We have just completed an exhausting nine‐month debate on the future of the Affordable Care Act. I see this debate as having ended—as of this writing—in a draw. After months of repeal efforts, Republicans in the House barely passed in early May, with a 217‐to‐213 margin, the American Health Care Act, which would have significantly amended the ACA. Republicans in the Senate spent the summer trying to arrive at amendments to the AHCA that could attract fifty of their fifty‐two votes, (...) but in the end, the clock ran out on their opportunity to enact an amendment without Democratic input. With this legislative failure, we appear to be in a stalemate. The Affordable Care Act remains in place as the law of the land, but the Trump administration seems committed to at best condemning the ACA to malign neglect and at worst actively undermining it at every opportunity. Given the political stalemate, the time is right to reassess the deeper issues at stake and ponder the prospects for a considered compromise on health reform. (shrink)

In her classic 1993 article, “The Struggle for the Soul of Health Insurance,” Deborah Stone contrasted the principle of mutual aid—“the essence of community” in the face of sickness—and the principle of actuarial fairness, under which “each person should pay for his own risk.” Stone claimed that “in most societies sickness is widely accepted as a condition that should trigger mutual aid,” while in the United States, a competitive insurance industry fosters in people “a sense of their difference, rather than (...) their commonalities, and their responsibility for themselves only, rather than their interdependence,” leading to the fragmentation of “communities into ever‐smaller, more homogeneous groups” and “the destruction of mutual aid.” The United States has, as Stone observes, long been an outlier in its approach to financing care for sickness. Over the past half century, we have developed mutual aid‐based programs to care for some, but most Americans have had to pay the “actuarially fair” cost of their care, either as individuals or as employee groups. Mutual aid has existed only on a limited scale. The Affordable Care Act is the most comprehensive attempt to date to remedy this situation. (shrink)

This “Legal Solutions in Health Reform” paper identifies and analyzes the legal issues raised by health insurance exchanges. Like all Legal Solutions papers, it does not purport to provide a concrete proposal as to how health insurance exchanges should be organized or even whether they should play a role in health care reform. Rather, it attempts simply to describe the legal issues that health insurance exchanges raise, and to propose alternative solutions to legal problems where useful. More specifically, it analyzes (...) and offers alternative solutions to the legal problems raised by proposals to establish insurance exchanges by the federal government, by state governments, and by private entities or associations. Because the focus of this project and paper is on legal issues, discussion of policy and design issues is attenuated. Nevertheless, some attention to policy issues is unavoidable because law is the realization of policy. (shrink)

Health insurance exchanges can organize the market for health insurance by connecting small businesses and individuals into larger insurance pools. HIEs have been proposed as a possible means of making insurance more accessible, increasing competition among health plans, and promoting choice of insurer. President Obama's campaign proposal and various congressional leaders have proposed establishing insurance exchanges through federal legislation. However, whether the federal or state government, or even a private entity, can organize an insurance exchange to connect health insurance sellers (...) and buyers under the law is the question explored in this paper. Specifically, the paper addresses legal restraints or limitations to such an exchange at the federal, state or private entity level, and offers solutions. Although exchanges implicate many design and policy issues regardless of whether they are implemented at a federal, state, or private entity level, the paper concludes that are no absolute legal bars to the establishment of health insurance exchanges. (shrink)

Even Americans who have only a vague knowledge of health policy know that the U.S. is different. We do not have “socialized medicine,” like our European or Canadian neighbors. We believe that health care is not rationed here, and that, unlike citizens of other nations, we do not have to wait in long queues when we need medical care. We believe that U.S. health care is the best in the world.At the same time, the U.S. spends more on health care (...) - both per capita and as percentage of gross domestic product - than other nations do. One in six non-elderly Americans has no health insurance, and voluminous studies show that lack of health insurance has a dramatic effect on both access to care and on health status. Furthermore, on many of the most important indicators of population health, such as infant mortality and life expectancy, the U.S. scores worse than do other nations. (shrink)

