Showing papers on "Legislation published in 1991"

The Dynamics of Political Control of the Bureaucracy.

Abstract: A new paradigm of political-bureaucratic relations emerged through the 1980s holding that U.S. democratic institutions continuously shape nonelective public bureaucracies. Several empirical studies support the paradigm with evidence suggestive of political manipulation but none reveals the scope or specific mechanisms of political control. We explore the dynamics of political control of the bureaucracy explicitly to determine the scope and mechanisms. We examine output time series from seven different public bureaucracies for responsiveness to political tools applied in the late Carter and early Reagan administrations. We find responsiveness in all seven cases. The evidence also shows that political appointments—a shared power of the president and Congress—is the most important instrument of political control; changing budgets, legislation, congressional signals, and administrative reorganizations are less important. These findings confirm intuitive assertions by institutional scholars and suggest a method of “policy monitoring” that could enhance future democratic control of the bureaucracy.

Disabled people in Britain and discrimination: A case for anti-discrimination legislation

Abstract: History of discrimination and disabled people education employment the disability benefits system the health and social support services housing, transport and the built environment leisure, social life and disabled people politics and disabled people the case for anti-discrimination legislation.

Family-Oriented Early Intervention Policies and Practices: Family-Centered or Not?:

Abstract: This article includes a multimethod, multisource analysis and synthesis of the degree to which contemporary family-oriented early intervention policies and practices are family centered. Federal laws and legislation, state-level policy positions, and the viewpoints of service providers and consumers were analyzed as part of the study. The findings, taken together, indicate a movement toward adoption of family-centered early intervention policies and practices at the different levels of analysis. There are, however, discrepancies between what state-level policymakers and "street-level" providers and consumers see as current beliefs and practices within states.

What does it mean to be green

Abstract: Today a company is not considered environmentalist unless it moves beyond mere compliance with government regulations to behavior its competitors, and even customers, do not expect How should it set its agenda? Author Art Kleiner proposes that, to be green, a company must ask three questions: What products should we bring to market? How much disclosure of pollution information should we support? And how can we reduce waste at its source? These questions can't be answered, Kleiner says, unless managers insist on sustainable growth In this sense, a big investment in environmentalism is like a big one in R&D--both presuppose patient capital and managerial maturity What are green products? Kleiner cautions against giving in to misinformed public opinion--as McDonald's did in giving up its styrene "clamshells," which were more recyclable than the composite papers it switched to Rather, companies should rely on literature that analyzes the product life cycle As for public disclosure, the benefits may be unexpected Federal legislation requiring companies to report the emission of potentially hazardous waste to a central data bank has not made environmentalists attack them Rather, it has forced companies to learn what chemicals they inadvertently produce and how much--knowledge that helps them improve production processes Sharing it helps ecological researchers study the combined effects of plant emissions As for pollution prevention, Kleiner notes the analogy to quality and observes that it is better to design harmful waste products out of the system than catch them at the end of the line(ABSTRACT TRUNCATED AT 250 WORDS)

Quasi-Markets for Education?

Abstract: The Education Reform Act I988 marked a decisive break in the tradition of administering education policy in the United Kingdom. Whereas the post war statutes, notably the I944 Education Act, fused finance and provision the Act of I988 separated those functions and introduced elements of a market type mechanism into UK education. (For an outline of the legislation and the principles it embodies see Glennerster, Power and Travers, I99I.) On March 23 I99I the Economist urged Americans to adopt a similar set of reforms. If the present Conservative Government is returned to power the principles will be extended further. These changes contain some, but only some, elements of an internal market for education within the state education system. Two separate sets of reforms are being implemented, one relates to schools, the other to higher education.

Innovation and reinvention in state policymaking: theory and the evolution of living will laws.

