Deliverance: A Study of Medicaid and Managed Care Essay -- Health Medi

Deliverance: A Study of Medicaid and Managed Care Since the inception of Medicaid in 1965, the program has seen extraordinary growth in expenditures and enrollment. From 1989 to 1992, the increases in Medicaid spending were the largest since the program began in. Enrollment in Medicaid by AFDC families grew from 3.8 million in 1990 to 4.4 million in 1992, almost a nine percent annual increase (Coughlin et al. 1994). During this period, states were also experiencing the effects of a nationwide recession. Rapidly rising expenditure levels stretched revenue streams to their limits. In efforts to save money, states looked primarily at the benefits of managed care, which was becoming a successful delivery and financing system (Ruggie 1996). Medicaid patients had a history of using emergency rooms for problems such as colds, flues, and other minor illnesses. Medicaid paid $75 for an emergency room visit in 1995, but only $29 for a physician’s office visit (Lutz 1995). Medicaid officials hoped that placing the patient in contact with a primary care physician would encourage the use of preventative medicine, thereby holding down costs. States began Medicaid managed care programs using the AFDC population as guinea pigs. With waivers allowed under Section 1115 of the Social Security Act, states restructured their Medicaid programs (Rotwein et al. 1995). This was the single largest Medicaid innovation of the 1990s (Couglin et al. 1999). Between 1991 and 1996, enrollment of Medicaid clients in managed care increased by a factor of six (Thompson and DiIulio 1998). Many reasons accompanied the assertion that the AFDC population would benefit the most from managed care. The women and children of AFDC could take advantage of the ... ...cience Review 67: 1174-1185. Key, V.O., Jr. 1999, reprinted. Southern Politics in State and Nation. Knoxville: University of Tennessee Press. Lutz, Sandy. 1995. â€Å"For Real Reform, Watch the States.† Modern Healthcare 25: 31- 35. Rotwein, Suzanne, Maria Boulmetis and Paul J. Boben. 1995. â€Å"Medicaid and State Health Care Reform: Process, Programs, and Policy Options.† Health Care Financing Review 16: 105-120. Ruggie, Mary. 1996. Realignments in the Welfare State: Health Policy in the United States, Britain, and Canada. New York: Columbia University Press. Thompson, Frank J., and John J. DiIulio Jr., eds. 1998. Medicaid and Devolution: A View from the States. Washington, D.C.: Brookings Institution Press. Walker, Jack. 1969. â€Å"The Diffusion of Innovations Among the American States.† American Political Science Review 63: 880-899.

