Опосредованное федеральное управление в Австрийской Республике

Federalism as an institutional doctrine

"Who should get the last ventilator?" was an esoteric ethics question until footage emerged from inside the main hospital in Bergamo in Northern Italy at the start of the COVID-19 pandemic.1 While Australia was spared the horror of that reality, the need to ration finite health resources is a perennial problem that confronts all health care systems. Health technology assessment (HTA) is a formal multidisciplinary process that aims to "inform decision-making in order to promote an equitable, efficient, and high-quality health system".2 This article uses a case study approach to examine the role of HTA in the introduction of disruptive technology into the Australian health care system. It identifies structural problems in Australia's current approach that prevent HTA from achieving its equity objective. Aortic stenosis is the most common form of valvular heart disease. It usually has a long asymptomatic phase, but once a patient develops symptoms, typically in their 70s or 80s, their prognosis without intervention is poor. Historically, the only effective treatment for aortic stenosis was surgical aortic valve replacement (SAVR). However, a significant proportion of afflicted patients were either unfit or unwilling to undergo open heart surgery, often simply because of their advanced age and associated frailty. It was the unmet needs of this group of patients that drove the development of the less invasive transcatheter aortic valve implantation (TAVI) procedure, which is usually performed via the femoral artery.3 Since the first-in-man implant in France in 2002, TAVI has displaced SAVR as the procedure of choice for progressively younger and healthier patient cohorts. The current point of equipoise in Australia is the 75–79-year-old cohort (Box 1).4 In clinical practice, TAVI is both a substitute treatment (for SAVR eligible patients) and a new treatment (for SAVR ineligible patients). This has resulted in a decrease in the number of SAVR procedures but an increase in the total number of aortic valve procedures. Both procedures are considered safe, clinically effective, and cost-effective.5, 6 While TAVI valves cost more than SAVR valves, the overall cost of implanting TAVI valves is less than the overall cost of performing SAVR.7-9 The long term (> 10 years) durability of TAVI is yet to be proven, whereas the long term durability of SAVR is well established.5, 6 In both the public and private sector, access to TAVI requires prior approval by a multidisciplinary heart team. "Who should get the last TAVI valve?" is an ethical dilemma that heart teams at many state-run public hospitals routinely grapple with. Unlike the ventilator scenario, where demand exceeds physical supply, this is purely a case of economic rationing, where demand exceeds available funding. For paternalistic and utilitarian clinicians, the decision can seem straightforward. But for clinicians who believe in patient autonomy and egalitarianism, or who are at least used to applying the rule of rescue, choosing between individual patients is an uncomfortable role. For patients who are denied access to TAVI, the consequences of the heart team's decision play out over time. Older, more comorbid patients must come to terms with being denied their only therapeutic treatment option. Younger, less comorbid patients must come to terms with being denied their preferred treatment option. In contrast, all patients with appropriate private health insurance (gold and silver policy holders) are guaranteed access to federally subsidised TAVI. This difference in access explains the disproportionately high rate of private TAVI (Box 2). Based on the level of public activity that would have been required to normalise the rate of private TAVI to that of private SAVR, 1440 public patients were unable to access TAVI in 2021–2022 (author's estimate).4, 10 SAVR = surgical aortic valve replacement; TAVI = transcatheter aortic valve implantation. Private patients are over-represented among patients undergoing TAVI, relative to SAVR. This observation is maximal beyond 85 years of age despite the participation rate for private health insurance declining significantly in this age group.11, 12 Contemporary data for SAVR is consistent with historical data for all surgical heart valve replacements (annual mean from 2000–01 to 2021–22, 40% ± 2%).4, 10 In Australia, public–private access gaps are typically attacked and defended along ideological lines. Such arguments are a red herring. These gaps are, for the most part, an unintended consequence of Australia being a federation of states, not a unitary state. Or more specifically, the fact that under our constitutional arrangements and inter-governmental agreements, state governments have direct responsibility for public hospital activity while the federal government has indirect responsibility for private hospital activity.13, 14 It is inevitable with two levels of government making decisions independent of each other that inconsistencies will arise, especially if the fiscal (or political) implications of a given decision are likely to affect one level of government differently from the other level of government. This problem is compounded by the significant vertical fiscal