Bücher veröffentlicht von Brookings Institution Press

"A key issue in the debate about reforming the U.S. health care system is how to finance and organize the delivery of long-term care. This volume offers perspectives on several important facets of this problem, including the regulation of private long-term care insurance, catastrophic out-of-pocket costs, and the use of long-term care and acute care services by the chronically disabled elderly.In addition to the editors, the contributors are Lisa Alecxih, David Kennell, and John Corea, Lewin-VHI; Brian Burwell and William Crown, SysteMetrics; Terry Coughlin, Korbin Liu, and Sharon Long, Urban Institute; Judith Kasper, Johns Hopkins University; Kenneth Manton and P.J. Eric Stallard, Duke University; Jennifer Schore, Mathematica Policy Research; Catherine Sullivan, Brookings; and Bruce Vladeck, Health Care Financing Administration.Dialogues on Public Policy "

"In the final days of this century, the United States will need to amend the core of its foreign policy-a formidable task in a large democracy. American thinking, still grounded in post-World War II perceptions, has failed to keep pace with the demands of a changing world. New realities in the U.S. and international economies, in security conditions, and in world politics call for restructuring American foreign policy.The policy experts contributing to this volume state the process of public debate that must precede the hard political choices ahead. Barry P. Bosworth and Robert Z. Lawrence consider the ramifications of an American economy no longer an implicit source of leverage in pursuing policy objectives. William W. Kaufmann prescribes ways to preserve international commitments and ensure American security in spite of fiscally constrained defense budgets. John D. Steinbruner discusses efforts to achieve a more stable military balance. In a related chapters, Kenneth Flamm and Thomas L. McNaugher propose a redraft of American investment patterns to make the defense technology more consistent with contemporary security requirements.All of this domestic restructuring will take place within the constraints and opportunities created by recent changes in China and the Soviet Union, continued economic expansion in Japan, and persistent unrest in the Middle East. Harry Harding and Ed A. Hewett review the prospects for reform in China and the Soviet Union. Harry Harding and Edward Lincoln describe the surge in many Asian economies and the increased importance of Japan as a world power. And in the final chapter, Harold H. Saunders turns attention to the Middle East, where identifying desirable solutions continues to be far easier than finding realistic methods for achieving them.The inauguration of a new administration creates an opportunity for political debate, a new conceptual focus, and effective political consensus. Restructuring American F"

Examines the development of anti-satellite weapons and discusses the American and Soviet policies concerning the military use of space.

"The transition to a market economy proves to be far more difficult in Russia than in the former centrally planned economies of eastern Europe. The Russian economy continues to face serious problems, including substantial inflationary pressures, falling output, and capital flight. The most positive aspect of the transition has been the relatively fast pace of privatization. Challenges for Russian Economic Reform contains papers published by the post-Soviet Business Forum at the Royal Institute of International Affairs that have been revised for this volume. The contributers, specalists in Russian economic affairs, examine the principal economic and institutional factors that have hindered transformation in Russia. The sheer size of the country has complicated the problem of exposing domestic producers to foreign competition and has weakened the ability of central authorities to control the regions. Economic stabilization has been hampered by the difficulties in establishing sound economic relations with the former Soviet republics.David Dyker and Michael Barrow analyze the problems of monopoly and competition policy in Russia. Philip Hanson assesses the obstacles to economic stabilization posed by regional economic interests and examines regional diversity in reform implementation. Michael Kaser examines the problems of privatization by regions and sectors in Russia and the CIS and the institutional obstacles encountered by foreign investors. Alan Smith explores the problems created by the breakup of traditional trade and payment relations with the non-Russian republics of the former Soviet Union and bilateral trade links with Eastern Europe. He also provides an overall assessment of Russian economic performance since the collapse of communism."