Even Americans who have only a vague knowledge of health policy know that the U.S. is different. We do not have “socialized medicine,” like our European or Canadian neighbors. We believe that health care is not rationed here, and that, unlike citizens of other nations, we do not have to wait in long queues when we need medical care. We believe that U.S. health care is the best in the world.At the same time, the U.S. spends more on health care (...) - both per capita and as percentage of gross domestic product - than other nations do. One in six non-elderly Americans has no health insurance, and voluminous studies show that lack of health insurance has a dramatic effect on both access to care and on health status. Furthermore, on many of the most important indicators of population health, such as infant mortality and life expectancy, the U.S. scores worse than do other nations. (shrink)

Since the Supreme Court of New Jersey decided the Quinlan case a quarter of a century ago, three American Supreme Court decisions and a host of state appellate decisions have addressed end-of-life issues. These decisions, as well as legislation addressing the same issues, have prompted a torrent of law journal articles analyzing every aspect of end-of-life law. In recent years, moreover, a number of law review articles, many published in this journal, have also specifically addressed legal issues raised by palliative (...) care. Much less is known in the United States, however, as to how other countries address these issues. Reflection on the experience and analysis of other nations may give Americans a better understanding of their own experience, as well as suggest improvements to their present way of dealing with the difficult problems in this area.This article offers a conceptual and comparative analysis of major legal issues relating to end-of-life treatment and to the treatment of pain in a number of countries. In particular, it focuses on the law of Australia, Canada, the United Kingdom, Poland, France, the Netherlands, Germany, and Japan. (shrink)

The Affordable Care Act is an essential first step toward making health insurance more affordable for lower and moderate income Americans. It has accomplished historic reductions in the proportion of Americans who are uninsured. The number of Americans reporting delaying medical care for financial reasons has declined by approximately one-third since 2010. Medicaid expansions, in particular, have significantly reduced financial burdens and accompanying anxieties experienced by low-income Americans in states that have embraced this opportunity. Consistent with these finding, one recent (...) analysis of credit report data finds that Medicaid expansion was associated with between a $600 and $1000 decline in collection balances among individuals who gained coverage. Notwithstanding these gains, premiums and cost-sharing are still too high for many Americans. And cost-sharing has continued to edge higher for the majority of Americans who have coverage through employer-based plans. Measures to address these challenges must build on the ACA to provide greater protection to millions of Americans and to address continued dissatisfaction with our health care financing system among middle-income Americans. (shrink)

Since the Supreme Court of New Jersey decided the Quinlan case a quarter of a century ago, three American Supreme Court decisions and a host of state appellate decisions have addressed end-of-life issues. These decisions, as well as legislation addressing the same issues, have prompted a torrent of law journal articles analyzing every aspect of end-of-life law. In recent years, moreover, a number of law review articles, many published in this journal, have also specifically addressed legal issues raised by palliative (...) care. Much less is known in the United States, however, as to how other countries address these issues. Reflection on the experience and analysis of other nations may give Americans a better understanding of their own experience, as well as suggest improvements to their present way of dealing with the difficult problems in this area.This article offers a conceptual and comparative analysis of major legal issues relating to end-of-life treatment and to the treatment of pain in a number of countries. In particular, it focuses on the law of Australia, Canada, the United Kingdom, Poland, France, the Netherlands, Germany, and Japan. (shrink)

Regardless of how health reform proceeds, we will continue to need public insurance programs to care for the poor, cover health problems not addressed by private insurance, and support the nation's health care infrastructure. This article examines that continuing role.