Abstract: Most research on the diffusion of policy innovations focuses on the date of adoption and its correlates. This research examines an aspect of innovation which has received little attention: policy reinvention during the initial diffusion process and through amendment. The central proposition is that even though a set of laws or policies may be grouped into one broad, general category, states create substantively different policies through reinvention, which has important consequences for groups affected by the legislation. Hypotheses concerning the relationship between date of adoption and policy content and the effect of particular controversial policy provisions on reinventions are examined. The study has general implications for the study of the diffusion of innovations and policy in state politics.

Advance Directives on Admission Clinical Implications and Analysis of the Patient Self-Determination Act of 1990

Abstract: DESPITE widespread acknowledgment of the need for individuals to draft living wills, durable powers of attorney, or other advance directives, few Americans have done so. To encourage patients to complete advance directives, Congress enacted the Patient Self-Determination Act (hereafter "the Act") last October. The Act takes effect on December 1,1991, and requires hospitals, nursing homes, and hospices to advise patients on admission of their right to accept or refuse medical care and to execute an advance directive. Managed care organizations and home health care agencies must provide the same information to each of their members on members' enrollment. Provider organizations will also be required to (1) document whether patients have advance directives, (2) implement advance directive policies, and (3) educate their staffs and communities about advance directives. Compliance with the Act is a condition for Medicare and Medicaid reimbursement and is tied to institutional

Reshaping the state : New Zealand's bureaucratic revolution

Abstract: Between 1984 and 1990 the fourth Labour Government embarked upon the reform of the structure, operation, and role of the public sector. That reform was the most thorough in New Zealand's history, and the changes rank amongst the most radical and comprehensive undertaken anywhere in the world. Not only were the scope and scale of the changes remarkable (involving commercialization, corporatization, privatization, the restructuring of numerous departments, the introduction of a new form of financial management, major changes to industrial relations, and an attempt to provide culturally more sensitive and responsive public services) but they were implemented with breathtaking speed and vigour. This book provides a systematic and critical analysis of these changes. It explores the theoretical basis of the reform programme, the nature and content of the changes, the management of the change process, and the problems of implementation. Particular attention is given to three pivotal pieces of legislation: the State Owned Enterprises Act 1986, the State Sector Act 1988, and the Public Finance Act 1989. The book also examines the effect of the reforms and evaluates their costs and benefits. This work is aimed at teachers and advanced students of politics, policy studies, public administration, accounting, public economics and industrial relations, as well as public servants.

Adversarial legalism and American government

Abstract: Compared to other economically advanced democracies, the United States is uniquely prone to adversarial, legalistic modes of policy formulation and implementation, shaped by the prospect of judicial review. While adversarial legalism facilitates the expression of justice-claims and challenges to official dogma, its costs are often neglected or minimized. A survey of existing research, together with a case study of environmental regulation in the Port of Oakland, indicates the extent to which adversarial legalism causes (or threatens) enormous dispute-resolving costs and procedural delays, which in turn distort policy outcomes. Adversarial legalism, moreover, has increased in recent decades, as Americans have attempted to implement the ambitious, socially transformative policies of activist government through political structures, forms of legislation, and legal procedures that reflect deep suspicion of governmental authority.

The Changing Nature of Employment Discrimination Litigation

Abstract: Two major pieces of employment discrimination legislation were passed in the early 1990s: the 1991 Civil Rights Act and Americans with Disabilities Act. Using some simple regression models, we examine the effects of this legislation on the volume, content and outcomes of employment discrimination cases filed in federal courts. We find, first, that the volume of discrimination cases nearly doubled between 1992 and 1997, in contrast to a 10 percent decline during the previous 8 years, and despite a sharply falling unemployment rate that–in the past–would have substantially reduced the amount of litigation. We also observe a significant shift in the composition of suits filed, with race and age discrimination cases declining substantially as a share of the total and sex and disability discrimination cases increasing. We tie these developments, as well as changes in the relationship between plaintiff win rates and the business cycle, to changes in the law that diminish the importance of back-pay damages. We conclude by tentatively suggesting how the meaning of and protection afforded by employment discrimination law has changed over the past 35 years. Yale Law School, j.donohue@yale.edu Univ. of Connecticut Law School, psiegelm@law.uconn.edu. This work was completed while Donohue was at Stanford Law School and Siegelman was at Fordham Law School. We benefitted from helpful comments by seminar participants at UConn. Law School, Fordham Law School, the American Bar Foundation, and conference participants at the American Law and Economics Association. Thanks to Katie Bilodeau and Jinhui Pan for excellent research assistance.