"In the late 1970s and 1980s, Middle Eastern states spent more than $600 billion expanding their military forces. They acquired thousands of tanks, advanced fighter aircraft, ballistic missiles, chemical weapons, and-in some cases-nuclear devices. These potent arsenals make the Middle East the tinderbox of world affairs.In this book, foreign policy analyst Yahya Sadowski shows that the arms race cannot be sustained in the 1990s. Declining oil prices, overpopulation, economic mismanagement, and foreign policy adventures-such as the 1992 Gulf War, which cost local states another $600 billion-have sapped the economies of the Middle East. Facing dwindling incomes and rising expenses, growing numbers of Middle Easterners now favor diverting funds away from military expenditures and concentrating them on economic development programs.Sadowski argues that arms control programs for the Middle East should be designed to reinforce and exploit these economic pressures for demilitarization. He examines the strengths and weaknesses of various arms control proposals, such as the U.S. call for a cartel of weapons exporters and a Jordanian plan to liquidate the foreign debt of states that curb military expenditures."

"A Brookings Institution Press and National Academy for Social Insurance publicationThis book presents a cross-cutting assessment of disability income policy in public and private programs in the United States and in European countries. It evaluates whether there is a crisis in disability benefit policy, drawing on an in-depth review of Social Security disability programs by a panel of national experts. In addition to highlighting the panel's findings and recommendations for reform, the authors debate issues in financing and delivering quality health care through Medicare and Medicaid for working-age persons with disabilities, and they examine new developments in how Workers' Compensation organizes and finances cash benefits and health care for workers injured on the job. These developments in benefits and health policy for disabled workers are examined in light of budget constraints and challenges posed by today's rapidly changing labor market. The book concludes with a provocative discussion of ""where are the jobs?""--an assessment of growing wage inequality between less skilled and highly skilled workers and the implication of labor market trends for goals of promoting employment among persons with chronic health conditions or disabilities.The contributors include Monroe Berkowitz, Rutgers University; Richard V. Burkhauser, Syracuse University; John Burton, Rutgers University; Philip de Jong, Institute for Law and Public Policy, Leiden University, the Netherlands; Alan Krueger, Princeton University; Katherine Newman, Harvard University; Van Ooms, Committee on Economic Development; Dallas Salisbury, Employee Benefit Research Institute; Leslie Scallet, Mental Health Policy Resource Center; and the Honorable Bruce C. Vladek, Health Care Financing Administration."

"In 1983 Congress changed the way Medicare pays for hospital care. Under the new prospective payment system, hospitals are paid a fixed rate, set in advance, to cover a patient's stay. If costs are less than the fixed rates, the hospital keeps the profit; if the costs are more, it absorbs the loss. From the beginning, prospective payment was recognized as a revolutionary change in Medicare. Congress wanted a system that would make federal expenditures more predictable and controllable, and expected hospitals to respond by becoming more efficient. Some observers have hailed it as a successful way to control the spiraling costs of the Medicare program. Others have criticized it as arbitrary and a threat to the health of the elderly.In the six years since prospective payment was introduced, a substantial amount of evidence has accumulated about its effects. Russell looks at the major characteristics of the rate payment system, how it has changed the pattern of medical service, how these changes have affected the health of the beneficiaries, and the system's effects on Medicare outlays. She reviews what is known and what needs to be learned to arrive at a valid assessment of the system. Moreover, she contributes to the larger debate on Medicare by making what are frequently quite technical evaluations accessible to the general public."