As we write this paper in spring 2008, many are hopeful that November’s election will open the door to some form of comprehensive health care reform. In all likelihood, we will elect a president who has campaigned to a greater or lesser extent on promises of improving access to health care, improving quality, and reducing costs. Equally important, it seems likely that the 111th Congress is preparing to undertake meaningful health care reform. And perhaps most important, despite recent attention to (...) energy issues and the economy, opinion polls consistently show that the American public continues to rank health care as one of the two or three most important domestic issues in the fall elections and supports comprehensive health care reform. (shrink)

Originally edited by Timothy Stoltzfus Jost, this text examines how different countries around the world approach the same challenges in health care law and ethics: how to finance care for as many people as possible; how to ensure quality care; how to best secure patients' rights; how to regulate abortion, end of life decision making, and assisted reproduction; and how to manage infectious diseases, tobacco use, and human subject research. The new edition considers a broader array of (...) countries, particularly from Asia, Latin America, Africa, and the Middle East. (shrink)

The United States, unlike all other industrialized nations, does not have a comprehensive public system for financing health care. Nevertheless, the magnitude of America's public health care financing effort is remarkable. Of the one trillion dollars the United States spent on health care in 1996, almost half, $483.1 billion, was spent by public programs. In 1995, Medicare—our social insurance program for persons over sixty-five and the long-term disabled—overed 37.5 million Americans; Medicaid—our program for indigent elderly and disabled persons and indigent (...) children and their families—covered 36.3 million. In 1996, Medicare and Medicaid spent $203.1 and $147.7 billion, respectively. The payment policies of these massive public health care programs have a profound effect on the provision of health care.Many of the recipients of Medicare and Medicaid suffer pain. In 1994, 376,200 Americans over age sixty-five died of cancer. Virtually all of these would have been Medicare recipients, and as many as 70 percent of them died in unrelieved pain. Nearly four million Americans over sixty-five endured the pain of inpatient surgery in 1995, again nearly all of whom were Medicare recipients. (shrink)

The United States, unlike all other industrialized nations, does not have a comprehensive public system for financing health care. Nevertheless, the magnitude of America's public health care financing effort is remarkable. Of the one trillion dollars the United States spent on health care in 1996, almost half, $483.1 billion, was spent by public programs. In 1995, Medicare—our social insurance program for persons over sixty-five and the long-term disabled—overed 37.5 million Americans; Medicaid—our program for indigent elderly and disabled persons and indigent (...) children and their families—covered 36.3 million. In 1996, Medicare and Medicaid spent $203.1 and $147.7 billion, respectively. The payment policies of these massive public health care programs have a profound effect on the provision of health care.Many of the recipients of Medicare and Medicaid suffer pain. In 1994, 376,200 Americans over age sixty-five died of cancer. Virtually all of these would have been Medicare recipients, and as many as 70 percent of them died in unrelieved pain. Nearly four million Americans over sixty-five endured the pain of inpatient surgery in 1995, again nearly all of whom were Medicare recipients. (shrink)

The last year, June 1992 through September 1993, has seen a great deal of ferment with respect to access to and financing of health care in the United States. The elections of 1992 portend dramatic changes in the American health care system, and vigorous debate regarding both expansion of access to health care and transformation of the health care financing system is taking place at the federal and the state levels. In fact, however, the time period covered here produced remarkably (...) few changes in the law, particularly at the federal level. The one piece of Medicare and Medicaid legislation passed by Congress in the fall of 1992, H.R. 11, was vetoed by President Bush immediately after the election. The Omnibus Budget Reconciliation Act of 1993 contained a host of minor adjustments to the Medicare and the Medicaid programs, but only the Medicaid asset transfer provisions and extensions to the self-referral provisions of the fraud and abuse laws, discussed below, are of import to us. (shrink)

The last year, June 1992 through September 1993, has seen a great deal of ferment with respect to access to and financing of health care in the United States. The elections of 1992 portend dramatic changes in the American health care system, and vigorous debate regarding both expansion of access to health care and transformation of the health care financing system is taking place at the federal and the state levels. In fact, however, the time period covered here produced remarkably (...) few changes in the law, particularly at the federal level. The one piece of Medicare and Medicaid legislation passed by Congress in the fall of 1992, H.R. 11, was vetoed by President Bush immediately after the election. The Omnibus Budget Reconciliation Act of 1993 contained a host of minor adjustments to the Medicare and the Medicaid programs, but only the Medicaid asset transfer provisions and extensions to the self-referral provisions of the fraud and abuse laws, discussed below, are of import to us. (shrink)