The politics of local tobacco control.

Abstract: Until the nonsmokers' rights movement, tobacco control activity was at the federal or state levels, which is where the tobacco industry dominates. Since the appearance of the nonsmokers' rights movement, progress in tobacco control has occurred primarily at the local level. In response to the success of this movement, the tobacco industry has developed "smokers' rights" groups and other tactics to fight local legislation. Several recent local campaigns in California illustrate these tactics. Tobacco control forces follow many paths, from sitting on the sidelines to making a serious commitment to smoking control legislation. Despite the tobacco industry's superior financial resources, the outcome of proposed local tobacco control legislation appears to depend on how seriously the health advocates mobilize in support of the local legislation. When the health community makes a serious commitment of time and resources, it wins. When it fails to make such a commitment, the tobacco industry prevails, more by default than by its superior financial resources. ( JAMA . 1991;266:2110-2117)

Sisters in Suits: Women and Public Policy in Australia

Abstract: Turning philosophy into public policy developing Commonwealth machinery - 1976-83 legislative and policy gains - 1983-88 double disadvantage - migrant and Aboriginal women policy machinery at the state level giving women a say - advisory bodies and information services anti-discrimination and equal opportunity legislation monitoring progress - the national and international agenda.

The Impact of Changes in Job Security Regulations in India and Zimbabwe

Abstract: Employment laws in India and Zimbabwe require employers to obtain permission from the government to retrench or lay off workers. The effect of these laws on the demand for employees in 64 manufacturing industries is examined using time series data. Little evidence is found indicating slower adjustments in employment levels and hence retardation in any structural adjustment following the new laws. However, in both countries a substantial decline in the demand for employees (other things equal) followed the new legislation. In Zimbabwe it is difficult to be precise about a causal connection between the drop in the demand for labor (allowing for concurrent increased wages) and the new legislation because enactment occurred simultaneously with Independence; however, the current economic climate induced high levels of investment in capital but not investments in long-term commitments to employees. But in India further evidence supports a causal connection: larger establishments covered by the job security regulations tended to experience a decline in the demand for labor while smaller, uncovered enterprises in the same industries did not; moreover the decline in demand for employees across industries in India was larger where the private sector predominates, where larger establishments covered by the new laws are important, and where a smaller proportion of employees are union members. Thus in both countries the policy implemented to protect jobs may bave resulted infarfewerjobs. Upon achieving independence in 1980, the government of Zimbabwe passed a new Employment Act, requiring employers to obtain permission from the Ministry of Labor to fire or lay off workers. Comparable regulations were imposed in India by the Industrial Disputes (Amendment) Act of 1976, requiring that written permission be obtained, normally from the relevant state government, either to close a plant or to retrench workers. The immediate goal of these items of legislation was to protect the livelihood of workers and to maintain jobs. Any addition to economic security in the lives of workers is clearly a laudable goal in its own right. But the question addressed in this article is whether these particular job security regulations have had undesirable side effects, which may even have thwarted the original goals of the legislation. India and Zimbabwe are

Prostitutes' Rights in the United States: The Failure of a Movement

Abstract: The prostitutes' rights campaign emerged in the early 1970s with the formation of COYOTE in San Francisco and affiliated movement organizations. This study examines the movement's major claims and goals, resource problems, and impact on public opinion, legislation, and law enforcement. The failure to attain key movement goals is explained in terms of chronic deficiencies of material and human resources that might compensate for the campaign's lack of moral capital and enhance its prospects for success.

