A Global Analysis of of Imperfect Competition in the Banking Systems and the Latest Israeli Regulation Dealing with Market Failures. ACES Working Paper No. 3, 2007

The high concentration of the banking sector is a cross-border phenomenon that has high impact on local and global economies. This paper's main goal is to analyze the factors that impact concentration in the banking systems around the globe. The innovation of this paper is that we combined economic, "economic environment", and culture variables as explanatory variables for this analysis. We found among other things that regulation in the banking system is helpful in order to keep it competitive. We also found that when the society has more individual values rather than collective ones, its banking sector is less concentrated. In the second part of the paper we focused on the Israeli case, showing that although recent indicators of the Israeli banking system indicate a higher level of concentration and lower level of competition, it seems that the recent trend is moving toward less concentration and higher competition.

A summer sojourn among the Inns of court,

Mode of access: Internet.

The eight volumes of letters writ by a Turkish spy, who liv'd five and forty years undiscover'd at Paris: giving an impartial account to the Divan at Constantinople, of the most remarkable transactions of Europe: and, discovering several intrigues and secrets of the Christian courts (especially of that of France) continued from the year 1637, to the year 1682 /

Authorities agree that the first part of the work, published in Paris 1684, was written by Marana. The remainder has been ascribed to different Englishmen, among them Dr. Robert Midgley and William Bradshaw. It is probable however that Midgley simply edited the English translation, made by Bradshaw, of the original Italian manuscript. cf. ESTC.

Balancing Cooperation and Competition: A New in Era in U.S.-China Relations

Created as part of the 2016 Jackson School for International Studies SIS 495: Task Force.

Substance-use disorders and psychological distress among police arrestees

Objectives: To determine the 12-month prevalence of substance-use disorders and psychological morbidity in an Australian arrestee population. Design: Cross-sectional descriptive study. Participants and setting: 288 police arrestees at the Brisbane City Police Watch House in February and March 2001. Outcome measures: Prevalence of drug and alcohol disorders; psychological caseness according to the 28-item General Health Questionnaire; demographics and index offences. Results: 86% of the arrestees had at least one substance-use disorder; most had multiple disorders. More than 80% were substance dependent. The predominant substances used were amphetamines, marijuana, opioids and alcohol. 82% of the men and 94% of the women were suffering significant psychological distress. Conclusions: Development of services for detoxification and treatment of this population is a pressing need. The findings provide crucial information for the planning and implementation of drug courts and court diversion systems.

Body-mass management of Australian lightweight rowers prior to and during competition

Purpose: Although the body-mass management strategies of athletes in high-participation weight-category sports such as wrestling have been thoroughly investigated, little is known about such practices among lightweight rowers. This study examined the body-mass management practices of lightweight rowers before competition and compared these with current guidelines of the International Federation of Rowing Association (FISA). Quantification of nutrient intake in the 1-2 h between weigh-in and racing was also sought. Methods: Lightweight rowers (N = 100) competing in a national regatta completed a questionnaire that assessed body-mass management practices during the 4 wk before and throughout a regatta plus recovery strategies after weigh-in. Biochemical data were collected immediately after weigh-in to validate questionnaire responses. Responses were categorized according to gender and age category (Senior B or younger than 23 yr old, i.e., U23, Senior A or OPEN, i.e., open age limit) for competition. Results: Most athletes (male U23 76.5%, OPEN 92.3%; female U23 84.0%, OPEN 94.1%) decreased their body mass in the weeks before the regatta at rates compliant with FISA guidelines. Gradual dieting, fluid restriction, and increased training load were the most popular methods of body-mass management. Although the importance of recovery after weigh-in was recognized by athletes, nutrient intake and especially sodium (male U23 5.3 ± 4.9, OPEN 7.7 ± 5.9; female U23 5.7 ± 6.8, OPEN 10.2 ± 5.4 mg-kg(-1)) and fluid intake (male U23 12.1 ± 7.1, OPEN 13.5 ± 8.1; female U23 9.4 ± 7.4, OPEN 14.8 ± 6.9 mL.kg(-1)) were below current sports nutrition recommendations. Conclusion: Few rowers were natural lightweights; the majority reduced their body mass in the weeks before a regatta. Nutritional recovery strategies implemented by lightweight rowers after weigh-in were not consistent with current guidelines.

