The ACA provided, however, that these reductions in out-of-pocket limits should not increase the actuarial value of plans above the limits set for cost-sharing reduction payments. Herbert Marcuse Köln, Dt. Herbert Marcuse und die Tradition," in: Books, Articles and Reviews about Herbert Marcuse. Herbert Marcuse argued that leisure is part of the one-dimensionality of alienated life defined in terms of possessions and market participation. Masturbation ou prise de conscience pratique, In:
David Held , Introduction to Critical Theory: From Horkheimer to Habermas Berkeley: University of California Press, , p. Barry Katz , Praxis and Poiesis: The Romantic Dimension," Telos 44 Summer Luke , "Marcuse's emancipatory politics," microform, prepared for delivery at the annual meeting of the American Political Science Association, Washington, D.
American Political Science Association. Proceedings 76th [UCB] Herbert Schnädelbach Hamburg , " Betrachtung eines Unzeitgemässen: Morton Schoolman , The Imaginary Witness: Collier Macmillan, c , p; bibliography: Durbin in Technology and Culture Vol. Antonio in Contemporary Sociology Vol. Jean-Paul Thomas , Libération instinctuelle, libération politique: Le Sycomore, , p. Zur Kritik der 'Kritischen Theorie'. Editorial RIN, , p.
Feminismus als weibliche Negation? Cornell University Press, Vincent Geoghegan , Reason and Eros: Pluto, , p. Jürgen Habermas , Philosophisch-politische Profile , , A Conversation with Herbert Marcuse," in: Hans-Dieter König , Libido und appetitus: Germinal-Verlag, , S. An Interview ," in: Moran , Marcuse's "New man": Exposition and a Christian dialogue Ann Arbor, Mich.: Forum Academicum in der Verl. Herbert Marcuse Köln, Dt.
A, , S. Zahn , "Herbert Marcuse: Die Utopie der Glücklichen Vernunft," in: Ben Agger , "Marcuse's Freudian Marxism," in: Studi di Sociologia , Anno 20, Fasc. John Burrill , Marcuse and Freedom Stockholm: Stockholms Universitet, Avdelningen för idéhistoria, , 27 leaves. Martin Jay , "Anamnestic Totalization: Reflections on Marcuse's Theory of Remembrance," in: Theory and Society An Intellectual Biography London: Schocken Books, , p pp.
The Journal of Politics Vol. Europäische Verlagsanstalt, Frankfurt am Main: Fischer, text excerpts Egon Viesel , Gesellschaftstheorie, Sprachanalyse und Ideologiekritik: Dialectical Anthropology Amsterdam , 8: Rudi Dutschke , Die Revolte: Wurzeln und Spuren eines Aufbruchs Reinbek bei Hamburg: Rowohlt, Spanish: José Jiménez , La estética como utopía antropológica: Bloch y Marcuse Madrid: Tecnos, , S.
A, , Bl. Pontificia, , S. Peter Prechtl , Bedürfnisstruktur und Gesellschaft: Lewis Pyenson , Neohumanism and the persistence of pure mathematics in Wilhelmian Germany Philadelphia: American Philosophical Society, , p. Memoir, about math teaching Ulrich Gmünder , Aesthetik, Wunsch, Alltaeglichkeit: Fink, , S.
The Phenomenological Heritage Manchester: Abstract at Telos website. Gerd Kleinstück , Das Menschenbild des ethischen Sozialismus: Issues in Radical Therapy Wolfgang Abendroth , Die Aktualität der Arbeiterbewegung: Beitrag zu ihrer Theorie und Geschichte Frankfurt am Main: Suhrkamp, , S. Alford , Science and the revenge of nature: University Presses of Florida, , p Contents and first pages of chapters available at Questia. The Issues Involved 1 2. Freedom and Labor in Marcuse's Early Works 21 3.