In Fixing Language, Herman Cappelen defends the project of conceptual engineering from a family of objections that he calls “the Strawsonian challenges.” Those objections are all versions of this: “If I ask you a question about the F’s, and you give me an answer that’s not about the F’s but rather about the G’s, then you haven’t answered my question. You have changed the subject.” I argue that Cappelen’s response succeeds in reply to one understanding of the Strawsonian challenge—on which (...) it is motivated by ordinary judgments of samesaying and continuity of topic—but that it fails as a response to another version—on which a parallel objection is motivated by philosophical considerations and is stated in a theoretical register. (shrink)

This work presents a historically informed, systematic exposition of the Christology of the first seven Ecumenical Councils of undivided Christendom, from the First Council of Nicaea in 325 AD to the Second Council of Nicaea in 787 AD. Assuming the truth of Conciliar Christology for the sake of argument, Timothy Pawl considers whether there are good philosophical arguments that show a contradiction or incoherence in that doctrine. He presents the definitions of important terms in the debate and a helpful (...) metaphysics for understanding the incarnation. -/- In Defense of Conciliar Christology discusses three types of philosophical objections to Conciliar Christology. Firstly, it highlights the fundamental philosophical problem facing Christology: how can one thing be both God and man, when anything deserving to be called "God" must have certain attributes, and yet it seems that nothing that can aptly be called "man" can have those same attributes? It then considers the argument that if the Second Person of the Holy Trinity were immutable or atemporal, as Conciliar Christology requires, then that Person could not become anything, and thus could not become man. Finally, Pawl addresses the objection that if there is a single Christ then there is a single nature or will in Christ. However, if that conditional is true, then Conciliar Christology is false, since it affirms the antecedent of the conditional to be true, but denies the truth of the consequent. Pawl defends Conciliar Christology against these charges, arguing that all three philosophical objections fail to show Conciliar Christology inconsistent or incoherent. (shrink)

The possibility of justified true belief without knowledge is normally motivated by informally classified examples. This paper shows that it can also be motivated more formally, by a natural class of epistemic models in which both knowledge and justified belief (in the relevant sense) are represented. The models involve a distinction between appearance and reality. Gettier cases arise because the agent's ignorance increases as the gap between appearance and reality widens. The models also exhibit an epistemic asymmetry between good and (...) bad cases that sceptics seem to ignore or deny. (shrink)

Isn't probability 1 certainty? If the probability is objective, so is the certainty: whatever has chance 1 of occurring is certain to occur. Equivalently, whatever has chance 0 of occurring is certain not to occur. If the probability is subjective, so is the certainty: if you give credence 1 to an event, you are certain that it will occur. Equivalently, if you give credence 0 to an event, you are certain that it will not occur. And so on for other (...) kinds of probability, such as evidential probability. The formal analogue of this picture is the regularity constraint: a probability distribution over sets of possibilities is regular just in case it assigns probability 0 only to the null set, and therefore probability 1 only to the set of all possibilities. (shrink)

The five commentators on my paper ‘Gettier Cases in Epistemic Logic’ (GCEL) demonstrate how fruitful the topic can be. Especially in Brian Weatherson's contribution, and to some extent in those of Jennifer Nagel and Jeremy Goodman, much of the material constitutes valuable development and refinement of ideas in GCEL, rather than criticism. In response, I draw some threads together, and answer objections, mainly those in the papers by Stewart Cohen and Juan Comesaña and by Goodman.

1 Department of Philosophy, University of Dundee, Dundee DD1 4HN. [email protected].

Considerable effort has been devoted over the last fifteen years by faculty and administrators in numerous colleges and universities, and by organizations such as the Aspen Institute and Teagle Foundation, to enhancing business education through broad infusion of the perspectives and content of the liberal arts. The emphasis has been on integration of the social sciences and especially the humanities. The author—a natural scientist—recounts a seminal experience that motivated him to work more intensively on this initiative with his colleagues across (...) academic divisions at his home institution and beyond. He also argues for more engagement by natural science faculty in this process and examines the transdisciplinary re-visioning required to transform business teaching, learning, and practice into a new paradigm consistent with ecological reality. (shrink)