"What is the outlook for educational reform in the United States? One of the most striking proposals has been to establish a system of national standards, which has raised many complex questions: Is it possible for the United States, with its history of extreme decentralization, to establish and enforce national standards for what students should know? Who will create these standards? What would be the role of the federal, state, and local governments?While the idea of national standards has been widely supported, many respected educators doubt their value from fear that such standards will institutionalize the lowest common denominator. Others cite the poor performance of U.S. students on international tests and insist that the U.S. will suffer because of this poor performance. The debate becomes even more intense when the question of assessment is posed. Is it possible to develop a national examination system tied to new standards? Should such tests be used to influence entry to colleges and jobs? Would the motivation of students to learn be increased if they knew that their performance would be reviewed by colleges and employers? Is it fair to set standards for students without setting standards for schools?To address these and other questions, this book, the result of a Brookings conference, brings together representatives of various viewpoints on the utility and equity of increasing the use of tests for students, teachers, and schools.The contributors are Chester Finn, Jr., the Edison Project; Daniel Koretz, RAND; Andrew Porter, Wisconsin Center for Education Research; Lauren Resnick, University of Pittsburgh; Roy Romer, Governor of Colorado; Albert Shanker, American Federation of Teachers; Theodore R. Sizer, Brown University; Marshall C. Smith, U.S. Department of Education; and Donald M. Stewart, The College Board.Brookings Dialogues on Public Policy"

"This book examines the nature of the international arms trade and the adjustment of the defense industries in the United States and Russia to the post-cold war world. O'Prey highlights the substantial reduction in demand for armaments both on the world market and by the two countries. Although this decrease in demand results partly from the decline of the superpower rivalry, it also represents the culmination of technological and industrial trends that have been under way for over a decade.O'Prey argues that many observers have not recognized the long-term nature of these changes. As a consequence, industry representatives and some government officials in both countries often unwisely emphasize arms exports as a means to preserve their cold war defense industries. Given the high expectations of export success and low levels of demand, competition among arms suppliers has become intense. In the process, proliferation of armaments, technologies, and production processes to outlaw states has become more likely. In addition, false expectations of arms export success may lead officials to forgo necessary restructuring and conversion of their defense industries. This problem is especially pronounced in Russia.O'Prey offers a number of suggestions for resolving the problems posed by arms export competition and defense industry adjustment. He argues that in virtually all cases, cooperation or partnership between the U.S. and Russia will be essential. Potential measures range from mutual restraint in arms exports to private industry partnerships for defense conversion and ultimately to multilateral initiatives for defense industry and export cooperation."

"Military analyst Michael O'Hanlon shows how outside forces could successfully intervene to stop an ongoing cycle of warfare in a country whose government has collapsed or come under severe internal challenge.Based largely on recent U.S. experiences in Panama, Somalia, Bosnia, and elsewhere, as well as on U.S. military doctrine and information from the Pentagon's training and simulation centers, the book discusses the steps in an intervention and estimates likely casualties and costs. O'Hanlon shows that modern Western militaries are capable of executing these types of operations with high proficiency. While conditions are unlikely to resemble those of Desert Storm, which allowed the U.S. and allies to take full advantage of modern technology, top-notch militaries have advantages in infantry combat situations-night-vision equipment, attack and transport helicopters, counterartillery radars-that would enable them to establish order and prevail in any firefights.O'Hanlon warns that operations as casualty-free as those in Haiti and, to date, in Bosnia would be unlikely. Moreover, the political framework that outside powers would attempt to employ in establishing a new order would be critical: if intervening forces are seen as taking sides or occupying territory without legitimacy, they could meet protracted guerrilla-style resistance of the types witnessed in Vietnam, Afghanistan, and Somalia.Part of the Studies in Foreign Affairs series"

