Synchronization of energy consumption by human societies throughout the Holocene.

We conduct a global comparison of the consumption of energy by human populations throughout the Holocene and statistically quantify coincident changes in the consumption of energy over space and time-an ecological phenomenon known as synchrony. When populations synchronize, adverse changes in ecosystems and social systems may cascade from society to society. Thus, to develop policies that favor the sustained use of resources, we must understand the processes that cause the synchrony of human populations. To date, it is not clear whether human societies display long-term synchrony or, if they do, the potential causes. Our analysis begins to fill this knowledge gap by quantifying the long-term synchrony of human societies, and we hypothesize that the synchrony of human populations results from (i) the creation of social ties that couple populations over smaller scales and (ii) much larger scale, globally convergent trajectories of cultural evolution toward more energy-consuming political economies with higher carrying capacities. Our results suggest that the process of globalization is a natural consequence of evolutionary trajectories that increase the carrying capacities of human societies.

A Comprehensive Assessment of Four Options for Financing Health Care Delivery in Oregon.

This article describes four options for financing health care for residents of the state of Oregon and compares the projected impacts and feasibility of each option. The Single Payer option and the Health Care Ingenuity Plan would achieve universal coverage, while the Public Option would add a state-sponsored plan to the Affordable Care Act (ACA) Marketplace. Under the Status Quo option, Oregon would maintain its expansion of Medicaid and subsidies for nongroup coverage through the ACA Marketplace. The state could cover all residents under the Single Payer option with little change in overall health care costs, but doing so would require cuts to provider payment rates that could worsen access to care, and implementation hurdles may be insurmountable. The Health Care Ingenuity Plan, a state-managed plan featuring competition among private plans, would also achieve universal coverage and would sever the employer-health insurance link, but the provider payment rates would likely be set too high, so health care costs would increase. The Public Option would be the easiest of the three options to implement, but because it would not affect many people, it would be an incremental improvement to the Status Quo. Policymakers will need to weigh these options against their desire for change to balance the benefits with the trade-offs.

COBRA subsidies for laid-off workers: an initial report card.

Initial reports about the new COBRA premium subsidy program for recently laid-off workers indicate that enrollment in COBRA continuation coverage has increased substantially, with a healthier mix of individuals enrolling than before. Moreover, implementation has gone smoothly, and most eligible people have heard about the subsidy. Still, many of those who are eligible cannot afford to purchase COBRA coverage, even with the 65 percent premium subsidy. Very high subsidies and very easy enrollment are likely needed to enroll all, or nearly all, newly unemployed people who lack another source of affordable coverage. If the subsidies are extended beyond February 2010, Congress should provide new assistance in ways that are consistent with the existing administrative infrastructure and rules for both COBRA and the ARRA subsidies

Consumer-driven health plans: design features to promote quality improvement.

The most prevalent form of consumer-driven health plans (CDHPs) presents risks in terms of the cost, quality and appropriate use of health care. This article identifies those risks and shows employers how they can reduce them without compromising the overall cost-control potential of CDHPs. A good CDHP strategy should work on both the demand and supply sides of the market.

Building on the job-based health care system: what would it take?

Recent surveys indicate widespread public support for reforming health care by building on our mixed public/private system. The authors present a blueprint for such reform, along with design choices and their implications, that would improve access, cost control, and quality. Requiring employers to provide coverage, or at least to help workers obtain group insurance, combined with income-based premium subsidies, expanded public programs, and backup "insurance exchanges," would make affordable coverage available to nearly everyone. Cost control and quality improvement would be achieved mainly through pressures applied on the health care system by multiple, large purchasers that wield much buying power.