imbalance that exists between these two levels of government, which makes the state governments dependent on a complex series of agreements that control transfer payments from the federal government to state governments.14 HTA in Australia is dominated by two highly respected federal committees, the Medical Services Advisory Committee (MSAC) and the Pharmaceutical Benefits Advisory Committee. MSAC advises the federal health minister directly on whether new services should be listed on the Medicare Benefits Schedule (MBS), and thus subsidised by the federal government. It should come as no surprise that when MSAC undertakes HTAs, it considers value for money and affordability from the perspective of the federal government. When a new procedure that requires hospitalisation is added to the MBS, it creates a legal obligation on the federal government and third party payers (such as private health insurance companies) to contribute to the cost of the service for patients who elect to be treated as a private patient when they undergo that procedure.15 It does not, however, create an obligation on state governments to provide that procedure in public hospitals.16 Moreover, once a procedure is listed on the MBS, there is no mechanism by which the federal government can limit the number of private patients who can undergo the procedure. In contrast, state governments can limit activity in public hospitals by imposing caps on specific procedures.16 This is the situation we find ourselves in with TAVI. TAVI has been performed in Australia since 200817 but Therapeutic Goods Administration approval, which is a prerequisite for MSAC consideration, was not obtained until 2013. In the absence of system level HTA guidance, early TAVI adopters were forced to rely on ad hoc institutional funding to establish programs in both public and private hospitals. The lack of coordination during this early phase has led to entrenched variations in activity between local health districts (LHDs), which equate to geographical variations in access.18 Between 2014 and 2021, MSAC considered, and ultimately supported, industry-initiated applications for federal funding of TAVI for private patients whose risk of death following SAVR had been assessed as being either prohibitive/high,19 intermediate,7, 8 or low.9 The federal health minister accepted MSAC's advice on each occasion. Corresponding item numbers were added to the MBS in November 2017, March 2022, and July 2022, respectively. Unsurprisingly, these federal HTAs had no immediate impact at the state level. New South Wales, for example, did not establish its High-risk TAVI Supra-LHD Service for prohibitive/high risk patients (which remains underfunded) until June 202120 and is yet to extend access to intermediate and low risk patients. Notably, some of these applications claimed, and MSAC did not contest, that performing TAVI rather than SAVR in intermediate and low risk patients was more efficient in both private and public hospitals.7, 9 This claim highlights the importance of understanding the funder's perspective in HTA, and how that influences HTA-informed decision making. Reduced length of hospital stay is pivotal to TAVI's cost-efficiency claim. In the private sector, these savings are real because third party payers do not have to pay the private hospital operators for as many bed days. But in the public sector, these savings are only theoretical because the state government invariably continues to pay for the bed. Indeed, caring for the patients to whom the bed days are reallocated may lead to a net increase in state government expenditure. The need for a nationally cohesive or federated approach to HTA is recognised in the National Health Reform Agreement as one of six key long term health reforms.16 However, the current Roadmap does not go far enough.21 It mistakenly conceives of HTA as an abstract process that should deliver consistent results when HTA is a contextual process that is dependent on the funder's perspective and their health care system's cost structure. If the existing fragmented approach to HTA is preserved, as planned, and the state and federal governments continue to make decisions independent of each other, the introduction of new technology will continue to be compromised by public–private access gaps. Australia needs a truly national body that can undertake HTA from the perspectives of both the state and federal governments. It needs to be proactive, using HTA as a facilitator for the introduction of new technology rather than a barrier. It should provide its advice to both state and federal health ministers in a form that can support joint decision making in intergovernmental fora. It is only through unified advice that policy makers can understand the differing implications of providing government funding for new technology in both the public and private health care systems. It is only through joint decision making that accounts for these differences that policy makers can develop implementation strategies that guarantee equitable access to new technology. Open access publishing facilitated by University of New South Wales, as part of the Wiley - University of New South Wales agreement via the Council of Australian University Librarians. No relevant disclosures. Not commissioned; externally peer reviewed.