The nation's capital is in a fiscal and political crisis. By 1995 the District of Columbia did not have the cash to pay its bills and faced a growing operating deficit. It was effectively shut out of the capital markets and at least three of its government agencies were in receivership. On any given day, 30 percent of the police vehicles were in the shop for repairs and 25 percent of the school buses were inoperable. Nor were adequate funds coming in: property assessors were making up the rules as they were undervaluing the tax base. In April 1995 Congress, beginning to come to grips with the situation, placed the fiscal control of the city in the hands of a presidentially appointed Control Board. The survival of the nation's capital is a matter of national concern. The Control Board and the chief financial officer have outlined the path to balancing the budget by 1999. Once the District government can deliver services efficiently, the issue of how they should be financed will need to be addressed. That is the focus of this book. Carol O'Cleireacain provides background for understanding the present situation, focusing on the revenue components and offering a realistic menu of revenue options for long-term, ongoing budget balance. She addresses such questions as: What is the "norm" for a city the size of Washington? What is the appropriate sharing among the federal government, District residents, and the region? How much compensation should be paid for the huge amount of tax-exempt property and the enormous number of nonprofit organizations in the capital? What taxes can the District impose fairly, collect efficiently without distorting decisions of individuals and businesses about where to locate? O'Cleireacain concludes that the District's fiscal crisis is the result, in part, of economic and demographic trends reflecting the dilemmas of central cities and their suburbs nationwide; in part, the historically flawed relationship between Congress and the local government. But at the heart of the District's fiscal crisis is its special status as the nation's capital. All other American cities benefit from state aid for welfare, Medicaid, prisons, higher education, juvenile justice, and a wide range of highway, infrastructure, and other capital investments. The District does not; it has to tax its residents in order to provide state-type services. Ongoing budget balance in D.C. will require a realignment of spending and revenue responsibilities by the federal government acting as the state parent to the nation's orphaned capital.

"Spending on U.S. foreign affairs, which constitutes only about one percent of the federal budget, is being sharply reduced. Under the President's 1996 budget plan, it will decline by just as great a percentage as defense between 1990 and 2002-and by substantially more than defense over the 1980-2002 period. No other major category of federal spending will undergo a real cut over either time period. The shrinking budget, totaling about $19 billion in 1997, will still have to fund the State Department, international broadcasting and educational exchanges, trade subsidies and investment guarantees for U.S. business overseas; United Nations operations including peacekeeping, and all types of foreign assistance.In this book, O'Hanlon and Graham focus primarily on this last component of international spending. Specifically, they analyze U.S. official development assistance (ODA) to poor countries. The authors place U.S. ODA in a broad historical, international, and economic perspective. They then recommend an alternative approach to ODA for the United States as well as other donors. They favor continuing to provide humanitarian and grass-roots aid to most poor countries, but providing ODA to promote macroeconomic growth only to those countries that maintain coherent, market-oriented economic policy frameworks. The authors argue that to provide effective aid, as well as to maintain U.S. leadership in world affairs, net resources for ODA and the international account need to increase only modestly. "

"The U.S. is not alone in its worries over the quality of its schools and the skills of its workforce.Not a single industrial nation is entirely happy with its education and worker training programs. But in four European countries-France, Britain, Sweden, and West Germany-educators have joined hands with government, industry, and local communities to face the problem head-on.The results of their imaginative initiatives recently were observed firsthand by participants in an equally innovative U.S. project-the West Philadelphia Improvement Corps (WEPIC). Support from the German Marshall Fund of the United States enabled two WEPIC groups-including public school teachers, principals, and administrators, as well as city and state policymakers-to tour some of the best European education, youth employment, and community development programs.SchoolWorks describes what these groups found in Europe. It also profiles a project that is seeking to make West Philadelphia schools the life centers of their communities. Finally, it presents guiding principles for strengthening workforce competence in America, with particular emphasis on those Americans who will make up an increasingly significant portion of our future workforce-young minorities and blacks from our most disadvantaged neighborhoods.A German Marshal Fund of the U.S. Book"