A history of nature conservation in Britain

Abstract: Our attitudes towards `nature' and the countryside are fickle. The conservation movement, despite enjoying its highest membership ever, has achieved only limited success over the last one hundred years of campaigning. Can conservationists now shake off their insular, disunited and negative image so as to gain the influence that the size of their movement warrants? A History of Nature Conservation in Britain traces the rise of the conservation movement from its beginnings in Victorian coffee houses to today's societies with their membership numbering in the millions. The first complete history of the British, and oldest, branch of the movement, David Evans's book offers invaluable insights into the campaigns for countryside protection and access, from battles against the use of pesticides, against pollution and genetic engineering through to legislation for the protection of our wildlife and the freedom to walk the mountains. The 2nd Edition has been fully revised and updated. Topical issues are considered afresh; and new chapters reflect the rapid changes throughout the 1990s both in social attitudes, conservation practices, legislation, funding and within conservation organizations themselves. In the light of recent developments, Evans also looks at some difficult choices to be made in years ahead and asks how the conservation movement will fare on the new global stage.

The Rise of the Chicago Packers and the Origins of Meat Inspection and Antitrust

Abstract: The Meat Inspection Act of 1891 and the Sherman Act of 1890 are shown to be closely tied. This link makes clearer Congress' intent in enacting the legislation. Both laws were products of conditions in the economy after 1880, and they reflected in part, a common concern about the Chicago packers, or Beef trust. The concerns of local slaughterhouses, which were being displaced by new, low-cost refrigerated beef, and of farmers, who sold their livestock to the large Chicago packers, were echoed elsewhere by other small businesses and farmers, who feared for their competitive positions during a time of structural change in the economy.

The Evolution of Unjust-Dismissal Legislation in the United States:

Abstract: In the past decade, many state courts have ruled in favor of employees alleging they were improperly dismissed. The author of this paper advances an evolutionary theory of unjust-dismissal legislation in which employer groups, responding to the threat of large and variable damage awards imposed by the judicial system, eventually support unjust-dismissal legislation in order to clearly define property rights, reduce uncertainty, and limit employer liability. Based on evidence from a case study of legislation enacted in Montana and an empirical analysis of the determinants of proposed unjust-dismissal legislation in a panel of states, the author concludes that proposals of unjust-dismissal legislation are a response to court rulings that weaken and obfuscate the employer's right to dismiss employees at will.

Common Property Resource Management in India

Abstract: This study reviews the state-of-knowledge regarding common property resource (CPR) management in India, based on published and unpublished sources and discussions with researchers in this field in India. CPR usage occurs on lands under a variety of customary and formal tenure arrangements. These lands include panchayat and revenue lands, reserved and unreserved forest lands, and private agricultural land under seasonal fallow. There may be multiple use, for different products or by different groups, or at different times of the year. During the colonial and post independence periods, the uncultivated lands of India which have been used as CPRs have been progressively reduced, as they have been brought under government control or have been privatized. In the last forty years many traditional forms ofCPR management have weakened or collapsed owing to increasing population pressure, greater commercialization, certain public policies, technological change and environmental pressure. The importance of the remaining CPRs in terms of sustainability is basically twofold. First, they fill crucial gaps in the resource and income flows from other resources; providing complementary inputs into agricultural systems often critical to their continued functioning. Second, they are often a major source of support for the poor, who are particularly heavily dependent on CPRs, generally lack access to the resources necessary to develop privatized common land, and benefit considerably from the employment created by CPR management activities. The strong thrust towards bringing use of common resources under private or government control has often been based on a thesis which confuses degradation due to unregulated use under an open access situation for breakdown in CPR management arrangements. This misunderstanding has been compounded by a tendency to overlook reasons why the alternatives of private or state control may themselves not be sustainable or efficient, and the bias that can exist in property legislation in favour of private property. The pressures on remaining CPRs will undoubtedly further erode many existing CPR management practices and institutions. Nevertheless, examination of surviving indigenous regimes, and of promising new ones, has identified a number of features which appear to define conditions for viable and sustainable CPR management in appropriate circumstances. These centre round control and management by the user group, securing the rights of the latter to use of the resource, and defence of those rights against intrusion, and investment in outputs that users value and can manage. It is notable that some recent interventions which have been less successful in inducing sustainable communal management, such as most Social Forestry woodlot programmes, have not been consistent with these conditions.