In the past dozen years, the Internet has become a major source of information for modern social and economic history. Given the overwhelming abundance of these sources, it is useful for researchers who want to take advantage of these data to have finding guides, in the style of the older guides prepared for individual archives. It is our aim in this first essay to provide such a guide for Internet sources on Brazilian history.The primary material now available on the Web tends to be of the highest quality. Although much qualitative material produced directly for the Web is of dubious reliability, most of the statistical and graphic materials available were generated by the agencies that gather and produce this material for Brazil and are the same as those available in print. Often, the data provided are more complete than can be obtained in any print-based archive. One potential problem with using Web materials is determining the source of data, in order to judge its quality. International agencies, foreign governments, and NGOs are involved in producing social and economic data on Brazil. Much of this information is usually of the same high quality as that generated by Brazilian government agencies; the data is either generated by these non-Brazilian government agencies or taken directly from the primary Brazilian producing institutions. In some cases, secondary agencies such as the UN’s FAO (Food and Agricultural Organization) provide more detailed information than Brazilian governmental sources. But in some cases, as with the World Bank and some other UN agencies, these data may conflict with information produced in Brazil, either because they have used Brazilian data that is out-of-date or rely on their own estimates, which may not be as accurate as the most current governmental statistics. In these cases, we recommend relying on the original Brazilian materials.It should be stressed that the Brazilian government, at all levels and across its various agencies, maintains these Web sites free or charge to all users, with no need to register, obtain a subscription, or pay a fee. The only exception is the subscriptions gateway maintained by CAPES, intended for Brazilian scholars who need access to subscription pay sites outside Brazil (http://www.periodicos.capes.gov.br). This open access is not the norm for many European and UN Web sites, which often require formal registration and sometimes charge usage fees. I have included this in my descriptions and suggest access through your local university.In comparison with most other countries, Brazil’s research institutes and government agencies both produce excellent quantitative materials and make them available on the Web. Most Brazilian Web sites offer good search functions, a crucial component of any site, and usually make it easy to download materials in either text, PDF, HTML, or spreadsheet formats (from generic CSV to Excel and Lotus). Maps and other graphic materials are becoming ever more abundant, usually provided in standard graphic compression formats (most often as JPEG or GIF files) or imbedded in PDF files. Almost all governmental Web sites also provide excellent links that can be used to expand the search for materials in other national and international agencies and organizations. Some sites offer a complete gateway (“portal” in Portuguese) that leads in a coherent way to subagencies or institutions within a given area.In providing this guide, we have grouped Web sites into sources that produce the original data and then grouped these and other institutions into broad social and economic categories. In each case we provide the Web site for the institution producing the data. But as anyone who has done Web searches knows, URLs often change or disappear. In these cases we recommend using a search engine such as Google to find the new addresses. Finally, for grammatical reasons, some of the URLs listed below end in a period in this document. But for searching purposes this period should be removed as they are not part of the Internet address.1. Instituto Brasileiro de Geografia e Estatística (IBGE), http://www.ibge.gov.br, the federal government’s national statistical bureau and clearly the single-most important Brazilian institution producing social, economic, and geographical data. IBGE’s site has a very useful links section, with lists of federal, state, and municipal government home pages, as well as federal, state, and municipal university sites. It also contains sources for geographic information and gives URLs for international organizations that provide information relevant to Brazil. Researchers can either download summary tables from the site or, through their special service SIDRA (see below), create their own tables of economic and social information taken from IBGE’s various censuses and surveys of population, the economy, and even of households (the famous PNAD surveys). The ability to generate personalized datasets is a very useful and unusual feature of this site.2. Ministério da Educação, http://www.mec.gov.br, offers general information on education, as well as access to several other important federal government agencies that work in this area, such as Fundo Nacional de Desenvolvimento da Educação (FNDE), the Conselho Nacional de Educação (CFE), the Fundo do Ensino Fundamental (FUNDEF), the Coordenação e Aperfeiçoamento de Pessoal do Ensino Superior (CAPES), the Fundescola, and the Instituto Nacional de Estudos e Pesquisas Educacionais (INEP).The INEP is the research branch of the ministry, and their site (http://www.inep.gov.br/default.asp) offers a great variety of information, including formal educational censuses.3. Ministério da Previdência e Assistência Social (Social Services and Welfare), http://www.mpas.gov.br/#, provides information concerning welfare, work accidents, and even annual census materials related to these themes, especially under the section “Estatísticas.”4. Ministério da Saúde (Health), http://www.datasus.gov.br/, offers data related to public health and other social concerns. The ministry also administers an excellent gateway to all other agencies in Brazil dealing with health: http://portal.saude.gov.br/saude/.5. Banco