1996), 212 Whitehead Hall, Johns Hopkins Univ., 3400 N. Charles St., Baltimore, Md. 21218–2692; "Orphanages: The Real Story" by Richard B. McKenzie, in The Public Interest (Spring 1996), 1112 16th St. N.W., Ste. 530, Washington, D.C. 20036.

"What We Know about Cheating in College" by Donald L. McCabe and Linda Klebe Trevino, in Change (Jan.–Feb. 1996), Heldref Publications, 1319 18th St. N.W., Washington, D.C. 20036–1802.

creating a federation of free states. War and the threat of war, in Kant's view, serve as the "most essential" force for peace. "The growth of republics, and of the rule of law among them (embodied in their federa- tion)," Huntley explains, "is not an inten- tional creation as much as a gadual product of accumulating self-interested reactions to lawlessness and violence. Conflict is the fountainhead of progress-and so the propensity for war itself sows the seeds of war's...

making things smaller, development density is increased. More function can be built on a given area, causing the price of electronic functions to be cheaper and cheaper.strands are repeatedly broken and reattached way of sidestepping the problems with the enzymes during the replication process." double helix, he observes, but they hardly Such mechanisms may be nature's ad hoc enhance its aesthetic appeal. Electromagnetism Unplugged"Apocalypse Not" by Jon Palfreman, in Technology Rev...

making things smaller, development density is increased. More function can be built on a given area, causing the price of electronic functions to be cheaper and cheaper.strands are repeatedly broken and reattached way of sidestepping the problems with the enzymes during the replication process." double helix, he observes, but they hardly Such mechanisms may be nature's ad hoc enhance its aesthetic appeal. Electromagnetism Unplugged"Apocalypse Not" by Jon Palfreman, in Technology Rev...

sodium lights, while Eastern is lit newer metal-halide lamps that produce something much closer to the full-spectrum "white" light of the sun. In car dealerships and shopping mall parking lots, where bad lighting can hurt sales, metal- halide lights are invariably used. Costs are the rub. Metal-halide lights burn out rela- tively quickly. In 1992, the city of Toronto judged that a switch to the aesthetically supe- rior lighting would triple maintenance out- lays-yet made the change anyway.Oddly,...

sodium lights, while Eastern is lit newer metal-halide lamps that produce something much closer to the full-spectrum "white" light of the sun. In car dealerships and shopping mall parking lots, where bad lighting can hurt sales, metal- halide lights are invariably used. Costs are the rub. Metal-halide lights burn out rela- tively quickly. In 1992, the city of Toronto judged that a switch to the aesthetically supe- rior lighting would triple maintenance out- lays-yet made the change anyway.Oddly,...

Alexander Calder and other artists, who exhibited mainly in gal- leries and museums, many of the new monu- ments are the work of artists who have left the studio behind. They go "from arts council to arts council, municipality to municipality, state to state . . . in answer to calls for public works of art." The resulting public art fre- quently is "compromised and tepid."Two works of public art that succeeded as art, in Plagens's view, prove the rule. Maya Lin's Vietnam War...

being particularized they are films as Triumph of the Will (1935), a docu- invested with personhood; they stand upright mentary of the 1934 Nazi Party Congress at and affirm their humanity." Nuremburg, in which filmmaker Leni Against the vivid newsreel footage of the Riefenstahl "worshipfully frames the hal-Nazi death camps, with their emaciated sur- lowed faces of beatific Hitlerjugend and vivors, heaps of corpses, and children with fanatic Labor Service workers." serial numbers...

tria provided in the 18th century for Franz Joseph Haydn lasted only 29 years.) But critics have often said that after Elling- ton's "greatest period," 1940-42, there was a falling off, that he exceeded the limits of his talent in his later, more extended composi- tions. Crouch, a New York writer and critic, begs to differ.Ellington wrote and recorded hundreds of compositions and arrangements between 1924 and 1973, and, Crouch argues, they make the case for their creator as the most...

some estimates, the number of "missing girls" (reflected in the abnormally high ratio of male infants to female ones) has been growing more than one million a year. In some regions of the country, Kay Johnson, a professor of Asian studies and politics at Hampshire College, Amherst, Mass., writes in Population and Development Review (Mar. 1996), "there is mounting evidence" that female infants are being abandoned by the tens of thousands, perhaps hundreds of thousands, each year.0riginally,...