Knowledge-based systems and legal applications

Abstract: Part 1 Context: the representation of law in computer programmes, Marck Sergot the opportunities of the Abbey-DHSS demonstrator project, Trevor Bench-Capon. Part 2 Tasks: a support environments for adjudicators, Andrew Taylor support for the formulation of legislation, Andrew Taylor and Trevor Bench-Capon support for members of the public, Nigel Gilbert using a common knowledge base in different applications, Trevor Bench-Capon. Part 3 Prototypes: the local office systems, Justine Forder and Andrew Taylor the policy system, Graham Storrs the claimant advice systems, Nigel Gilbert managing a large collaborative project, Charlie Portman. Part 4 Issues: analyzing texts for knowledge based systems, Elizabeth Cordingley knowledge representation for legal applications, Trevor Bench-Capon and Justine Forder mixed initiative interaction, David Frolich and Paul Luff group decision making, Graham Storrs social and organizational implications, Andrew Taylor.

The Needs and Rights of Victims of Crime

Abstract: The "victims' movement" can claim considerable success in putting the interests of crime victims on the political agenda in North America and Europe. Pioneering groups of volunteers and activists laid the groundwork for financial, practical, and psychological support services that are now funded by government on a significant scale. In the United States, legislation creates rights for victims to participate in the criminal justice process. It has not been firmly established how many (and what kinds of) victims are seriously in need of assistance, or what form this should take: research findings are contradictory and confusing, plagued by methodological and definitional problems. Service delivery also presents difficult dilemmas because many victims will not ask for help; high take-up rates emerge only when a personal approach is made. Although there is evidence of high levels of client satisfaction with victim services, research has not established that service provision greatly affects recovery from the ...

Politics and Economics in the Eighties

Abstract: Is the federal budget deficit a result of congressional deadlocks, gross miscalculation of economic trends, or a Republican strategy to tie the budgetary hands of future Democratic leadership? To what extend does the partisan split between Congress and the executive branch constrain the president's agenda? In this volume, political scientists and economists tackle these and many other contentious issues, offering a variety of analytical perspectives.Certain to provoke controversy, this interdisciplinary volume brings together policy experts to provide a coherent analysis of the most important economic policy changes of the 1980s. Through a detailed examination of voting patterns, monetary and fiscal policies, welfare spending, tax reform, minimum wage legislation, the savings and loan collapse, and international trade policy, the authors explore how politics can influence the direction of economic policymaking.

Presidential Commitment and the Veto

Abstract: A president's power to veto is widely recognized as an important weapon in the struggle with Congress over legislation. In this paper we investigate the effectiveness of the veto weapon with a simple model of presidential powers that incorporates informal institutional structure-the president's unique position as the focus of public attention-into an otherwise standard agenda-control model of the formal institutional structure governing the legislative process. We show that the president can exploit this public attention to make commitments regarding his veto intentions that, given the formal institutional structure, will enhance the value of the veto. One implication of the model is that commitment over "principles" (e.g., no taxes) will sometimes be more effective than commitment over "degree" (e.g., 3.2% tax rate). In addition, a president can sometimes improve his utility by making commitments that ultimately lead to a veto that is overridden.