Gázolaj-jövedékiadó verseny az Európai Unióban (Fiscal competition on the market for diesel fuel in the European Union)

A tanulmány azt a kérdést vizsgálja, hogy versenyeznek-e az európai kormányok gázolajra vonatkozó jövedékiadó-kulcsaikkal a nagyobb adóbevételekért, és ha igen, befolyásolja-e az országok mérete kormányaik adóztatási stratégiáját. Az üzemanyagturizmussal szembesülő kormányok adókivetési magatartását egy kétországos adóverseny modellel jelezzük előre, amelyben a standard modellektől eltérően a fogyasztók kereslete árrugalmas. Megmutatjuk, hogy ha a kereslet nem teljesen rugalmatlan, mint Nielsen [2001], illetve Kanbur-Keen [1993] modelljeiben, akkor a nagy ország kormányának egyensúlyi viselkedése nemcsak abban különbözik a kicsiétől, hogy nagyobb adót állapít meg, hanem abban is, hogy válaszfüggvénye meredekebb. Az aszimmetrikus adóverseny általunk használt modelljét a dízelüzemanyagoknak 16 európai ország 1978 és 2005 közötti jövedékiadó-adatain vizsgáljuk. Az 1995 és 2005 közötti időszakra vonatkozó becslési eredményeink megerősítik, hogy az európai országok szomszédaik adókulcs-változtatásának hatására változtattak saját adókulcsaikon, és hogy a területileg/gazdaságilag kisebb országok kisebb intenzitással reagáltak szomszédaik adóváltoztatásra, mint a nagyobbak. Tanulmányunk ezzel magyarázatot nyújt arra is, hogy miért erősödött fel a tagállamok jövedéki adókulcsainak méret szerinti differenciálódása az elmúlt bő tíz évben, valamint hogy miért nem sikerült az Európai Uniónak a minimumadószintre vonatkozó előírásával előbbre lépnie az egységes adóztatás megvalósításában. / === / The paper assesses spatial competition in diesel taxation among European governments. By adding an extension to the standard model, it is shown that asymmetric competition – small countries undercutting large – implies that small countries respond less strongly to tax changes by their neighbours than large countries do. An estimate is then made of the fiscal reaction functions for national governments, employing a first-difference regression model with a weighting scheme constructed from road-traffic density data at national borders. Data from 16 countries (EU-15 minus Greece plus Norway and Switzerland) between 1978 and 2005 provides evidence that European governments set their diesel tax interdependently, and moreover, that small European countries tend to react less strongly to changes in their competitors' tax rate than large countries do.

Latin America and the Caribbean in 2011 and Beyond: A conversation among Latin America and Caribbean Specialists.

