If federal health reforms continue to rely on employer-sponsored health care coverage, ERISA preemption reform should be part of the next steps. State-level reform has acquired greater urgency, while the justifications for preempting that source of reform has eroded. This article recommends a statutory waiver for ERISA preemption as a feasible way to adapt to these circumstances. It offers proposed statutory text for reformers inclined to pursue ERISA reform as health reform.

Cost-effectiveness analysis suggests that a society should allocate its health care budget in order to achieve the greatest total health for its budget. However, in ‘rescue’ cases, where an individual’s life is in immediate peril, reasoning in terms of cost-effectiveness can appear inhumane. Hence considerations of cost-effectiveness and of rescue appear to be in tension. However, by attending to the division of labour in medical decision making it is possible to see how cost-effectiveness analysis and rescue-style reasoning are commonly combined (...) in an ethically acceptable fashion. (shrink)

This article examines criticisms of cost-benefit analysis and the contingent valuation method from methodological and moral philosophical perspectives. Both perspectives argue that what should be elicited for public decisions are attitudes or values, not preferences, and that respondents should be treated as citizens and not consumers. The moral philosophical criticism argues in favour of deliberative approaches over cost-benefit analysis. The methodological perspective is here criticized for overemphasizing the importance of protest responses and anomalies and biases in contingent valuation, and for (...) failing to provide the necessary information needed to make public decisions over the allocation of scarce goods. The moral philosophical perspective is criticized for: failing to provide criteria for distinguishing between values and preferences, assuming impartiality requires expression of values and not preferences; failing to recognize the diversity of forms of expression of values, including expression of values through monetary evaluation; and assuming that cost-benefit analysis is necessarily an implementation of a utilitarian political philosophy. The article concludes by showing that deliberative decision-making mechanisms can be overly demanding on citizens, and argues for greater openness in the potential moral justifications of cost-benefit analysis. Key Words: cost-benefit analysis • values • preference aggregation • democracy • willingness to pay. (shrink)

Two Lagrangians L and L′ are equivalent if the equations of motion derived from them have the same set of solutions. In that case, a matrix Λ may be defined which has the property that the trace of any analytic function of Λ is a constant of the motion. We extend this trace theorem to the case of classical field theory and discuss some of the implications for quantum theory and for procedures for finding equivalent Lagrangians.

This is the first book to give a collective treatment of philosophical issues relating to tax. Given that the tax system is central to the operation of states and to the ways in which states interact with individual citizens, more interdisciplinary attention to conceptual and normative issues relating to tax is urgently needed.

The ACA shifted U.S. health policy from centering on principles of actuarial fairness toward social solidarity. Yet four legal fixtures of the health care system have prevented the achievement of social solidarity: federalism, fiscal pluralism, privatization, and individualism. Future reforms must confront these fixtures to realize social solidarity in health care, American-style.

Health‐related Quality of Life measures have recently been attacked from two directions, both of which criticize the preference‐based method of evaluating health states they typically incorporate. One attack, based on work by Daniel Kahneman and others, argues that ‘experience’ is a better basis for evaluation. The other, inspired by Amartya Sen, argues that ‘capability’ should be the guiding concept. In addition, opinion differs as to whether health evaluation measures are best derived from consultations with the general public, with patients, or (...) with health professionals. And there is disagreement about whether these opinions should be solicited individually and aggregated, or derived instead from a process of collective deliberation. These distinctions yield a wide variety of possible approaches, with potentially differing policy implications. We consider some areas of disagreement between some of these approaches. We show that many of the perspectives seem to capture something important, such that it may be a mistake to reject any of them. Instead we suggest that some of the existing ‘instruments’ designed to measure HR QoLs may in fact successfully already combine these attributes, and with further refinement such instruments may be able to provide a reasonable reconciliation between the perspectives. (shrink)