"In the United States, proposals for gasoline tax hikes have consistently met with broad-based congressional opposition. Although such taxes are a common and effective method of conserving energy in other industrialized nations, U.S. policy has traditionally relied on regulatory programs rather than fuel taxes to promote energy efficiency in automotive transportation. This book examines both the political causes and the economic effects of this idiosyncratic policy preference.Moderating the consumption and importation of oil has been an explicit goal of the United States over the past twenty years. Pietro S. Nivola and Robert W. Crandall argue that a higher levy on gasoline would be a more efficient way of achieving this goal than current automotive fuel economy standards. In fact, they find that an additional excise of less than twenty-five cents per gallon over the past dozen years would have conserved more oil than has the existing policy of administering gas mileage requirements for new passenger vehicles. And such a tax, they maintain, would not be as detrimental to the economy as opponents fear, nor as regressive as they claim.Why, then, is there such a strong national resistance to a fuel tax in the United States? And why is there less resistance in other countries? The authors examine the development of motor-fuel excises in Great Britain, France, Germany, Japan, and Canada, and explain the historical and political factors that have led to different national policy orientations.Turning their attention back to the United States, Nivola and Crandall show how regulatory measures have fallen short of their goal and why political barriers to bolder taxation of gasoline remain formidable. They conclude by offering suggestions for new directions in U.S. energy policy at the federal, state, and local level."

"Since the beginning of the crisis precipitated by Iraq's invasion of Kuwait in August 1990, the threat posed by Iraq's arsenal of ballistic missiles has been the focus of international attention. In the opening days of the U.S.-led military counteroffensive beginning on January 16, 1992, Iraq launched ballistic missiles against population centers in Israel and military bases in Saudi Arabia. The attacks intensified the terror of the war and prompted renewed efforts by the multinational force to destroy Saddam Hussein's military machine.The countries aligned against Iraq were prepared for attacks by chemically armed missiles, but Iraq's missile force proved to be of little military consequence. The missiles that survived the opening hours of Operation Desert Storm were conventionally armed, inaccurate and unreliable. Most of those that were actually launched either were intercepted by American antimissile defenses or failed to hit vital targets.But the political impact of the missiles was inestimable. The strikes symbolized Iraq's determination to prosecute the war no matter what the cost. By threatening to involve Israel, they created severe tensions and posed the risk that multinational military coalition would be dissolved, and they underscored the potential vulnerability of all the states in the region to Iraqi aggression.In this book, Janne E. Nolan argues that the use of missiles is a harbinger of the altered international security environment confronting the Untied States and its allies in the late twentieth century. Long believed to be a distant prospect, the adoption of technological resources to missile development is already occurring in over a dozen developing countries, many of them long-standing regional antagonists. These capabilities present complicated challenges to American interests and foreign policy, challenges that have only begun to be explored as a result of the Iraqi crisis.The author examines the evolution"

"With the rapid deterioration of the U.S. trade balance in the 1980s, the United States was forced to finance deficits by borrowing heavily from the rest of the world. In doing so, the United States went from being the world's largest creditor country to the world's largest debtor, while Japan and West Germany experienced a rise in trade surpluses. Such a shift in international trade flows has had profound effects on the world economy. McKibbin and Sachs address a range of issues involving macroeconomic imbalances in the world economy. Through the use of a new simulation model of the world economy they explore how policy actions undertaken in one country affect the trade flows and macroeconomic patterns among the other counties. The authors show that key macroeconomic features of the 1980s can be explained by shifts in monetary and fiscal policies in the major economies and by supply shocks due to changes in oil prices. In addition to showing how the global macroeconomic experience can be understood, they focus on a number of current policy issues, including the reduction of global trade imbalances, the consequences of U.S. fiscal consolidation, the effects of an oil price shock, the implications for the U.S. economy of increases in Japanese and German fiscal spending, the effects of targeting exchange rates among the major currencies, and the gains of increased coordination of macroeconomic politics among the major economies. In several cases, their conclusions are shown to be quite different from those that form the basis of many conventional views. The authors also analyze the importance of interaction between policymakers in industrial economies and conclude by reemphasizing the need for U.S. politicians and policy experts to recognize that macroeconomic results in the U.S. now depend heavily on events abroad. "