For the first time in more than fifty years, the domestic and external conflicts in Latin America and the Caribbean (LAC) are not primarily ideological in nature. Democracy continues to thrive and its promise still inspires hope. In contrast, the illegal production, consumption, and trading of drugs – and its links to criminal gangs and organizations – represent major challenges to the region, undermining several States’ already weak capacity to govern. While LAC macroeconomic stability has remained resilient, illegal economies fill the region, often offering what some States have not historically been able to provide – elements of human security, opportunities for social mobility, and basic survival. Areas controlled by drug trafficking organizations (DTOs) are now found in Central America, Mexico, and the favelas of Rio de Janeiro and São Paulo, reflecting their competition for land routes and production areas. Cartels such as La Familia, Los Zetas, and Primeiro Comando da Capital (PCC-Brazil), among others, operate like trade and financial enterprises that manage millions of dollars and resources, demonstrating significant business skills in adapting to changing circumstances. They are also merciless in their application of violence to preserve their lucrative enterprises. The El Salvador-Guatemala-Honduras triangle in Central America is now the most violent region in the world, surpassing regions in Africa that have been torn by civil strife for years. In Brazil’s favelas and Guatemala’s Petén region, the military is leaving the barracks again; not to rule, however, but to supplement and even replace the law enforcement capacity of weak and discredited police forces. This will challenge the military to apply lessons learned during the course of their experience in government, or from the civil wars that plagued the region for nearly 50 years during the Cold War. Will they be able to conduct themselves according to the professional ethics that have been inculcated over the past 20 years without incurring violations of human rights? Belief in their potential to do good is high according to many polls as the Armed Forces still enjoy a favorable perception in most societies, despite frequent involvement in corruption. Calling them to fight DTOs, however, may bring them too close to the illegal activities they are being asked to resist, or even rekindle the view that only a “strong hand” can resolve national troubles. The challenge of governance is occurring as contrasts within the region are becoming sharper. There is an increasing gap between nations positioned to surpass their “developing nation” status and those that are practically imploding as the judicial, political and enforcement institutions fall further into the quagmire of illicit activities. Several South American nations are advancing their political and economic development. Brazil in particular has realized macro-economic stability, made impressive gains in poverty reduction, and is on track to potentially become a significant oil producer. It is also an increasingly influential power, much closer to the heralded “emerging power” category that it aspired to for most of the 20th century. In contrast, several Central American States have become so structurally deficient, and have garnered such limited legitimacy, that their countries have devolved into patches of State controlled and non-State-controlled territory, becoming increasingly vulnerable to DTO entrenchment. In the Caribbean, the drug and human trafficking business also thrives. Small and larger countries are experiencing the growing impact of illicit economies and accompanying crime and violence. Among these, Guyana and Suriname face greater uncertainty, as they juggle both their internal affairs and their relations with Brazil and Venezuela. Cuba also faces new challenges as it continues focusing on internal rather than external affairs and attempts to ensure a stable leadership succession while simultaneously trying to reform its economy. Loosening the regime’s tight grip on the economy while continuing to curtail citizen’s civil rights will test the leadership’s ability to manage change and prevent a potential socio-economic crisis from turning into an existential threat. Cuba’s past ideological zest is now in the hands of Venezuela’s President Hugo Chavez, who continues his attempts to bring the region together under Venezuelan leadership ideologically based on a “Bolivarian” anti-U.S. banner, without much success. The environment and natural disasters will merit more attention in the coming years. Natural events will produce increasing scales of destruction as the States in the region fail to maintain and expand existing infrastructure to withstand such calamities and respond to their effects. Prospects for earthquakes, tsunamis, and hurricanes are high, particularly in the Caribbean. In addition, there are growing rates of deforestation in nearly every country, along with a potential increase in cross-sector competition for resources. The losers might be small farmers, due to their inability to produce quantities commensurate to larger conglomerates. Regulations that could mitigate these types of situations are lacking or openly violated with near impunity. Indigenous and other vulnerable populations, including African descendants, in several Andean countries, are particularly affected by the increasing extraction of natural resources taking place amongst their terrain. This has led to protests against extraction activities that negatively affect their livelihoods, and in the process, these historically underprivileged groups have transitioned from agenda-based organization to one that is bringing its claims and grievances to the national political agenda, becoming more politically engaged. Symptomatic of these social issues is the region’s chronically poor quality of education that has consistently failed to reduce inequality and prepare new generations for jobs in the competitive global economy, particularly the more vulnerable populations. Simultaneously, the educational deficit is also exacerbated by the erosion of access to information and freedom of the press. The international panorama is also in flux. New security entities are challenging the old establishment. The Union of South American Nations, The South American Defense Council, the socialist Bolivarian Alliance, and other entities seem to be defying the Organization of American States and its own defense mechanisms, and excluding the U.S. And the U.S.’s attention to areas in conflict, namely Iraq, Afghanistan, and Pakistan – rather than to the more stable Latin America and Caribbean – has left ample room for other actors to elbow in. China is now the top trading partner for Brazil. Russian and Iran are also finding new partnerships in the region, yet their links appear more politically inclined than those of China. Finally, the aforementioned increasing commercial ties by LAC States with China have accelerated a return to the preponderance of commodities as sources of income for their economies. The increased extraction of raw material for export will produce greater concern over the environmental impact that is created by the exploitation of natural resources. These expanded trade opportunities may prove counterproductive economically for countries in the region, particularly for Brazil and Chile, two countries whose economic policies have long sought diversification from dependence on commodities to the development of service and technology based industries.