Dummett's account of the semantic paradoxes in terms of his theory of indefinitely extensible concepts is compared with Bürge's account in terms of indexicality. Dummett's appeal to intuitionistic logic does not block the paradoxes but Bürge's attempt to avoid the Strengthened Liar is unconvincing. It is argued that in order to avoid the Strengthened Liar and other semantic paradoxes involving nonindexical expressions (constants), one must postulate that when we reflect on the paradoxes there are slight shifts in the meaning (not (...) just reference) we ascribe to metalinguistic expressions (in particular 'say', and derivatively 'true' and 'false'). Consideration of metaphor and gradual linguistic change suggests that such semantic shifts are consistent with language-learning and communication. On this account there is no threat to classical logic, bivalence or the fundamental principles governing 'true' and 'false'. (shrink)

In a recent issue of Faith and Philosophy, Steven Cowan calls into question our success in responding to what we called the “Problem of Heavenly Free- dom” in our earlier “Incompatibilism, Sin, and Free Will in Heaven.” In this reply, we defend our view against Cowan’s criticisms.

Recent studies of organizational behavior have witnessed a growing interest in unethical leadership, leading to the development of abusive supervision research. Given the increasing interest in the causes of abusive supervision, this study proposes an organizing framework for its antecedents and tests it using meta analysis. Based on an analysis of effect sizes drawn from 74 studies, comprising 30,063 participants, the relationship between abusive supervision and different antecedent categories are examined. The results generally support expected relationships across the four categories (...) of abusive antecedents, including: supervisor related antecedents, organization related antecedents, subordinate related antecedents, and demographic characteristics of both supervisors and subordinates. In addition, possible moderators that can also influence the relationships between abusive supervision and its antecedents are also examined. The significance and implications of different level factors in explaining abusive supervision are discussed. (shrink)

Defines the cutting-edge of scholarship on ancient Greek history employing methods from social science.

Rational thinkers respect their evidence. Properly understood, that is a platitude. But how can one respect one's evidence unless one knows what it is? So must not rational thinkers know what their evidence is?

What we call “the evidential argument from evil” is not one argument but a family of them, originating (perhaps) in the 1979 formulation of William Rowe. Wykstra’s early versions of skeptical theism emerged in response to Rowe’s evidential arguments. But what sufficed as a response to Rowe may not suffice against later more sophisticated versions of the problem of evil—in particular, those along the lines pioneered by Paul Draper. Our chief aim here is to make an earlier version of skeptical (...) theism more responsive to the type abductive atheology pioneered by Draper. In particular, we suggest a moderate form of skeptical theism may be able to resist Draper’s abductive atheology. (shrink)

A kind of intellectual project characteristic of Ernest Sosa is to resolve an apparently flat-out dispute by showing that it is not after all a zero-sum game. His irenic goal is to do justice to both sides and give each of them most of what it wants. In his subtle paper ‘Abilities, Concepts, and Externalism’ he applies this strategy to the dispute between internalism and externalism in the philosophy of mind. It is a pleasure to engage in discussion with a (...) philosopher of Sosa’s fair-mindedness and analytical skills. (shrink)

This book aims to give a coherent interpretation of the whole dialogue, paying particular attention to these etymologies.The book discusses the rival theories ...

The core of Tony Brueckner’s critique in ‘Knowledge, Evidence, and Skepticism according to Williamson’ is his claim in section 5 that my account of perceptual knowledge has an unacceptable consequence. My reply will concentrate on that claim and largely ignore the rest of Brueckner’s interesting discussion, for it is easy to check that the claim is essential to Brueckner’s argument against my analysis of skepticism and evidence. The alleged consequence at issue concerns a case in which Brueckner knows by seeing (...) that his cup is red. According to Brueckner, I am committed to the implausible view that ‘[his] belief of the proposition that [his] cup is red is justified in virtue of [his] belief of the proposition that [his] cup is red!’ Why does he take my account of.. (shrink)