Central do Brasil, http://www.bacen.gov.br, is a valuable source of primary information on the Brazilian economy that can be accessed through “Sistema Financeiro Nacional” and “Informações Econômicas e Financeiras” and offers general statistics on the economy and financial systems, with dozens of statistical series, short-term economic indicators, and macroeconomic information. The institution also generates numerous publications, including periodicals, special studies, and technical notes. The Central Bank’s data is notable for its quality and frequency. The Central Bank also provides information on the expanding agricultural sector, with statistics relative to various agricultural markets and public and private financing. Finally, it offers a gateway in both English and Portuguese, at http://www.bb.com.br/appbb/portal/index.jsp.6. Ministério da Fazenda (Treasury), http://www.fazenda.gov.br, contains much economic information, including data on the public debt and fiscal information, and an excellent set of links. The ministry also has legislative information, including acts related to the Treasury. Here one can also find copies of all the agreements signed between Brazil and the IMF.7. Caixa Econômica Federal (Federal Savings Bank), http://www.caixa.gov.br; through its “Fundo de Garantia por Tempo de Serviço,” the Caixa is the principal source of funding in the areas of Housing and Sanitation. Its site provides qualitative information on its programs, as well as relevant legislation. Unfortunately, the site offers no statistical information.8. Ministério do Planejamento, Controle e Gestão (Planning), http://www.planejamento.gov.br, presents general information concerning long-term federal investments, budget outlays, and principal programs. It also offers information on the relation of the federal government to international agencies and the administration of federal state enterprises. It offers links to a large number of national and international public agencies. The best social and economic research center in Brazil—IPEA—is located within this ministry but is discussed separately below (see section 4.2).9. Ministério da Agricultura, http://www.agricultura.gov.br/, is a very useful site with information on the production and commercialization of agricultural products. It also gives access to dozens of federal and state agencies on agriculture and food supply. A subsection of the ministry is the Empresa Brasileira de Pesquisa Agropecuária (EMBRAPA), one of the principal research centers in the country, http://www.embrapa.br. The site offers access to the fundamental “Base de Dados da Pesquisa Agropecuária de 2002,” which gives the latest statistical information (http://bdpa.cnptia.embrapa.br). Information on family agriculture can be found at http://gipaf.cnptia.embrapa.br. A virtual library with emphasis on agriculture can be accessed at http://www.sct.embrapa.br/liv/. Here one also finds the “Rede Nacional de Meteorologia,” offering information on climate and agricultural regions: http://masrv54.agricultura.gov.br/rna.10. Ministério do Trabalho e Emprego (Labor and Employment), http://www.mte.gov.br, contains information on unemployment insurance, annual employment figures in the private sector, and retirement plans from the Fundo de Garantia por Tempo de Serviço (FGTS). The “Estatísticas” section offers statistical materials on themes such as the “Relação Anual de Informações Sociais,” which gives annual data sent by private companies that contract workers. The site also presents employment and unemployment data from the “Salário Desemprego” and the “Sistema Nacional de Emprego (SINE),” data on work-related accidents, and other information related to workers.11. Ministério do Desenvolvimento Indústria e Comércio Exterior (Indus trial Development and Foreign Commerce), http://www.mdic.gov.br/default.asp, provides information on foreign trade, costs of production in various economic sectors, and research on productivity in general. It reproduces material from its Anuário Estatístico da Secretaria de Desenvolvimento da Produção on the Gross Domestic Product (PIB), as well as employment data for the industrial sector. This site also has a gateway to agencies that with deal with inter-industrial productive relations.A subsection of this ministry is the National Economic and Social Development Bank (Banco Nacional de Desenvolvimento Econômico e Social, BNDES, which has an excellent site at http://www.bndes.gov.br. “Estudos e Publicações” presents statistical studies concerning the principal economic sectors, especially related to basic inputs and infrastructure, as well as material on social and urban development. The BNDES, as the administrator of the national program of privatization, also furnishes important information on this theme.The IBGE offers a very detailed listing of summary statistics and maps for every municipality in the country, showing the latest population, economic, and social data, at http://www.ibge.gov.br/cidadesat/default.php.Many of the states’ own statistical agencies maintain excellent Internet sites. São Paulo’s Fundação Sistema Estadual de Análise de Dados (SEADE), http://www.seade.gov.br, provides basic statistics on the state’s population and economy and direct access to the “Memória das Estatísticas Demográficas,” http://www.seade.gov.br/500anos, which presents, among other types of information, demographic statistics on the state’s municípios over the past one hundred years, along with useful historical maps. The SEADE site also offers links to all of Brazil’s state statistical agencies—for example, the Centro de Informações e Dados do Rio de Janeiro (Fundação CIDE), http://www.cide.rj.gov.br, and the Fundação João Pinheiro do Governo de Minas Gerais, http://www.fjp.gov.br.The IBGE site also offers links to many municipal governments, but there is also a special gateway to all municípios, Municípionline, at http://www.municipionline.com.br. http://brasilchannel.com.br/municipios serves a similar purpose. Finally “Rede Governo,” http://www.redegoverno.gov.br, functions as a gateway to numerous government agencies and services at all levels, including to Brazilian legislation.1. Under the section “População,” the IBGE site presents a series of statistical information, primarily demographic in nature. The two most important are the results from the last two national censuses, 1991 and 2000. This sectional also offers much information on health, education, labor force activity, and even sanitation, disaggregated at the national, state, and municipal levels. Another important subsection contains information from the famous household surveys—the Pesquisa Nacional por Amostra de Domicílios, or PNAD, which has been systematically gathered from a very large national sample since the 1960s and is one of the most important periodical surveys carried out in Brazil. These surveys collect detailed information on income, employment, and housing, as well as educational and demographic data. Many of the earlier surveys are now available on CD, and data from the 2001 PNAD are already available on the Web. Vital statistics are found in the subsection “Estatisticas de Registro Civil,” which contains data on births, deaths, marriages, and divorce/separation for 1997–98 and 1999–2000. Life tables (“tabua de vida”) are available for 2000 and 2001. Finally, the latest population estimates and projections, made in 2000 and projecting basic demographic indices through 2050, can be obtained through FTP.One can link from the main IBGE site to their special Web program, SIDRA (“Sistema IBGE de Recuperação Automática”), at http://www.sidra.ibge.gov.br/bda. As mentioned earlier, this system allows users to create their own tables of selected data, controlling its tabular presentation, level of desegregation, and geographic scope. The tables created can either be viewed as HTML to cut- and-paste, or saved as a file in various formats.1 SIDRA contains both demographic and economic and social data2. Núcleo de Estudos em Demografia Histórica (NEDH), http://members.tripod.com/~Historia_Demografica/INDEX.HTM, publishes an online journal, as well as important bibliographic information and working papers. “Rol On-Line: Relação de Trabalhos Publicados na Área de História Demográfica” contains bibliographic citations and hundreds of summaries of articles.3. Associação Brasileira de Estudos Populacionais (ABEP), http://www.abep.org.br, offers access to numerous demographic studies, as well as links to other national and international institutions that have an interest in Brazilian demographic conditions.4. Centro de Documentação (CENDOC) do Núcleo de Estudos da Popu-lação (NEPO), http://www.unicamp.br/nepo, provides qualitative information and access to bibliographic data and studies produced by the researchers of the center. It also possesses a link to listings of similar institutions.5. Comisión Económica para América Latina y el Caribe, Santiago de Chile, (ECLAC/CEPAL), http://www.eclac.cl, is an important UN regional agency providing fundamental comparative economic and social information. Access to its more-detailed statistical information (as with most UN agencies) may require a university subscription. However, their important studies, many of which have very detailed statistical information, are available in PDF format. Their most important publication is the Statistical Yearbook for Latin America and the Caribbean, a fundamental source of excellent materials. They also publish special reports, such as Foreign Investment in Latin America and the Caribbean—2002 Report, and Social Panorama of Latin America 2001–2002. CEPAL is also the parent for the Centro Latinamericano y Caribeño de Demografía (CELADE), http://www.eclac.cl/celade/. CELADE works closely with all the Latin American government statistical agencies, including IBGE. Its site contains excellent demographic information, and the agency publishes the Boletín Demográfico, which can be accessed online and which normally concentrates on a different theme each issue (urbanization, for example). An examination of the CELADE publications list shows around 2,500 documents, reports, and publications related to Brazil.6. The United Nations Population Division, http://www.un.org/popin, is the best source for international demographic materials, some of which go back to the mid–twentieth century, but requires a university subscription for access. The Population Division also produced An Historical Supplement covering world and country data from 1948–97, available on CD-ROM. The organization collects data on housing, vital statistics, and social indicators, along with information about migration, urbanization, refugees, and so on.7. The World Health Organization of the United Nations can best be used through its WHOSIS search engine (WHO Statistical Information System), http://www3.who.int/whosis/menu.cfm. The WHO also can lead one to the regional health organization PAHO (Pan American Health Organization), http://www.paho.org/default.htm. Data can be found at the section called “Health Data.”8. U.S. Census Bureau, International Program Center, http://www.census.gov/ipc/www/index.html, contains information on Brazil and the other countries of Latin America. A list of publications is available at http://www.census.gov/ipc/www/idbnew.html.9. IPUMS International, http://www.ipums.umn.edu/international/index.shtml, at the University of Minnesota, is currently generating public-use samples (of individuals) from Latin American censuses in the twentieth century, available in either SAS or SPSS format.10. Institut National d’Études Démographique (INED), http://www.ined.fr/population-en-chiffres/indexF.html, maintains a great quantity of demographic information from all the countries of the world.11. Max Plank Institute, http://www.demogr.mpg.de, and the University of California at Berkeley, Department of Demography, maintain an online historical mortality database. This excellent source for nineteenth- and twentieth-century age, sex, birth, death, and life-expectancy tables for many European and American countries is available at http://www.mortality.org. Along with INED, these two institutions also maintain a life table for world populations at The World Bank offers statistics on Brazil and other Latin American at under and and some dealing with Brazil. This section can only be used through a university subscription. is