Collective Bargaining in the Public Sector: The Effect of Legal Structure on Dispute Costs and Wages

Abstract: This paper examines the impact of collective-bargaining legislation on dispute costs and wages using a panel of Canadian public-sector contracts. The authors' results suggest that policymakers designing collective-bargaining legislation face a trade-off between reducing dispute costs and increasing wages. Dispute costs are lower under compulsory arbitration than under the right to strike or when no collective-bargaining legislation exists. Hence, a switch to compulsory arbitration could potentially make both the union and the employer better off by reducing dispute costs. However, the authors find that wages are higher under compulsory arbitration than under other legal structures. Copyright 1991 by American Economic Association.

Constraining Administrative Decisions: A Critical Examination of the Structure and Process Hypothesis

Abstract: Policy-making does not end with the passage of legislation. Congress may authorize a program, but responsibility for implementing it is usually delegated to another organization or institution (i.e., to some administrative body). Over the years Congress has developed a variety of techniques for supervising the decisions of these administrative bureaucracies. In order to avoid the high cost of formal, extensive, and systematic investigations, legislators use reauthorization hearings and personal exchanges with administrators as opportunities for oversight (Ogul). To further reduce the cost of oversight, legislators have developed a system of "fire-alarm oversight" in which interest groups and constituents monitor administrators and inform Congress of improper, inappropriate, or unsatisfactory decisions. Legislators then become involved only after their monitors have identified some problem or transgression. This system thus supplies legislators with the information required to maintain control over the bureaucracy without having to undertake systematic surveillance themselves (McCubbins and Schwartz). Congress uses these groups to do more than inform it of administrative errors. In a series of articles, McCubbins, Noll, and Weingast (1987, 1989)

Monitored conditional release of persons found not guilty by reason of insanity.

Abstract: This article reviews the recent literature documenting changes that have taken place in the management and treatment of insanity defense acquittees with the development of conditional release and monitored community treatment. The review demonstrates that conditional release is particularly important as a means of balancing the protection of society with the treatment of insanity defense acquittees in the least restrictive environment. The review also highlights the development of community programs based on treatment models for the chronically mentally ill. In addition, monitored community treatment programs appear cost-effective when compared with hospital-based programs. These factors point to the development in the 1990s of program standards for the release of insanity defense acquittees.

Copinger and Skone James on Copyright

Abstract: This new edition incorporates the Copyright, Designs and Patents Act 1988 as well as a plethora of Orders in Council that come in its wake. New chapters have been added on moral rights, performers' and recording rights and design rights and the book also includes case law generated since the last edition. While the law of copyright becomes increasingly complex, the emphasis of the work remains one of penetrative clarity. To this end the text is paragraphed and cross referenced. The work confronts the practical problems that will face the copyright lawyer in the 1990s, but also retains its scholarly approach, commencing with a narrative review of copyright law. The work deals with international copyright, EEC community law, related forms of protection including breach of confidence, passing off and malicious falsehood, income tax and associated subjects and American copyright law. The appendices include relevant parts of the 1988 Act, as well as the 1911 and 1956 Copyright Acts with comparative tables, UK orders, US legislation and materials and relevant parts of the Treaty of Rome.

The Limitations of Legal Institutions for Addressing Environmental Risks

Abstract: Deterring environmental degradation and compensating victims of environmental harms are among the most important and difficult problems facing modern industrial societies. The choice of regulatory institutions to control environmental risks—whether courts, administrative agencies, markets or some combination—significantly determines the achievement of these objectives. For a variety of historical and political reasons, the United States relies heavily upon courts, through traditional decentralized adjudication, to assign responsibility for environmental harms. The common law tort system remains, with the exception of job-related injuries, a principal means of compensating victims of environmental pollution. In addition, the federal Superfund legislation uses the court system to assign liability for the clean-up of dangerous hazardous waste sites. When viewed through the micro lens and simplifying assumptions of traditional law and economics, court adjudication appears to address both the incentives—efficient deterrence of environmental degradation—and compensation objectives. By identifying the cause of environmental harms, assessing the behavior of the actors responsible for such harms, and quantifying the harm to plaintiffs, individual assignment of liability through courts, in theory, provides compensation to victims while internalizing the social costs of harmproducing activities (Calabresi, 1970; Landes and Posner, 1987; Shavell, 1987). When viewed from a macro perspective with a richer appreciation of the limitations of legal institutions (relative to other regulatory institutions), however, the desirability of relying upon case-by-case adjudication as a principal

The Oregon priority-setting exercise: quality of life and public policy.