"In 1979, after a decade of enormous increases in the price of oil, U.S. influence in the oil-rich Persian Gulf region declined sharply. Early in the year the Iranian revolution replaced the shah, the principal pro-American leader in the region, with rulers hostile to the United States and to its remaining friends around the Gulf. In December Soviet troops moved into Afghanistan, bringing the Soviets closer to the Gulf and the Indian Ocean. In the United States these events spurred the announcement of the Carter Doctrine and the creation of a new military command to handle Gulf crises. Yet the United States established no new fighting forces, and U.S. friends around the Gulf proved less willing than the shah of Iran to host a U.S. military presence. Thus debate has continued about whether and how the United States can secure important interests in the Gulf region.In this book Thomas L. McNaugher offers a military strategy that integrates U.S. forces into the security framework that already exists in the region. He suggests that the United States should encourage Jordan, Pakistan, Great Britain, and others to continue their historical involvement in Gulf security, especially in such areas as internal security where U.S. forces are no better equipped than theirs and where U.S. participation may undermine the legitimacy of local rulers. In turn, the United States should focus on protecting the oil-rich states of the Arabian peninsula from external attack and on deterring further Soviet encroachment in the region. These missions demand an increase in the agility, rather than the size, of U.S. forces. But the more important requirement, McNaugher argues, is for skillfully blending U.S. military strategy into a diplomacy that exploits, rather than needlessly upsets, regional security mechanisms."

"The proposed North American Free Trade Agreement (NAFTA) represents a historic change in relations among Canada, Mexico, and the United States. The effect of the agreement on the three economies has generated controversy and some degree of alarm within each country.In this book, noted trade and development experts review the available literature on the effects of NAFTA on the three member countries and the world trading system. They evaluate how NAFTA will affect areas such as economic growth, employment, income distribution, industry, and agriculture in Canada, Mexico, and the United States; and consider the significance the trade agreement holds for the rest of the world.Drusill K. Brown begins the discussion by providing an overview and comparison of the general results from recent studies. Raúuacute;l Hinojosa-Ojeda and Sherman Robinson explore in greater detail the potential effects of NAFTA on wages and employment in Mexico and the United States. Sidney Wintrab reviews industry-specific effects of NAFTA, in particular, the environment, the social agenda, and human rights and democracy. Finally, Carlos Alberto Primo Braga considers the implications of NAFTA on the rest of the world.Following each of these chapters, international scholars assess the alternatives and provide recommendations for future research."

"To consider the problems of high litigation costs and delay that burden both plaintiffs and defendants, average citizens and large corporations, Senator Joseph R. Biden, Jr., Chairman of the Senate Judiciary Committee, suggested in August 1988 the formation of a working conference of natural competitors in the legal system. In response, the Brookings Institution and the Foundation for Change invited leading litigators from the plaintiffs' and defense bar; civil and women's rights, consumer, and environmental lawyers; representatives of the insurance industry; general counsels of major corporations; former judges; and law professors from throughout the United States to analyze these issues and develop a set of concrete recommendations for procedural reform.The 36 members of the working group, together with the Rand Corporation's Institute for Civil Justice, which served as a technical consultant, met at Brookings six times between September 1988 and June 1989. In conjunction with the conference, the Foundation for Change commissioned Louis Harris and Associates to conduct a major survey of over 1,000 federal trial judges and litigators on their views about procedural reform.The recommendations in this report are significant not only because they are comprehensive in scope but also because of the diverse group of individuals who stand united behind them. The report reflects a consensus that a comprehensive program for civil justice reform can be successfully implemented and that such reform can significantly reduce litigation costs and delay."

The momentous changes in the Soviet Union brought about by glasnost' and perestroyka have far-reaching implications that continue to grip the attention of the international community. This volume and its companion volume, The Economy, feature research and analysis of the significant events in the development of the revolutionary reforms in the Soviet Union-from the beginning stage, through the period of great euphoria, to the recent troubled times. Ed A. Hewitt, founding editor of Soviet Economy and formerly a senior fellow at Brookings, is now Special Assistant to the President on National Security Affairs and Senior Director of Soviet Affairs at the National Security Council. Victor H. Winston is an adjunct professor of international affairs at George Mason University and coeditor of Soviet Economy.