also an that presents statistical series on economic as well as research The an important online guide for and demographic research on Brazil. This listing is complete and contains a large number of important The of Population of University presents an on demographic themes under its The University of Population Center, maintains a very listing of working papers. It also has a useful links The Development has a list of studies available on Brazil, related to Latin American social produced by the Development of the can be found at the IBGE home the section on presents numerous economic census materials, such as the national for as well as regional the agricultural and general information about the principal economic for example, contains data on agricultural national by industrial and general of along with information on employment and Another important is the Pesquisa de a household with detailed information on and very detailed family budget The Instituto de Pesquisa Econômica an research center within the of is one of the most important research centers dealing with the economy and of Brazil. 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Native American Voting Rights in Utah: Federal Policy, Citizenship, and Voter Suppression

How have the efforts to coordinate the actions of federal, state, and local governments adjusted to the iterative shifting of responsibilities among levels of governments? The efficiency and effectiveness of intergovernmental interactions have been challenged by current constraints. Using the hypothetical Reinvent, Inc., the following example illustrates the constraints currently affecting the productivity of intergovernmental interactions. At Reinvent, Inc., three profit center executives -- A, B, and C -- have specific authority, responsibilities, and resources at their disposal. The nature of Reinvent, Inc.'s business requires that the executives coordinate the work of their profit centers. Initially, Executive A provided funds and directives to Executives B and C to assist in accomplishing their profit centers' work. Executives B and C were in a subordinate role to Executive A due to their economic dependence. The owners of Reinvent, Inc. recently directed Executive A to reduce funds to Executives B and C. As they have sought and obtained other sources of funds, Executives B and C have become more economically dependent on Executive A. Although the economic relationship has changed, the owners directed Executive A to retain and assert more authority over Executives B and C by increasing the directions, and the requirements, expectations, and the responsibilities of Executives B and C. The three executives communicate regularly to adjust the coordination of their work as each change is instituted. This example portrays current intergovernmental relations, with Executive A representing public administrators in the federal government, and Executives B and C representing public administrators in state and local government (Wright, 19990; ACIR, 1996). Ideally, for intergovernmental relations to have high productivity, the authority, purposes, responsibilities, and resources of federal, state, and local governments would be clearly delineated and stable. Given that less than ideal circumstances exist, the following discussion identifies coping strategies that should be or are being used to enhance the productivity of intergovernmental relations. Continuous Awareness of Current Capacities Awareness of three-year and five-year trends is informative, but it is increasingly important for governments at all three levels to monitor the nearer term in order to capture unanticipated changes that will spike demand for public services. Public organizations at each level can individually and collectively determine on an ongoing basis what their unique and current strengths are and assess what each can realistically accomplish. The following discussion of the unique strengths of the three levels of government is directed to that end. At the federal level, comprehensive knowledge is avoidable from which overall trends a-nd statistics can be derived. The resources are also comprehensive, enabling the broadest range of activities to be supported. Through these resources, the federal. government has the greatest capacity to function as a change agent using regulation and unfunded mandates or by tying funding to planning, performance measurement, civil service, or other requirements (Hatry, 1989). The federal government has also served as a trendsetter for other government units with regard to public employees through the passage of civil service reforms (Henry, 1992). State and county governments are confronted by a smaller range of competing interests than the federal government. Regional interests are both more specialized and more unified than at the federal level. For example, states have specific industries such as farming, oil, or aeronautics instead of the full spectrum of industries that compete for favor at the federal level. State and county governments have narrower tax bases than the federal government and, without the extensive public-good obligations like defense, they can focus these resources on issues and problems unique to their region. …

Historians writing in the future are likely to regard the two terms of the Reagan administration as a watershed period in the development of the American administrative state. This period is likely to be seen as a time when some issues of governance and public administration that had been brewing for quite a while were finally brought to the surface of political debate. At the center of this debate is the issue of the desirability of government intervention in the nation's social and economic affairs. An airing of this issue in the 1980s is particularly compelling because it is obvious to even the most casual observer that the United States is in the midst of a longterm technological, economic, and demographic transformation that is creating problems and opportunities for its people and government at a rapid pace. The technical and economic changes are closely interwoven. The nation is moving from an industrial era where the United States dominated the world economy