Abstract: In 1989 the Oregon State legislature passed the Oregon Basic Health Services Act, which created a Health Services Commission charged with "developing a priority list of health services, ranging from the most important to the least important for the entire population to be served." [1] The goal of this legislation was to permit the expansion of Medicaid to 100 percent of all Oregonians living in poverty by covering only services deemed to be of sufficient importance or priority. The Oregon Health Services Commission (OHSC) initially interpreted "for the entire population to be served" as suggesting the use of cost-effectiveness principles for developing the priority list. These principles are based on the utilitarian quest for "the greatest good for the greatest number" and tend to devalue adverse effects of a policy on specific individuals. [2] By the lights of cost-effectiveness, the "importance" of a health service depends not only on the expected outcomes of treatment (such as prolongation of life, reduction of pain), but also on the cost of that service and on the number of patients who can benefit from it. Thus, even very beneficial treatments might not be considered important if the costs of providing those treatments are high or if only a few people benefit from them. In keeping with their interpretation of the statute, the OHSC initially conducted a cost-effectiveness analysis of over 1,600 health services ranging from appendectomies to treatment of colds and flu. Predictably, the resulting draft list rated outpatient office visits for minor problems as the "most important" services; the cost of these visits was estimated at $98.51. Indeed, the first 94 items on Oregon's initial list were for office visits, for often self-limiting conditions such as thumb-sucking and low back pain. By contrast, certain life-saving surgeries, such as appendectomies, were rated relatively low because of their higher associated costs. This counterintuitive priority order (and negative public reaction to it [3]) led the OHSC to abandon cost-effectiveness analysis for purposes of developing its final priority list. [4] Instead, the OHSC developed a set of seventeen health service "categories," which described either a specific type of service (for example, maternity care, preventive services) or, more generically, the expected outcomes of care (for example, "treatment of life-threatening illness where treatment restores life-expectancy and return to previous health"). Commissioners formally ranked these seventeen categories in order of importance according to three subjective criteria: value to the individual, value to society, and whether the category seemed "necessary." Each treatment was then assigned to the single most appropriate category, based on Commissioners' judgment. Services were ranked within categories according to the degree of benefit expected from treatment. Finally, the OHSC rearranged apparently misplaced services "by hand," for example, moving obviously important services rated low by the method higher on the final list. This alternate methodology produced a much more intuitively sensible final priority list than the earlier draft list, although more work may be needed before the "final" list can serve as the basis for public policy, particularly with respect to better specifying treatments and indications for treatment. [5] At the time of this writing, independent actuaries are estimating the costs of providing services on the final list. The Oregon legislature will then decide whether to accept the list as the basis for expanding the State's Medicaid program, as per the Oregon Basic Health Services Act. If so, the legislature will draw a line somewhere on the list to separate the services that will be covered under Medicaid from those that will not. Finally, if this step is taken, Oregon will appeal to the federal government for a Medicaid waiver, which must be granted if the plan is to proceed. …

The Patient Self-Determination Act.

Abstract: KIE: The Patient Self-Determination Act was signed into law in November 1990 to take effect in December 1991. The Act marked Congress's first legislative action related to life-sustaining medical treatment. It requires every health care facility that participates in Medicare or Medicaid to inform adult patients about advance directives. McCloskey discusses the legislative process leading to passage of the Act; pro-life groups' opposition to federal support of advance directives; provider groups' skepticism toward the perceived administrative burden of federal intervention; and professor Alexander Capron's preference for existing voluntary efforts over premature legislation.