The World Trade Organization, competition policy, and developing countries: A cross -country examination of domestic policy actions

This dissertation addresses the following research question: in a particular policy area, why do countries that display unanimity in their international policy behavior diverge from each other in their domestic policy actions? I address this question in the context of the divergent domestic competition policy actions undertaken by developing countries during the period 1996-2007, after these countries had quite conspicuously displayed near-unanimity in opposing this policy measure at the World Trade Organization (WTO). This divergence is puzzling because (a) it does not align with their near-unanimous behavior at the WTO over competition policy and (b) it is at variance with the objectives of their international opposition to this policy at the WTO. Using an interdisciplinary approach, this dissertation examines the factors responsible for this divergence in the domestic competition policy actions of developing countries. ^ The theoretical structure employed in this study is the classic second-image-reversed framework in international relations theory that focuses on the domestic developments in various countries following an international development. Methodologically, I employ both quantitative and qualitative methods of analysis to ascertain the nature of the relationship between the dependent variable and the eight explanatory variables that were identified from existing literature. The data on some of the key variables used in this dissertation was uniquely created over a multi-year period through extensive online research and represents the most comprehensive and updated dataset currently available. ^ The quantitative results obtained from logistic regression using data on 131 countries point toward the significant role played by international organizations in engineering change in this policy area in developing countries. The qualitative analysis consisting of three country case studies illuminate the channels of influence of the explanatory variables and highlight the role of domestic-level factors in these three carefully selected countries. After integrating the findings from the quantitative and qualitative analyses, I conclude that a mix of international- and domestic-level variables explains the divergence in domestic competition policy actions among developing countries. My findings also confirm the argument of the second-image-reversed framework that, given an international development or situation, the policy choices that states make can differ from each other and are mediated by domestic-level factors. ^

Relative roles of dispersal dynamics and competition in determining the isotopic niche breadth of a wetland fish

1. The niche variation hypothesis predicts that among-individual variation in niche use will increase in the presence of intraspecific competition and decrease in the presence of interspecific competition. We sought to determine whether the local isotopic niche breadth of fish inhabiting a wetland was best explained by competition for resources and the niche variation hypothesis, by dispersal of individuals from locations with different prey resources or by a combination of the two. We analysed stable isotopes of carbon and nitrogen as indices of feeding niche and compared metrics of within-site spread to characterise site-level isotopic niche breadth. We then evaluated the explanatory power of competing models of the direct and indirect effects of several environmental variables spanning gradients of disturbance, competition strength and food availability on among-individual variation of the eastern mosquitofish (Gambusia holbrooki). 2. The Dispersal model posits that only the direct effect of disturbance (i.e. changes in water level known to induce fish movement) influences among-individual variation in isotopic niche. The Partitioning model allows for only direct effects of local food availability on among-individual variation. The Combined model allows for both hypotheses by including the direct effects of disturbance and food availability. 3. A linear regression of the Combined model described more variance than models limited to the variables of either the Dispersal or Partitioning models. Of the independent variables considered, the food availability variable (per cent edible periphyton) explained the most variation in isotopic niche breadth, followed closely by the disturbance variable (days since last drying event). 4. Structural equation modelling provided further evidence that the Combined model was best supported by the data, with the Partitioning and the Dispersal models only modestly less informative. Again, the per cent edible periphyton was the variable with the largest direct effect on niche variability, with other food availability variables and the disturbance variable only slightly less important. Indirect effects of heterospecific and conspecific competitor densities were also important, through their effects on prey density. 5. Our results support the Combined hypotheses, although partitioning mechanisms appear to explain the most diet variation among individuals in the eastern mosquitofish. The results also support some predictions of the niche variation hypothesis, although both conspecific and interspecific competition appeared to increase isotopic niche breadth in contrast to predictions that interspecific competition would decrease it. We think this resulted from high diet overlap of co-occurring species, most of which consume similar macroinvertebrates.

Adherence to latent tuberculosis treatment among immigrants in low endemic settings : a scoping review

