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Use of prospective reimbursement -- ie, setting payment rates in advance -- as a means of government control over rising hospital costs is discussed. The growing governmental role in hospital payments since the enactment of Medicare & Medicaid is examined, noting the unequal distribution of repayment in the current retroactive reimbursement formats & the long-range incentives for hospitals to increase volume regardless of costs. The pilot prospective programs initiated by Blue Cross & some state systems are evaluated; while persistent fractionalization problems are identified, cost inflation is seen as slowing in NJ & Md health units having prospective plans. Potential development of the Diagnosis Related Groups system used in NJ is also considered. 1 Table. L. Whittemore.

Most analyses of arms control during the Cold War focus on its role in maintaining strategic stability between the United States and the Soviet Union. However, history shows that the superpowers' search for strategic stability is insufficient to explain the roots and course of negotiations. This essay argues that arms control was used as one tool in a broader strategy of war prevention, designed to contain a series of challenges to U.S. and Soviet dominance of the international system that both sides worried could upset bipolarity and increase the chances of conflict between them. At the same time, U.S. policy-makers balanced this joint superpower interest with Washington's extended deterrent commitment to its allies, which ultimately upheld the integrity of the system as a whole. The essay concludes that today's leaders should integrate arms control into a more comprehensive strategy of political accommodation fit for twenty-first-century conditions.

In order to prevent the rapid spread of COVID-19, governments have placed significant restrictions on liberty, including preventing all non-essential travel. These restrictions were justified on the basis the health system may be overwhelmed by COVID-19 cases and in order to prevent deaths. Governments are now considering how they may de-escalate these restrictions. This article argues that an appropriate approach may be to lift the general lockdown but implement selective isolation of the elderly. While this discriminates against the elderly, there is a morally relevant difference—the elderly are far more likely to require hospitalisation and die than the rest of the population. If the aim is to ensure the health system is not overwhelmed and to reduce the death rate, preventing the elderly from contracting the virus may be an effective means of achieving this. The alternative is to continue to keep everyone in lockdown. It is argued that this is levelling down equality and is unethical. It suggests that in order for the elderly to avoid contracting the virus, the whole population should have their liberty deprived, even though the same result could be achieved by only restricting the liberty of the elderly. Similar arguments may also be applied to all groups at increased risk of COVID-19, such as men and those with comorbidities, the obese and people from ethnic minorities or socially deprived groups. This utilitarian concern must be balanced against other considerations, such as equality and justice, and the benefits gained from discriminating in these ways must be proportionately greater than the negative consequences of doing so. Such selective discrimination will be most justified when the liberty restriction to a group promotes the well-being of that group (apart from its wider social benefits).