Finding a lasting cure for U.S. health care

In "Making Competition in Health Care Work" (July-August 1994), Elizabeth Olmsted Teisberg, Michael E. Porter, and Gregory B. Brown ask a question that has been absent from the national debate on health care reform: How can the United States achieve sustained cost reductions while at the same time maintaining quality of care? The authors argue that innovation driven by rigorous competition is the key to successful reform. A lasting cure for health care in the United States should include four basic elements: corrected incentives to spur productive competition, universal insurance to secure economic efficiency, relevant information to ensure meaningful choice, and innovation to guarantee dynamic improvement. In this issue's Perspectives section, eleven experts examine the current state of the health care system and offer their views on the shape that reform should take. Some excerpts: "On the road to innovation, let us not forget to develop the tools that allow physicians, payers, and patients to make better decisions." I. Steven Udvarhelyi; "Health care is not a product or service that can be standardized, packaged, marketed, or adequately judged by consumers according to quality and price." Arnold S. Relman; "Just as antitrust laws are the wise restraints that make competition free in other sectors of the economy, so the right kind of managed competition can work well in health care." Edward M. Kennedy "Biomedical research should be considered primarily an investment in the national economic well-being with additional humanitarian benefits." Elizabeth Marincola.     

Sustainable Entrepreneurship: A Convergent Process Model

Sustainable entrepreneurship pursues a triple bottom line approach of economic, social and ecological goals. The main aim of this paper is to add to our understanding of the process of sustainable entrepreneurship. Since the field of sustainable entrepreneurship is in a nascent stage, we conduct a qualitative study. We employ a multiple case study design to build theory. Based on four case studies we develop a model, which describes the process of sustainable entrepreneurship, including six phases: 1) recognizing a social or ecological problem; 2) recognizing a social or ecological opportunity; 3) developing a double bottom line solution; 4) developing a triple bottom line solution; 5) funding and forming of a sustainable enterprise; 6) creating or entering a sustainable market. By developing a convergent process model with two pathways, we make theoretical contributions to the emerging fields of sustainable entrepreneurship and social entrepreneurship. A key finding is that the triple bottom line of ecological, social and economic goals is integrated sequentially, not simultaneously. Copyright © 2015 John Wiley & Sons, Ltd and ERP Environment.     

Stochastic Growth Models and Their Econometric Implications

This article considers the consequences of explicitly allowing for stochastic technological progress and stochastic labor input in the discrete-time Solow-Swan and AK growth models. It shows that the capital-output ratio, but not output per capita, is ergodic irrespective of whether there is a unit root in technology, and thus is the more appropriate measure to use in the cross-sectional analysis of the growth process. Furthermore, the article derives the cross-sectional and time-series implications of the stochastic Solow-Swan model and contrasts these to those of its deterministic counterpart. Among these implications are that the mean of the capital-output ratio depends in a precise way not only on the saving rate and the growth rate of labor input, but also on the variance and higher-order cumulants of the capital-output ratio. Using the Summers-Heston data for seventy-two countries from 1960 to 1992, strong support is found for the predictions of the stochastic Solow-Swan model as compared to those of its deterministic counterpart (as well as those of the AK model), including a significant negative cross-sectional relationship between the mean and the variance of the capital-output ratio.     

A constitutional paradigm is not enough—would sovereign citizens really agree to manipulative nudges?—A reply to Christian Schubert

In this short note I reply to a comment made by Christian Schubert, who argues that my criticism of libertarian paternalism cannot be upheld under a constitutional economics paradigm. I disagree: it is implausible to assume that sovereign individuals behind a veil of ignorance would actually agree on manipulative nudges from the public sector. Resorting to a constitutional economics paradigm does not diminish the force of the manipulation objection—libertarian paternalism remains morally objectionable. Moreover, where sovereign citizens would agree on permissible (morally legitimate) nudges behind a veil of ignorance, these would no longer constitute “paternalism” under its commonly agreed definition. More constructively, the only morally defensible paternalistic nudges would be those that improve welfare while respecting or, better yet, improving individual autonomy. These are not the typical nudges defended by libertarian paternalists.     

Functions of scenarios in transition processes

Given the interplaying tendencies of economic decline, social instability, and environmental depletion, any transition towards sustainable development faces a challenging task. To successfully cope with this complexity requires transition management. Integrated approaches for supporting sustainability transitions have been elaborated in the last years. Future studies and scenario construction are regarded as essential components in these approaches. However, the related studies in this field have focused either on a specific type of transition process, or on decision support in a different contextual process, or on a specific function of scenarios. Thus, an evaluation of the wide range of viewpoints on the functions of scenarios with respect to the requirements for transition management is still missing. In this paper, we systematically elaborate upon the functions for transition management that scenarios can fulfil. The developed concept is applied to five empirical scenario studies supporting transition processes on the national, regional and local level in Switzerland. The paper contributes to the development of a functional methodology of transition support, providing initial guidelines for answering the question of which method is appropriate for what type and phase of a transition process.     

Comparing system visions of farmers and experts

The goal of this paper is to identify farmers’ future in terms of the pesticide management of potato growing farmers in Vereda la Hoya (Boyacá, Colombia).To achieve this goal we applied the Future-Structured Mental Model Approach (Future-SMMA) and interviewed 10 farmers concerning their future perspectives and expectations to derive their future visions. Subsequently, 10 experts were interviewed about the feasibility and the consequences of farmers’ future visions.Applying the Future-SMMA, we analyzed farmers’ future visions and found that farmers take account of social and environmental threats and that their visions are optimistic. In addition we compared farmers’ and experts’ perceptions of external constraints on farmers’ future and discovered that the future visions of farmers and experts were inconsistent. Finally, we determined how farmers’ livelihood assets and self-perception influence the formation of farmers’ future visions and found that the more a person was able to differentiate his livelihood assets the more differentiated were the future visions of that person.In discussing our findings, we deduce that the inconsistency of future visions found is due to diverging attitudes towards future scenarios and differing opinions about who should take responsibility for the knowledge management of farmers.     

Life satisfaction and self-employment: a matching approach

Despite lower incomes, the self-employed consistently report higher satisfaction with their jobs. But are self-employed individuals also happier, more satisfied with their lives as a whole? High job satisfaction might cause them to neglect other important domains of life, such that the fulfilling job crowds out other pleasures, leaving the individual on the whole not happier than others. Moreover, self-employment is often chosen to escape unemployment, not for the associated autonomy that seems to account for the high job satisfaction. We apply matching estimators that allow us to better take into account the above-mentioned considerations and construct an appropriate control group (in terms of balanced covariates). Using the BHPS dataset that comprises a large nationally representative sample of the British populace, we find that individuals who move from regular employment into self-employment experience an increase in life satisfaction (up to 2 years later), while individuals moving from unemployment to self-employment are not more satisfied than their counterparts moving from unemployment to regular employment. We argue that these groups correspond to “opportunity” and “necessity” entrepreneurship, respectively. These findings are robust with regard to different measures of subjective well-being as well as choice of matching variables, and also robustness exercises involving “simulated confounders”.     

Ecological aspects of structural change

Structural change in advanced industrialized countries has followed a very ambivalent course, with the resulting reductions in environmental stress in one area often being cancelled out by increases in another. What role has been played in this to date by industrial and economic policy? What options are open to policy-makers for the future?