Contexte : En dépit du fait que la tuberculose est un problème de santé publique important dans les pays en voie de développement, les pays occidentaux doivent faire face à des taux d'infection important chez certaines populations immigrantes. Le risque de développer la TB active est 10% plus élevé chez les personnes atteintes de TB latente si elles ne reçoivent pas de traitement adéquat. La détection et le traitement opportun de la TB latente sont non seulement nécessaires pour préserver la santé de l'individu atteint mais aussi pour réduire le fardeau socio- économique et sanitaire du pays hôte. Les taux d'observance des traitements préventifs de TB latente sont faibles et une solution efficace à ce problème est requise pour contrôler la prévalence de l'infection. L'objectif de ce mémoire est d'identifier les facteurs qui contribuent à l'observance thérapeutique des traitements de TB latente auprès de nouveaux arrivants dans les pays occidentaux où les taux endémiques sont faibles. Méthodologie : Une revue systématique a été effectuée à partir de bases de données et répertoires scientifiques reconnus tels Medline, Medline in Process, Embase, Global Health, Cumulative Index to Nursing, le CINAHL et la librairie Cochrane pour en citer quelques un. Les études recensées ont été publiées après 1997 en français, en anglais, conduites auprès de populations immigrantes de l'occident (Canada, Etats-Unis, Europe, Royaume-Uni, Australie et la Nouvelle Zélande) dont le statut socio-économique est homogène. Résultats : Au total, neuf (9) études réalisées aux Etats-Unis sur des immigrants originaires de différents pays où la TB est endémique ont été analysées: deux (2) études qualitatives ethnographiques, six (6) quantitatives observationnelles et une (1) quantitative interventionnelle. Les facteurs sociodémographiques, les caractéristiques individuelles, familiales, ainsi que des déterminants liés à l'accès et à la prestation des services et soins de santé, ont été analysés pour identifier des facteurs d'observance thérapeutique. L'âge, le nombre d'années passées dans le pays hôte, le sexe, le statut civil, l'emploi, le pays d'origine, le soutien familiale et les effets secondaires et indésirables du traitement de la TB ne sont pas des facteurs ii déterminants de l'adhésion au traitement préventif. Toutefois, l’accès à l'information et de l'éducation adaptées aux langues et cultures des populations immigrantes, sur la TB et des objectifs de traitement explicites, l'offre de plan de traitement plus court et mieux tolérés, un environnement stable, un encadrement et l'adhésion au suivi médical par des prestataires motivés ont émergés comme des déterminants d'observance thérapeutique. Conclusion et recommandation : Le manque d'observance thérapeutique du traitement de la TB latente (LTBI) par des populations immigrantes, qui sont déjà aux prises avec des difficultés d'intégration, de communication et économique, est un facteur de risque pour les pays occidentaux où les taux endémiques de TB sont faibles. Les résultats de notre étude suggèrent que des interventions adaptées, un suivi individuel, un encadrement clinique et des plans de traitement plus courts, peuvent grandement améliorer les taux d'observance et d'adhésion aux traitements préventifs, devenant ainsi un investissement pertinent pour les pays hôtes.

Interspecific competition between the potato cyst nematode species Globodera pallida and G. rostochiensis

The two potato cyst nematode species, Globodera pallida and G. rostochiensis, are among the most important pests of potato. PCN are difficult to manage, while the two species respond differently to the main control methods. An increase in the incidence of G. pallida had been reported and is generally attributed to greater effectiveness of control measures against G. rostochiensis. The status of PCN in Ireland was studied using PCR. The results demonstrated qPCR to be an efficient means of high-throughput PCN sampling, being able to accurately identify both species in mixed-species populations. Species discrimination using qPCR revealed an increase in the incidence of G. pallida in Ireland in the absence of G. pallida-selective control measures. The population dynamics of G. pallida and G. rostochiensis in Ireland were studied in mixed- and single-species competition assays in vivo. G. pallida proved to be the more successful species, with greater multiplication in mixed- than single-species populations, with G. rostochiensis showing the opposite. This effect was similarly observed in staggered inoculation trials and population proportion trials. It was hypothesised that the greater G. pallida competitiveness could be attributed to its later hatch. G. pallida exhibited a later peak in hatching activity and more prolonged hatch, relative to G. rostochiensis. G. rostochiensis hatch was significantly reduced in mixedspecies hatching assays. G. pallida hatch was significantly higher when hatch was induced in potato root leachates containing G. rostochiensis-specific compounds, indicating that G. pallida hatch is stimulated upon perception of G. rostochiensis–derived compounds. Rhizotron studies revealed that root damage, caused by feeding of the early-hatching G. rostochiensis, resulted in increased lateral root proliferation and significantly increased G. pallida multiplication. Split-root trials indicated a significant G. pallida-induced ISR effect. G. rostochiensis multiplication was significantly reduced in split-root rhizotrons when G. pallida colonised roots before or after G. rostochiensis infection.