Pat Tillman Essay

Situation Analysis of Tillman Story Stephen Stone Black Sheep, Tillman’s platoon, had to make it to Mana on time. However, they had an inoperable vehicle with them that had to bring back to the FOB, forward operating base. Black Sheep could not abandon the vehicle. There only viable option was to bring it to a nearby paved highway for a wrecker to pick it up. Luckily, they came across a local who could tow it to the highway. However, they ran into an another problem.Whether to split the group or not; Either have the whole platoon escort the local to the highway, split the platoon and have one half escort the local while the other half continued on with the mission, or let the local tow it alone. Black Sheep’s leaders agreed that splitting the platoon would be inviting unnecessary danger and allowing the local to tow the vehicle alone was not even possible. However, the order came down from higher that the platoon would be split in order to stay on schedule. Black Sheep was split into two groups, Serial 1 and Serial 2.Serial 2 will escort the local while Serial 1 continues on with the mission. During this time, there were several miscommunications between headquarters and the platoon. Serial 2’s original path was a difficult and harsh terrain. The local offered an easier and quick path that Serial 2’s leader agreed upon. The local took the front of the convoy and led Serial 2 along the newly decided path. However, they came upon indirect fire, which was later, identify as mortar fire. The local stopped and took cover, which resulted in blocking the convoy on the narrow strip of pass.Serial 2’s members had to force the driver to drive in order to the convoy out of the danger zone. Serial 1 heard the firefight near Serial 2 and went towards it to provide fire. However, communications between Serial 1 and Serial 2 was never established during the incumbent firefight. As Serial 1’s members got into position, Serial 2 mistake nly Serial 1 as hostiles. During the firefight, Serial 1 was engaged with the PID, positive identification, of the enemy while calling out ceasefire towards Serial 2.While all along, Serial 2 was engaged with who they believed was the enemy. Attached to Serial 1 was a AMF, afghan military force, soldier, who wasn’t properly briefed upon to the platoon. Serial 2 mistaken the AMF soldier as an enemy and Serial 1 members near him as hostiles, even though, neither Serial 1 member or AMF soldier were wearing the traditional uniform of the enemy and wearing US Army uniform. Tillman’s group was fire upon and hit. Most of the platoon was deafen by the firefight.It took a few minute before Serial 2 recognized the ceasefire and the aftermath, in which they called for help. Black Sheep had two killed in action, KIA, and few injured from the firefight mainly due to the friendly fires. One of the contributing factors to the deaths in Black Sheep was the leaderships’ devotion to staying on schedule. Leadership continuously sacrifice ranger’s advantages in battle to make up lose time and get back on schedule. The leadership didn’t provide their men enough time to prepare for the mission or at least properly brief their squad.For example, the AMF soldier was supposed to be introduce to the platoon, so friendly fire would not fall upon him like it did. The one of rangers’ standards of operation, SOP, is to operate at night in order to provide them the advantage over the enemy. At night, ranger has a huge advantage over the enemy through technology means and night takes away most of the control from enemy with roadside bombs. However, during the daytime, the enemy has an easy observation of US armed forces and optimal control of their use of roadside bombs and improvises explosive devices, IEDs.I would have further delay the platoon to give the platoon time to brief. I would have stuck to the SOP and used the guises of night to move out . One of the main contributing factors for the outcome was communication. Communication between the platoon and headquarters, communication between squads, and communications inside the squads had several flaws. Headquarters didn’t establish properly with the platoon. Headquarters didn’t take any of the suggestion or opinions from the platoon leaders into account and stuck to their schedule.Also, headquarters didn’t clarify on certain items nor didn’t the platoon make sure the intention of commander with items such as the route to the highway. Communications between squads were made hasty or were never established. During the firefight, the radio was crowded with Serial 2 taking to understand the situation so communication between Serial 1 and 2 was never established. Due to the noise from the firefight and time of day, verbal and visual communication for ceasefire and signs of friendly was not established in time. Communication within squads was never pr operly established.If there was proper channels established, the radio might had been less crowded allowing room for Serial 1 to establish communication. Also, PIDs might have been properly established if communication was established with the squads. Due to the lack communication with Serial 2, there was no PID on the enemy, where Tillman was at, but Serial 2 continued to fire. I would’ve again allowed for more time to the platoon to establish and/or go over the protocols to use the radios, if the radio goes down, reminders of rules of engagement, to ask questions, and such.The lack time and hasty movement contribute to the breakdown of communication which enflame the disarray that surrounded the firefight. I would have sacrifice the time in order to not send my platoon into unnecessary danger. Army doesn’t want to engage an enemy if we don’t not have an overwhelm advantage. We do not want to set up ourselves for failure. However, when the leadership of Black S heep didn’t provide enough time to platoon to prepare and took away various advantages of the rangers in order to stay on schedule. The leadership was setting up the rangers for failure.

The African Of African Diaspora - 1329 Words

The African diaspora also known as the forced movement of primarily Western Africans to various parts of the globe including the Americas, Asia, Europe, and the Middle East. One of the most influential sectors of the African diaspora was the Trans-Atlantic trade route. According to PBS’ How Many Slaves Landed in the U.S.? â€Å"Between 1525 and 1866, in the entire history of the slave trade to the New World, according to the Trans-Atlantic Slave Trade Database, 12.5 million Africans were shipped to the New World,† out of the 12..5 million who were taken, approximately 10 million survived the dreaded middle passage. These freshly chained slaves afoot on unknown terrain were then separated and sold to the highest bidder at a local slave auction.†¦show more content†¦Ancillary, employees who quit before the end date of their labor contract could be arrested and returned to their masters by a judge’s order. Southern Black Codes counted on vagrancy laws to co erce freedmen to sign labor contracts. Not all state constitutions limited these laws to unemployed blacks, many included others such as peddlers and gamblers. The code provided that vagrants could be arrested and imprisoned with harsh labor. However, the county sheriff could rent black vagrants to white employers to work off their sentence.Southern states constitutions also executed apprenticeship laws which yet again supplied white employers with black orphans, and the children of vagrants. These codes allowed courts to apprentice black children against their will until the age of 21 for men, and 18 for women. For another time, those in charge of the children were able to inflict whippings as punishment. Lastly, most Southern states established a racially segregated court systems for both civil and criminal cases. This was also the circumstance for any case that either involved a black defendant or plaintiff. The African American courts exclusively granted black witnesses the rig ht to to testify in court, only in those pertaining to the person or property of an African American. Any crimes that a white person believed and African American may have committe had excruciating penalties. For the most part crimes such as, rebellion, arson, burglary, or assaulting a white womanShow MoreRelatedThe African Of African Diaspora Essay1382 Words   |  6 PagesOver the course of four months, through my African World Survey class, I have seen a glimpse of five thousand years of African history unfold. Before entering the class, my expectations from the course was to learn where did my people come from and how did they live. Within the time I spent in the first class, I soon realized that these two questions did not have simple answers to them. 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