Health-related Quality of Life measures have recently been attacked from two directions, both of which criticize the preference-based method of evaluating health states they typically incorporate. One attack, based on work by Daniel Kahneman and others, argues that ‘experience’ is a better basis for evaluation. The other, inspired by Amartya Sen, argues that ‘capability’ should be the guiding concept. In addition, opinion differs as to whether health evaluation measures are best derived from consultations with the general public, with patients, or (...) with health professionals. And there is disagreement about whether these opinions should be solicited individually and aggregated, or derived instead from a process of collective deliberation. These distinctions yield a wide variety of possible approaches, with potentially differing policy implications. We consider some areas of disagreement between some of these approaches. We show that many of the perspectives seem to capture something important, such that it may be a mistake to reject any of them. Instead we suggest that some of the existing ‘instruments’ designed to measure HR QoLs may in fact successfully already combine these attributes, and with further refinement such instruments may be able to provide a reasonable reconciliation between the perspectives. (shrink)

David Lewis is widely credited with the first formulation of common knowledge and the first rigorous analysis of convention. However, common knowledge and convention entered mainstream game theory only when they were formulated, later and independently, by other theorists. As a result, some of the most distinctive and valuable features of Lewis' game theory have been overlooked. We re-examine this theory by reconstructing key parts in a more formal way, extending it, and showing how it differs from more recent game (...) theory. In contrast to current theories of common knowledge, Lewis' theory is based on an explicit analysis of the modes of reasoning that are accessible to rational individuals and so can be used to analyse the genesis of common knowledge. Lewis' analysis of convention emphasises the role of inductive reasoning and of salience in the maintenance of conventions over time. Footnotes Earlier versions of this paper were presented at the 13th Amsterdam Colloquium at the University of Amsterdam, at a workshop on social norms at Wissenschaftskolleg zu Berlin, and at seminars at Tilburg University and the University of Bristol. We are grateful for comments from participants at those meetings, from two anonymous referees, and from Michael Bacharach, Nick Bardsley, Cristina Bicchieri, Luc Bovens, Simon Grant, David McCarthy, Shepley Orr, Brian Skyrms, Peter Vanderschraaf, Peter Wakker and Jörgen Weibull. Robert Sugden's work was supported by the Leverhulme Trust. (shrink)

In General Relativity in Hamiltonian form, change has seemed to be missing, defined only asymptotically, or otherwise obscured at best, because the Hamiltonian is a sum of first-class constraints and a boundary term and thus supposedly generates gauge transformations. Attention to the gauge generator G of Rosenfeld, Anderson, Bergmann, Castellani et al., a specially _tuned sum_ of first-class constraints, facilitates seeing that a solitary first-class constraint in fact generates not a gauge transformation, but a bad physical change in electromagnetism or (...) General Relativity. The change spoils the Lagrangian constraints, Gauss's law or the Gauss-Codazzi relations describing embedding of space into space-time, in terms of the physically relevant velocities rather than auxiliary canonical momenta. But the resemblance between the gauge generator G and the Hamiltonian H leaves still unclear where objective change is in GR. Insistence on Hamiltonian-Lagrangian equivalence, a theme emphasized by Castellani, Sugano, Pons, Salisbury, Shepley and Sundermeyer among others, holds the key. Taking objective change to be ineliminable time dependence, one recalls that there is change in vacuum GR just in case there is no time-like vector field xi^a satisfying Killing's equation L_xi g_mn=0, because then there exists no coordinate system such that everything is independent of time. Throwing away the spatial dependence of GR for convenience, one finds explicitly that the time evolution from Hamilton's equations is real change just when there is no time-like Killing vector. The inclusion of a massive scalar field is simple. No obstruction is expected in including spatial dependence and coupling more general matter fields. Hence change is real and local even in the Hamiltonian formalism. The considerations here resolve the Earman-Maudlin standoff over change in Hamiltonian General Relativity: the Hamiltonian formalism is helpful, and, suitably reformed, it does not have absurd consequences for change and observables. Hence the classical problem of time is resolved. The Lagrangian-equivalent Hamiltonian analysis of change in General Relativity is compared to Belot and Earman's treatment. The more serious quantum problem of time, however, is not automatically resolved due to issues of quantum constraint imposition. (shrink)