Adherence to latent tuberculosis treatment among immigrants in low endemic settings : a scoping review

Contexte : En dépit du fait que la tuberculose est un problème de santé publique important dans les pays en voie de développement, les pays occidentaux doivent faire face à des taux d'infection important chez certaines populations immigrantes. Le risque de développer la TB active est 10% plus élevé chez les personnes atteintes de TB latente si elles ne reçoivent pas de traitement adéquat. La détection et le traitement opportun de la TB latente sont non seulement nécessaires pour préserver la santé de l'individu atteint mais aussi pour réduire le fardeau socio- économique et sanitaire du pays hôte. Les taux d'observance des traitements préventifs de TB latente sont faibles et une solution efficace à ce problème est requise pour contrôler la prévalence de l'infection. L'objectif de ce mémoire est d'identifier les facteurs qui contribuent à l'observance thérapeutique des traitements de TB latente auprès de nouveaux arrivants dans les pays occidentaux où les taux endémiques sont faibles. Méthodologie : Une revue systématique a été effectuée à partir de bases de données et répertoires scientifiques reconnus tels Medline, Medline in Process, Embase, Global Health, Cumulative Index to Nursing, le CINAHL et la librairie Cochrane pour en citer quelques un. Les études recensées ont été publiées après 1997 en français, en anglais, conduites auprès de populations immigrantes de l'occident (Canada, Etats-Unis, Europe, Royaume-Uni, Australie et la Nouvelle Zélande) dont le statut socio-économique est homogène. Résultats : Au total, neuf (9) études réalisées aux Etats-Unis sur des immigrants originaires de différents pays où la TB est endémique ont été analysées: deux (2) études qualitatives ethnographiques, six (6) quantitatives observationnelles et une (1) quantitative interventionnelle. Les facteurs sociodémographiques, les caractéristiques individuelles, familiales, ainsi que des déterminants liés à l'accès et à la prestation des services et soins de santé, ont été analysés pour identifier des facteurs d'observance thérapeutique. L'âge, le nombre d'années passées dans le pays hôte, le sexe, le statut civil, l'emploi, le pays d'origine, le soutien familiale et les effets secondaires et indésirables du traitement de la TB ne sont pas des facteurs ii déterminants de l'adhésion au traitement préventif. Toutefois, l’accès à l'information et de l'éducation adaptées aux langues et cultures des populations immigrantes, sur la TB et des objectifs de traitement explicites, l'offre de plan de traitement plus court et mieux tolérés, un environnement stable, un encadrement et l'adhésion au suivi médical par des prestataires motivés ont émergés comme des déterminants d'observance thérapeutique. Conclusion et recommandation : Le manque d'observance thérapeutique du traitement de la TB latente (LTBI) par des populations immigrantes, qui sont déjà aux prises avec des difficultés d'intégration, de communication et économique, est un facteur de risque pour les pays occidentaux où les taux endémiques de TB sont faibles. Les résultats de notre étude suggèrent que des interventions adaptées, un suivi individuel, un encadrement clinique et des plans de traitement plus courts, peuvent grandement améliorer les taux d'observance et d'adhésion aux traitements préventifs, devenant ainsi un investissement pertinent pour les pays hôtes.

Competition for Cooperation: variability, benefits and heritability of relational wealth in hunter-gatherers

Many defining human characteristics including theory of mind, culture and language relate to our sociality, and facilitate the formation and maintenance of cooperative relationships. Therefore, deciphering the context in which our sociality evolved is invaluable in understanding what makes us unique as a species. Much work has emphasised group-level competition, such as warfare, in moulding human cooperation and sociality. However, competition and cooperation also occur within groups; and inter-individual differences in sociality have reported fitness implications in numerous non-human taxa. Here we investigate whether differential access to cooperation (relational wealth) is likely to lead to variation in fitness at the individual level among BaYaka hunter-gatherers. Using economic gift games we find that relational wealth: a) displays individual-level variation; b) provides advantages in buffering food risk, and is positively associated with body mass index (BMI) and female fertility; c) is partially heritable. These results highlight that individual-level processes may have been fundamental in the extension of human cooperation beyond small units of related individuals, and in shaping our sociality. Additionally, the findings offer insight in to trends related to human sociality found from research in other fields such as psychology and epidemiology.

The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.