Genetic screening technology: ethical issues in access to tests by employers and health insurance committees

Whereas the introduction of new technologies previously has raised the ethical question of who ought to have access to a new procedure or device, genetic testing technology raises the new ethical question of to whom access to a new technology ought to be limited. In this article we discuss the implications of employers and private health insurance companies having access to genetic testing technology. Although there may be legitimate business interests in allowing employers and insurers to conduct genetic screening, there are other valid societal interests in regulating or limiting the use of this technology by third parties. Public policy developed in the area of new genetic technology must reflect such interests.     

Subsidized elderly housing: public-private partnerships on the brink

Starting in the early 1960s, the federal government joined with the private-sector housing developers in a partnership: in return for subsidized mortgages and tax benefits, developers would rent to low- and moderate-income tenants. Today, many elderly people live in these "publicly subsidized" units. The initial agreement, however, held out an escape clause: after 15 to 20 years, for-profit developers that wanted to end the partnership could prepay their mortgages, leaving tenants in those buildings "at risk" of rent increases and/or evictions. This article discusses that partnership, its options for dissolution, and the current solutions to the problem of the expiring agreements, including a moratorium, vouchers, and incentives. The compromise legislation responds to all interested parties--owners, current and would-be tenants, local governments, tax-payers--through a multi-stage sequence of dissolution, yet such a finely tuned, acutely sensitive legislative solution may not work easily or efficiently.     

Net worth and the economic diversity of the elderly

Using data from the 1984 panel of the Survey of Income and Program Participation (SIPP), this article examines characteristics of the older population disaggregated by net-worth quintiles. The authors argue that income is not a sufficient measure of economic status for current policy discussions on issues such as changing Medicare co-payments, increasing the taxation of social security benefits, or means-testing under Medicaid. Net worth is a better measure of economic status, particularly for the elderly, because it represents the net value of assets accumulated over the life course. Their results indicate that there is considerable diversity in the economic status of the older population, which is masked by aggregate statistics (such as means and medians) typically used to summarize the economic status of population groups. Stereotypical views of the elderly based on such aggregates result in misdirected policy formulation. In the future, policymakers will need to formulate policies and programs using information on the distributions of income and assets among the older populations rather than relying on statistical aggregates.     

The NTEE classification system: tests of reliability/validity in the field of higher education

An analysis of the field of higher education reveals a surprisingly large number of classification errors within the (US) National Taxonomy of Exempt Entities database. Of the nearly 4,000 non-profit entities coded within the universe of institutions of higher education, we estimate that approximately 60 per cent were incorrectly included (Type II errors). Institutions incorrectly excluded from the higher education universe (Type I errors) represent roughly 10 per cent of the institutions coded correctly. These errors result primarily from assigning codes on the basis of the names of organisations (for example, College Park Towers is classified as a college, when it is in fact a housing complex for senior citizens) and from trying too hard to assign codes in ambiguous situations. The consequences can be significant for the users of these data, and we recommend raising bright warning flags while simultaneously enlisting the help of the entire non-profit sector in improving the classification coding process.The authors are with The Andrew W. Mellon Foundation. In addition to our colleagues on the staff of the Foundation, we wish to thank Helmut Anheier, Ted Bozovich, Harvey Dale, Virginia Hodgkinson, Stephen Noga and Christopher Toppe for helpful suggestions.     

Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

Poland's crisis and East European socialism

Conclusion We began this article by asking whether the Polish crisis is a socialist or a Polish disease. By citing the structural factors, we brought out the common difficulties affecting all East European societies in their political and economic development. These difficulties arose out of the transition from extensive to intensive economic growth and the consequent need to replace political mobilization of the population with their political integration. The structural contradictions occurred together with conjunctural developments in the world economy, the collapse of detente, the post-war demographic explosion, and natural calamities. Poland was least able to cope with these structural and conjunctural dynamics. The result was a society united on a national basis in its conflicts with the Party State apparatus. This conflict was never resolved by Solidarity nor by the subsequent military coup.While Poland and Romania had quite similar structural and conjunctural dynamics, it was only in Poland that the constellation of nation-specific factors yielded a societal reaction of system-threatening character. Looking at the rest of Eastern Europe, we do not see a similar constellation of factors. Rather, the combination of structural, conjunctural, and specific conditions has prevented the deeper contradictions from evolving into Solidarity-type mass movements of the Polish variety. Thus, we believe that the Polish developments will not be replicated in any of the other East European countries in the foreseeable future.Does this mean that the Polish experience is so unique that it is without relevance for the other East European states? On the contrary, the recognition of common structural problems points to fundamental conflicts in all the countries of actually existing socialism. The essence of these conflicts may be the same. It is the ability to identify and deal with them that distinguishes one East European regime from another. This ability varies with the specific and conjunctural factors as applied to each country. While there is little likelihood that the Polish disease will spread, this is partly because the other East European states are beginning to take preventive measures. In other words, they are learning from the Polish experience.There are several indicators that these regimes have learned from the Polish crisis. We can summarize them in the following predictions:First, we believe that state power and the repressive apparatus of the various East European countries will be reinforced and made more effective. This applies not so much to overt shows of force but to more sophisticated methods of social control and repression: e.g., limiting information channels, dispersing dissident groups, giving in to workers protests before they spread, taking practical measures to prevent consumer shortages from getting out of hand, and the like.Second, we can expect that oppositional forces, especially intellectuals, will be increasingly restricted in their ability to formulate and articulate system-threatening demands. The East European states will take any measures - jail, slander, internal deportation, cooptation, forced emigration - to make sure that intellectuals' contact with workers is weakened or at least strictly supervised.Third, we can expect the Eastern European states to take further measures to integrate potential system-threatening movements into the official system. We will see further attempts to improve the access possibilities for those social interests that have up to now been neglected, e.g. in physical and social infrastructures, neglected regions. Moreover, there will be renewed efforts to make the system of political socialization (education, propaganda, culture) more effective. Finally, we can expect anti-corruption campaigns within the State, Party, and industrial bureaucracies as the elites attempt to make these organs more legitimate in the eyes of the population.In recent months there seems to be considerable evidence that the East European regimes have taken all these measures. There have been attempts to re-invigorate the official trade unions. Yuri Andropov's succession was marked by a highly publicized anti-corruption campaign designed to win favor among rank-and-file workers. In Romania there have been exhortations towards more self-sufficiency and self-management, so that individual producers will be less dependent on State retail outlets, and the country less dependent on costly foreign imports. The reduction in East-West trade and decline of detente have also given more leeway for the East European repressive apparatus to crack down on dissidents and oppositional movements.With reduced trade, the economic benefits of detente no longer exist as a restraining factor on the authorities. The West now has reduced influence on domestic politics in East Europe. The combination of integration and repressive measures has so far prevented the structural contradictions from growing into true political crises of the Polish variety. Eastern Europe (and Poland) is remarkably quiet.With the broad enthusiasm fostered in the West by the rise of Solidarity, it is understandable that its brutal demise had generated parallel feelings of disillusionment. It would be erroneous to consider the Polish events as an archetype for Eastern Europe. The problems of East European regimes reflect a general system crisis (economic and political), each country's response depends on specific local conditions and fortuitous conjunctures. If the Polish events are to be understood, they must be explained as a variant in a larger East European context.Having concentrated on the crisis aspects in Poland and Romania should not blind us from the fact that these systems have an amazing ability to reproduce themselves - to muddle through. Actually existing socialism is more than simply brute force. Each of the East European societies exhibits a complex dialectic between the forces of functional stability and the forces of immanent contradictions. As such, in addition to their structural aspects, we must analyze each of these societies in their differing vulnerability to conjunctural events and in their specific political, social, and cultural characters.For those who seek to replace actually existing socialism with a more emancipatory socialism, the Polish crisis constitutes a key point of departure. It should be discussed both in terms of what it means for Poland, and for Eastern Europe. The Polish events provide further evidence that the tasks of social theory reside as much in explaining why societies muddle through as why they fall apart.