A model of factors determining levels of public support for health care policy in the United States

Public preferences for policy are formed in a little-understood process that is not adequately described by traditional economic theory of choice. In this paper I suggest that U.S. aggregate support for health reform can be modeled as tradeoffs among a small number of behavioral values and the stage of policy development. The theory underlying the model is based on Samuelson, et al.'s (1986) work and Wilke's (1991) elaboration of it as the Greed/Efficiency/Fairness (GEF) hypothesis of motivation in the management of resource dilemmas, and behavioral economics informed by Kahneman and Thaler's prospect theory. ^ The model developed in this paper employs ordered probit econometric techniques applied to data derived from U.S. polls taken from 1990 to mid-2003 that measured support for health reform proposals. Outcome data are four-tiered Likert counts; independent variables are dummies representing the presence or absence of operationalizations of each behavioral variable, along with an integer representing policy process stage. Marginal effects of each independent variable predict how support levels change on triggering that variable. Model estimation results indicate a vanishingly small likelihood that all coefficients are zero and all variables have signs expected from model theory. ^ Three hypotheses were tested: support will drain from health reform policy as it becomes increasingly well-articulated and approaches enactment; reforms appealing to fairness through universal health coverage will enjoy a higher degree of support than those targeted more narrowly; health reforms calling for government operation of the health finance system will achieve lower support than those that do not. Model results support the first and last hypotheses. Contrary to expectations, universal health care proposals did not provide incremental support beyond those targeted to “deserving” populations—children, elderly, working families. In addition, loss of autonomy (e.g. restrictions on choice of care giver) is found to be the “third rail” of health reform with significantly-reduced support. When applied to a hypothetical health reform in which an employer-mandated Medical Savings Account policy is the centerpiece, the model predicts support that may be insufficient to enactment. These results indicate that the method developed in the paper may prove valuable to health policy designers. ^

PRETERM BIRTH AND OCCUPATIONAL PHYSICAL ACTIVITY: A CASE-CONTROL STUDY OF THE RELATIONSHIP BETWEEN LENGTH OF GESTATION AND THE PHYSICAL DEMAND OF U.S. ARMY MILITARY OCCUPATIONAL SPECIALTIES (UNITED STATES)

A case-control study has been conducted examining the relationship between preterm birth and occupational physical activity among U.S. Army enlisted gravidas from 1981 to 1984. The study includes 604 cases (37 or less weeks gestation) and 6,070 controls (greater than 37 weeks gestation) treated at U.S. Army medical treatment facilities worldwide. Occupational physical activity was measured using existing physical demand ratings of military occupational specialties.^ A statistically significant trend of preterm birth with increasing physical demand level was found (p = 0.0056). The relative risk point estimates for the two highest physical demand categories were statistically significant, RR's = 1.69 (p = 0.02) and 1.75 (p = 0.01), respectively. Six of eleven additional variables were also statistically significant predictors of preterm birth: age (less than 20), race (non-white), marital status (single, never married), paygrade (E1 - E3), length of military service (less than 2 years), and aptitude score (less than 100).^ Multivariate analyses using the logistic model resulted in three statistically significant risk factors for preterm birth: occupational physical demand; lower paygrade; and non-white race. Controlling for race and paygrade, the two highest physical demand categories were again statistically significant with relative risk point estimates of 1.56 and 1.70, respectively. The population attributable risk for military occupational physical demand was 26%, adjusted for paygrade and race; 17.5% of the preterm births were attributable to the two highest physical demand categories. ^

Nomination of Robert B. Pirie, Jr. : hearing before the Subcommittee on Manpower and Personnel of the Committee on Armed Services, United States Senate, Ninety-sixth Congress, first session, on the nomination of Robert B. Pirie, Jr., to be Assistant Secretary of Defense for Manpower, Reserve Affairs, and Logistics, April 6, 1979.

Mode of access: Internet.

The history of the Chaplain Corps, United States Navy

Vol. 4-5 compiled by the Chaplains Division of the Bureau of Naval Personnel, Navy Dept.; v. 7 by the staff and students of the Naval Chaplains School, Naval Officer Training Center; v. 8-<9 > edited by H. Lawrence Martin.

So many, so much, so far, so fast : United States Transportation Command and strategic deployment for Operation Desert Shield/Desert Storm /

Mode of access: Internet.

History of the expedition under the command of Captains Lewis and Clarke, to the sources of the Missouri ... : performed during the years 1804, 1805, 1806, by order of the government of the United States /

The chapter on natural history (1st edition, v. 2, chapter 7) is in this edition transferred to the appendix. In this appendix the Estimate of the western Indians is given under the heading: "Enumeration of Indian nations and their places of general residence."

The Peace Corps. Hearings before the Committee on Foreign Relations, United States Senate, Eighty-seventh Congress, first session, on S. 2000, a bill to provide for a Peace Corps to help the peoples of interested countries and areas in meeting their needs for skilled manpower. June 22 and 23, 1961.

Mode of access: Internet.

Port and terminal charges at United States Great lakes ports.

At head of title: War Department. Corps of Engineers, U.S. Army .

Supplement to Port and terminal charges at United States seaports /

At head of title: War Department, Corps of Engineers, U.S. Army.

Harry A. Levinson, 9527 Brighton Way, Beverly Hills, California, plaintiff, v. Arthur E. Summerfield, individually and as Postmaster General of the United States, Washington D.C., defendent : points and authorities in support of mottion for preliminary injunction, in the United States District Court for the District of Columbia.

Mode of access: Internet.

Department of Defense authorization for appropriations for fiscal year 2010 : hearing before the Committee on Armed Services, United States Senate, One Hundred Eleventh Congress, first session, on S. 1390, to authorize appropriations for fiscal year 2010 for military activities of the Department of Defense, for military construction, and for defense activities of the Department of Energy, to prescribe personnel strengths for such fiscal year, and for other purposes.

"May 20 and June 3, 2009"--Pt. 6-7.

Coastal engineering studies in support of Virginia Beach, Virginia, beach erosion control and hurricane protection project.

Cover title.

Tides and tidal datums in the United States /

"February 1981."

Building salt marshes along the coasts of the continental United States /

Cover title.

Stem design and shotcrete, grout, and concrete support /

Project pre-SCHOONER.