"Cuba’s Long Reform" by Wayne S. Smith, in Foreign Affairs (Mar.–Apr. 1996), 58 E. 68th St., New York, N.Y. 10021; "You Can’t Get There from Here" by Ann Wroe, in The Economist (Apr. 6, 1996), 25 St. James’s St., London SW1A 1HG; "Fidel and Mr. Smith" by Charles Lane, in The New Republic (Mar. 25, 1996), 1220 19th St. N.W., Washington, D.C. 20036.

"Cultural Captivity: Japan’s Crippled Financial System" by Eugene Dattel, in World Policy Journal (Spring 1996), World Policy Institute, New School for Social Research, 65 Fifth Ave., Ste. 413, New York, N.Y. 10003.

Book Reviews

WHY THINGS BITE BACK: Technology and the Revenge of Unintended Consequences. By Edward Tenner. Knopf. 352 pp. $26

DEMOCRACY'S DISCONTENT: America in Search of a Public Philosophy. By Michael J. Sandel. Belknap of Harvard Univ. Press. 417 pp. $24.95

THE OPEN SORE OF A CONTINENT: A Personal Narrative of the Nigerian Crisis. By Wole Soyinka. Oxford University Press. 176 pp. $19.95

Essays

The “father of scientific management” always looked back fondly on his days as an apprentice in a small manufacturing firm. It was an experience he believed every engineer should have. Ironically, his system of industrial efficiency helped make that impossible.

Robert Kanigel

During the 1990s, the WQ published a regular poetry feature edited by a series of distinguished poets, who selected and introduced the works of other writers past and present. After the death of our first poetry editor, the Nobel laureate Joseph Brodsky, Anthony Hecht, one of his successors, published this tribute.

Anthony Hecht

Despite its many sterling qualities, the nation’s health-care system has become a $1 trillion monster with oversized problems that seem to grow larger by the minute: soaring federal outlays for Medicare and Medicaid, nearly one-sixth of the population without medical insurance, and rising expenses everywhere. Now the system is lumbering in a new direction, toward managed care. Appraising this new destination—with all its implications for patients and doctors, hospitals and researchers—our authors suggest a variety of midcourse alterations.

Two years ago, 'the United States was caught up in a furious national debate over the future of its health-care system. That debate is over, with nothing substantial accomplished, and most Americans probably believe that its passing spelled the end of any signifi- cant change in the health-care system in the immediate future. Today, however, that system is changing right before our eyes. Only now there is little debate, and the driving forces are said to be beyond anybody's control. The signs...

Caroline Poplin

Years of debate have not produced much agreement on the future of the American health-care system. But people who study the system are virtually unanimous in their diagnosis of what's wrong with the country's traditional forms of health-care financing. The patient (with advice from a doctor) ultimately decides what services and care are purchased, but another party--an insurance company, or the government, through Medicaid or Medicare--pays the bills.

Peter J. Ferrara

Primary care is a more effective medicine not only for people with simple ailments but for those with illnesses that are serious and complex.

Eric J. Cassell

One of the legacies of the national debate over the Clinton health-care plan is a new public ambivalence about the value of medical research and technology.

Louis Lasagna

Even were we to make angels out of doctors and philanthropists out of insurance company executives, we would not stem the rise of health-care costs. That is because this increase, far from being a symptom of modern medicine’s failure, is a product of its success.

Willard Gaylin

The missiles that the People’s Republic of China launched toward Taiwan this spring were but the latest salvo in a long and sometimes heated dispute over control of the tiny island. Such threats of force, Anne Thurston suggests, will do little to improve chances of reconciliation. The People’s Republic might be wiser to adopt some of the ways of its forward-moving neighbor.

Anne F. Thurston

The recent rediscovery of Rebecca West’s masterful study of Yugoslavia, Black Lamb and Grey Falcon (1941), has brought deserved recognition to one of the more remarkable minds of this century. As her biographer here shows, West’s early stand against communism made her an isolated voice of conscience on the British Left.

Carl Rollyson

The front door of my high school was a thousand feet from the front door of the Metropolitan Museum of Art, but Greenland might as well have blocked the distance for all the travel there was between the two. Not once, in four years, were we directed to the museum, and the museum, in those chilly 1950s, folded its arms against the temptation to reach out.

James Morris

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