through durable goods manufacturing and financial dealing toward what some have labeled a postindustrial, technoservice, or knowledgeintensive society. I In this new era, the world economic system is quickly becoming considerably more complex than before, with the movement of money and the production of goods and services more internationalized than in the past. In the process, the economic dominance of the United States has become more problematic than at any time since World War II reflecting a change in America's ability to control international markets and their importance in the economic health of the nation. To further complicate this picture, the demographic shape of the nation itself is changing. At least four dimensions of this demographic shift are cause for concern: (1) the growth in our aged population-the population of people over age 65 is expected to rise from 27 million in 1983 to about 35 million by the year 2000that will generate new demands on private resources and the federal treasury by way of pension, social security, and health care costs; (2) the aging of the baby boom generation-those born between 1945-1959-who will also be expected to place heavy demands on government but may also produce pressure for conservative social

First Bank of the United States as a Prototype for the Federal Reserve SystemSummaryThe article describes the history of the First Bank of the United Statesfirst banking- institution, that was charted in XVII-th century North America as an effect of a cooperation of two federal bodies – Congress and the President. Although, the federal government possessed only 20 %, of the shares with federal licences it could conduct its activity on territory of the whole country. Moreover – the Bank is now referred to as the first central bank in the United States because of its national scope and services rendered to the federal government. The Bank helped the government to obtain emergency loans, facilitated the payment of taxes, and served as the receiver and disburser of the public funds. In addition, it issued bank notes and made them fully redeemable in coin. During a 20-years period the Bank achieved a commercial success and maintained a financial stability. However, in 1811 Congress did not renew the charter because the Bank’s constitutionality was questioned.Alexander Hamilton (the first U.S. Secretary of the Treasury), who was [the followerof creation of the bank, already in 1790 assumed that the federal government had the power to charter banks because the Constitution granted the government the right to establish institutions necessary for its operations. Addifferent viewpoint was presented by Thomas Jefferson who favored a more decentralized government and believed that only the states could charter banks under the Constitution. Furthermore – because the Constitution did not expressly grant the power to Congress, he reasoned that federally chartered banks were unconstitutional. Finally in 1819, as a far-reaching decision, the Supreme Court Chief Justice John Marshall followed Hamilton’s reasoning and ruled in case McCulloch vs Maryland that the Second Bank of the United States was constitutional. For U.S. federal government this decision of the Supreme Court was very important about 200 years later – in 1913, when president Wilson, many politicians’ and main U.S. bankers decided to create the Federal Reserve System.

The Potential for Federal Preemption of State and Local Sugar-Sweetened Beverage Taxes

Following ratification of the Constitution, Alexander Hamilton raised a fundamental question about the new system of government not directly addressed in the Constitution: What is the appropriate role of the federal government in the economic and social development of the nation? As secretary of Treasury, Hamilton advocated strong policies, and strong central administration of those policies: assumption by the federal government of debts of the states and of the United States; payment of debts through taxes; and establishment of a national bank to carry out these and related policies. According to Charles Beard,' Hamilton's program was a capital formation program designed to promote economic growth in the new nation. Hamilton's program was enacted by the first Congress and signed into law by President Washington. It contributed to the development of a central administrative organization of the new government.2 Hamilton's justification of his program significantly affected constitutional history. It was adopted by Chief Justice John Marshall almost for word in Marshall's decision in 1819 upholding the power of Congress to charter a bank.3 Marshall's decision served as precedent for the exercise of substantial economic and administrative powers by the federal government later in the nineteenth and twentieth centuries. Hamilton's program raised but did not definitively answer a question recurrently debated ever since: To what extent and in what ways should the federal government be responsible for economic and social develop

The handbook provides a comprehensive and fundamental description of the organization, tasks, working methods and functions of the Federal Chancellery and the federal ministries as well as cooperation within the entire federal government. The 8th edition of the handbook has been revised and updated. Complete new information has been added on the Federal Government Commissioner and Minister of State for East Germany, which was created in the 20th legislative period. In order to contribute to a deeper understanding of the function of executive constitutional structures, the handbook covers topics on the parliamentary system of government and specifically on decision-making processes within the federal government. However, it also conveys a practical picture of the course of day-to-day government work, which is at the center of political interest. The initial focus is on the constitutional role of the Federal Chancellor and the exercise of his constitutional powers within the government and in relation to other constitutional bodies. In addition, the book is intended to provide a well-founded as well as descriptive insight into the functioning of the federal government.