In Dirac-Bergmann constrained dynamics, a first-class constraint typically does not _alone_ generate a gauge transformation. By direct calculation it is found that each first-class constraint in Maxwell's theory generates a change in the electric field E by an arbitrary gradient, spoiling Gauss's law. The secondary first-class constraint p^i,_i=0 still holds, but being a function of derivatives of momenta, it is not directly about E. Only a special combination of the two first-class constraints, the Anderson-Bergmann -Castellani gauge generator G, leaves E (...) unchanged. This problem is avoided if one uses a first-class constraint as the generator of a _canonical transformation_; but that partly strips the canonical coordinates of physical meaning as electromagnetic potentials and makes the electric field depend on the smearing function, bad behavior illustrating the wisdom of the Anderson-Bergmann Lagrangian orientation of interesting canonical transformations. The need to keep gauge-invariant the relation dot{q}- dH/dp= -E_i -p^i=0 supports using the primary Hamiltonian rather than the extended Hamiltonian. The results extend the Lagrangian-oriented reforms of Castellani, Sugano, Pons, Salisbury, Shepley, _etc._ by showing the inequivalence of the extended Hamiltonian to the primary Hamiltonian even for _observables_, properly construed in the sense implying empirical equivalence. Dirac and others have noticed the arbitrary velocities multiplying the primary constraints outside the canonical Hamiltonian while apparently overlooking the corresponding arbitrary coordinates multiplying the secondary constraints _inside_ the canonical Hamiltonian, and so wrongly ascribed the gauge quality to the primaries alone, not the primary-secondary team G. Hence the Dirac conjecture about secondary first-class constraints rests upon a false presupposition. The usual concept of Dirac observables should also be modified to employ the gauge generator G, not the first-class constraints separately, so that the Hamiltonian observables become equivalent to the Lagrangian ones such as the electromagnetic field F. (shrink)

Axiomatic utility theory plays a foundational role in some accounts of normative principles. In this context, it is sometimes argued that transitivity of “better than” is a logical truth. Larry Temkin and Stuart Rachels use various examples to argue that “better than” is non–transitive, and that transitivity is not a logical truth. These examples typically involve some sort of “discontinuity.” In his discussion of one of these examples, John Broome suggests that we should reject the claim which involves “discontinuity.” We (...) can, I suggest, make sense of the examples which Temkin uses while sacrificing neither transitivity nor “discontinuity.” This response to Temkin's examples involves developing and modifying James Griffin's account of “discontinuity.” If the account of “discontinuity” seems implausible, that is because of a failure to allow for vagueness. A similar argument can be made in the context of the well-known “repugnant conclusion.” Footnotes1 This paper emerged from a discussion in one of John Broome's seminars. I am very grateful to John Broome, Erik Carlson, James Griffin, Wlodek Rabinowicz, Stuart Rachels, and Larry Temkin for allowing me to read various forthcoming manuscripts which are mentioned in the paper. I am also extremely grateful to Gustaf Arrhenius, Walter Bossert, Luc Bovens, John Broome, Richard Cookson, Robin Cubitt, James Griffin, Graham Loomes, Ben McQuillin, Shepley Orr, Wlodek Rabinowicz, Stuart Rachels, Bob Sugden, and two anonymous referees for comments on earlier versions. Any errors or omissions are mine. (shrink)

Is change missing in Hamiltonian Einstein–Maxwell theory? Given the most common definition of observables, observables are constants of the motion and nonlocal. Unfortunately this definition also implies that the observables for massive electromagnetism with gauge freedom are inequivalent to those of massive electromagnetism without gauge freedom. The alternative Pons–Salisbury–Sundermeyer definition of observables, aiming for Hamiltonian–Lagrangian equivalence, uses the gauge generator G, a tuned sum of first-class constraints, rather than each first-class constraint separately, and implies equivalent observables for equivalent massive electromagnetisms. (...) For General Relativity, G generates 4-dimensional Lie derivatives for solutions. The Lie derivative compares different space-time points with the same coordinate value in different coordinate systems, like 1 a.m. summer time versus 1 a.m. standard time, so a vanishing Lie derivative implies constancy rather than covariance. Requiring equivalent observables for equivalent formulations of massive gravity confirms that G must generate the 4-dimensional Lie derivative for observables. These separate results indicate that observables are invariant under internal gauge symmetries but covariant under external gauge symmetries, but can this bifurcated definition work for mixed theories such as Einstein–Maxwell theory? Pons, Salisbury and Shepley have studied G for Einstein–Yang–Mills. For Einstein–Maxwell, both \ and \ are invariant under electromagnetic gauge transformations and covariant under 4-dimensional coordinate transformations. Using the bifurcated definition, these quantities count as observables, as one would expect on non-Hamiltonian grounds. (shrink)