This work tracks the role of the states in US health care policy reform. It reviews the challenges faced by the states in dealing with rising costs and looks at their policy competence and role in managed care, whilst focusing on the outcomes of policy reform in states such as Hawaii and Oregon.

Sharing the costs of ill health is the mark of a civilised society. However, every society has limited healthcare resources, and must therefore make finely balanced decisions on how best to allocate them. The National Institute for Health and Clinical Excellence (NICE) has been responsible for the UK's health resource allocation for a decade. To inform its decisions, a Citizens Council of 30 members of the general public was established by NICE to gauge the underlying values of the society it serves. A number of national and international organisations and governments have asked NICE to share its experiences in establishing and running the Citizens Council, and encouraging and supporting patient involvement. As part of NICE's response, this book provides an up to date 'position statement' on the Citizens Council, an exploration of how patients interact with NICE and how their views are taken into account, and a national and international perspective on new issues facing the interaction between patients, the public and healthcare provision. 'Reading this volume will enable you, the reader, to assess how well NICE is acting as a means of fostering responsible public choice. I hope you profit from its chapters as much as I have.' - Albert Weale in his Foreword

As part of an eventual statewide set of health insurance reform measures, the State of Oregon has proposed implementing a demonstration program, with Federal cofunding, that would change the State's existing Medicaid program in three fundamental ways. It would: 1) expand coverage to include all persons with incomes up to 100 percent of the Federal poverty level; 2) enroll all covered persons in some form of managed care, such as with a health maintenance organization or a "gatekeeper"primary care physician; and 3) determine acute and primary health care benefits according to a ranked list of services, with actual benefits dependent on the level of program funding. [Foreword, p. III]

Bioethics, born in the 1960s and 1970s, has achieved great success, but also has experienced recent growing pains, as illustrated by the case of Terri Schiavo. In The Future of Bioethics, Howard Brody, a physician and scholar who dates his entry into the field in 1972, sifts through the various issues that bioethics is now addressing--and some that it is largely ignoring--to chart a course for the future. Traditional bioethical concerns such as medical care at the end of life and research on human subjects will continue to demand attention. Brody chooses to focus instead on less obvious issues that will promise to stimulate new ways of thinking. He argues for a bioethics grounded in interdisciplinary medical humanities, including literature, history, religion, and the social sciences. Drawing on his previous work, Brody argues that most of the issues concerned involve power disparities. Bioethics' response ought to combine new concepts that take power relationships seriously, with new practical activities that give those now lacking power a greater voice. A chapter on community dialogue outlines a role for the general public in bioethics deliberations. Lessons about power initially learned from feminist bioethics need to be expanded into new areas--cross cultural, racial and ethnic, and global and environmental issues, as well as the concerns of persons with disabilities. Bioethics has neglected important ethical controversies that are most often discussed in primary care, such as patient-centered care, evidence-based medicine, and pay-for-performance. Brody concludes by considering the tension between bioethics as contemplative scholarship and bioethics as activism. He urges a more activist approach, insisting that activism need not cause a premature end to ongoing conversations among bioethicists defending widely divergent views and thcories.

That America's natural environment has been degraded and despoiled over the past 25 years is beyond dispute. Nor has there been any shortage of reasons why-short-sighted politicians, a society built on over-consumption, and the dramatic weakening of environmental regulations. In Retaking Rationality, Richard L. Revesz and Michael A. Livermore argue convincingly that one of the least understood-and most important-causes of our failure to protect the environment has been a misguided rejection of reason. The authors show that environmentalists, labor unions, and other progressive groups have declined to participate in the key governmental proceedings concerning the cost-benefit analysis of federal regulations. As a result of this vacuum, industry groups have captured cost-benefit analysis and used it to further their anti-regulatory ends. Beginning in 1981, the federal Office of Management and Budget and the federal courts have used cost-benefit analysis extensively to determine which environmental, health, and safety regulations are approved and which are sent back to the drawing board. The resulting imbalance in political participation has profoundly affected the nation's regulatory and legal landscape. But Revesz and Livermore contend that economic analysis of regulations is necessary and that it needn't conflict with-and can in fact support-a more compassionate approach to environmental policy. Indeed, they show that we cannot give up on rationality if we truly want to protect our natural environment. Retaking Rationality makes clear that by embracing and reforming cost-benefit analysis, and by joining reason and compassion, progressive groups can help enact strong environmental and public health regulation.