The Symposium on the National Performance Review (NPR) and Public Administration, contained in this issue of the International Journal of Public Administration, offers some insights from prominent scholars in the field. They have presented their research and assessments of a subject with enduring importance: government reform. They have critically appraised the progress of the latest effort toward such change, but they are generally pessimistic about the prospects for improving the effectiveness and economy of the federal government. However, they have not sought to evaluate the work of the NPR as a matter of what they think ought to have been examined. Instead, they explore whether it is accomplishing what it set out to do. They do not contend, as did management luminary Peter F. Drucker recently, that this commission should have explored a far different topic—namely, possible normative purposes of government at federal, state, and local levels and potential relationships with non-government sectors (non...

The Legal Boundaries of Educational Governance

Interstate pollution spillover and setting environmental standards

Review: Large-Scale Ecosystem Restoration: Five Case Studies from the United States Mary Doyle and Cynthia A. Drew (Eds.) Reviewed by Elery Hamilton-Smith Charles Sturt University, Australia Doyle, Mary and Drew, Cynthia A. (Eds.). Large-Scale Ecosystem Restoration: Five Case Studies from the United States. Washington, D.C.: Island Press. 325pp. ISBN 1-59726-026-6. US $35.00, recycled, acid-free paper. The basic practical organizational problems which arise in almost any co-operative initiative within a Federal government are notorious. Pressman and Wildavsky (1973) carried out a valuable critical review and case study under the title (!) Implementation: How great expectations in Washington are dashed in Oakland; or, why it’s amazing that Federal Programs work at all, this being a saga of the Economic Development Administration as told by two sympathetic observers who seek to build morals on a foundation of ruined hopes. (University of California Press, Berkeley). Since that time governmental administrators have learned a great deal about adaptive management, but new issues in governance arise, and introduce new problems in co-operative initiative. The current emphasis upon risk management is one of these, and although it was probably seen as not relevant to co-operative action, it inevitably adds to the difficulties. Similarly, the arena within which action is planned and acted upon will also grow to be more complex. The current example which is central to this book is the recognition that to focus any restoration program upon a single element of the environment is not likely to be effective. Rather we now accept the centrality of ecological thinking with its basis in complexity and inter-connectedness. So, we have moved towards tackling all aspects of the restoration program at one time and in a balanced way. In turn this leads us to continuing research and the struggle to integrate new knowledge into our practical strategies or in other words to adopt an adaptive management approach. Inevitably this leads to contest and the need to resolve differences. But restoration at this level demands immense resources and co-operation across all levels of social organisation. So the restoration arena is also a contested one with differences and immense problems in attaining resolution and continuing commitment. This book is organised around five major regional programs, each defined by the boundaries of a major watershed – Everglades, Platte River, California-Bay Delta, Chesapeake Bay and the Upper Mississippi. The watershed boundary itself represents a significant change in thinking as it defines a common basis for conceptualizing what is to be done. It avoids the almost universal fragmentation of natural environment by cadastral and political boundaries. Yet at the same time, it introduces a new contest over access to and management of resources. Each program is examined from three viewpoints: the origin and evolution of the program, the scientific understanding of the region, and the political economy of the project and its impacts. The authors have achieved a great deal in their clarity of analysis. They provide an excellent model for case studies of this kind through identification of the key dimensions which must be assessed and the key inter-related elements which shape the success or failure of any project: Timing and levels of funding Setting and meeting interim and final goals Nature and status of the federal-state partnership Quality of the science and its integration in decision making Conflict management and resolution Building and maintaining public awareness and support Although federal and state governments are the major partners in these projects, a very similar model might well be used in planning, managing and assessing any other complex inter-organisational

Canada enjoys a global reputation as a defender of human rights at home and abroad that reflects a solid record on core civil and political rights protections, and a generally progressive approach to economic and social rights. Nonetheless, serious human rights concerns demand remedial action by federal and provincial governments, particularly with regard to the rights of the indigenous peoples of Canada, people impacted abroad by Canada’s extractive industries, and ethnic and religious minorities in Quebec. Recent federal government actions undermining the ability of civil society organizations to engage in advocacy impede progress on a range of human rights issues.In February 2013, the federal government established an all-party committee in Canada’s House of Commons to hold hearings on the issue of missing and murdered indigenous women and to propose solutions to address root causes of violence. The committee made limited progress and was criticized by missing women advocates for lacking clear direction, prioritizing government witnesses over victims’ family members, and failing to consider alternative, culturally sensitive methods of family and community participation.The Native Women’s Association of Canada has documented 582 cases of missing and murdered indigenous women and girls in Canada as of March 2010. Many of the killings and disappearances were between the 1960s and the 1990s, but 39 percent occurred after 2000. The number of cases is undoubtedly higher today, but comprehensive data is not available since the government cut funding for the organization’s database, and police forces in Canada do not consistently collect race and ethnicity data.