The Ground of Absolute Freedom in Eros 37 4. Science and Survival 69 6. Habermas' New Science 9. Reconciliation with Nature or New Categories of Experience? Ross Fitzgerald , " Human Needs and Politics: The arti- cle also demonstrates how the notion of "need" itself coalesces "is" and "ought" and argues how a politics based on a theory of human needs has dangerous authoritarian implications and involves a denial of individual freedom.
Friesenhahn , Kritische Theorie und Pädagogik: Express, , p. Gerhard Gamm , Angesichts objektiver Verblendung: Über die Paradoxien Kritischer Theorie Tübingen: Ulrich Gmünder , Kritische Theorie: Horkheimer, Adorno, Marcuse, Habermas Stuttgart: Metzler, , p. Daniel Innerarity , " Dialéctica de la liberación. La utopía social de Herbert Marcuse, Anuario filosófico, Dominque Janicaud , "Critique de la rationalite marcusienne," in: Diffusion, Les Belles Lettres, , p. Jacob Klapwijk , Philosophien im Widerstreit: Erhard Koch , Eros und Gewalt: Untersuchungen zum Freiheitsbegriff bei Herbert Marcuse Würzburg: Berthold Langerbein , Roman und Revolte: Centaurus, , p.
Peter Lind , Marcuse and Freedom London: Croom Helm, , p. Lukes , The Flight into Inwardness: Lee Ann Osbun , The problem of participation: Roland Roth , Rebellische Subjektivität: Campus, , p. Cincel, , S.: Axel Honneth, Albrecht Wellmer eds. Referate eines Symposiums der Alexander von Humboldt-Stiftung vom Dezember in Ludwigsburg , Harvest House, , p.
Fred Alford in Contemporary Sociology Vol. Horkheimer und Marcuse," in: André Vachet , Marcuse, la révolution radicale et le nouveau socialisme: Editions de l'Université d'Ottawa, , p. Rolf Wiggershaus , Die Frankfurter Schule: Hanser, , p; Bibliography: Lang, , p. Ben Agger , "Marcuse's Aesthetic Politics: Ideology-Critique and Socialist Ontology," in: Columbia University Press,, , pages. Kelly , "Possessing Leisure: VEblen and Marcuse Reconsidered," in: World Leisure and Recreation Thorstein Veblen presented leisure as an economic symbol of social status.
Herbert Marcuse argued that leisure is part of the one-dimensionality of alienated life defined in terms of possessions and market participation. Free and self-determinative action is reduced to choices of products and packaged experiences. Leisure as earned time and purchasing power is one aspect of buying into the capitalist system designed to protect and reward investment capital first.
Such alienated leisure is compared to concepts of leisure as action and creative freedom. However, research into what most people actually do and the meanings they ascribe to their activity suggests that neither the commodification critique nor the creative ideal adequately explain the diversity of contemporary leisure. Neither, on the other hand, is without analytical merit. The differences are partly based on perspectives. Each approach asks different questions.
Veblen and Marcuse are probably both right… and incomplete. Another metaphor is offered to augment the themes of status symbolism and repressive commodification. Evidence for any perspective, however, is incomplete. Marte-Bettina Partsch , Entfremdung und Revolution: Nicht für den Austausch Webel et al , Marcuse: University Press of America, c , p. Eric Wainwright , "Herbert Marcuse: Freedom and Dialectic," Politikon: South African Journal of Political Studies This article is mainly concerned with the analysis and evaluation of Marcuse's conceptualisation of freedom.
Marcuse differentiates between the realm of freedom and freedom itself — which exists independently of the realm of freedom. The point is made that freedom from want is the substance of all other forms of freedom. The article subsequently focuses on the theoretical and practical considerations of Marcuse's dialectic, followed by a consideration of the factors that limit the possibilities for the attainment of freedom.
Man's movement to freedom, a new genesis for all men, is symbolised in the end of alienation. The article concludes with some points of criticism on Marcuse's use of the dialectic, his belief in the power of destruction, and his idea of conversion. Ideological and Socio-Historical Context," in: Heinz Ludwig Arnold ed. M H47 Spanish: Bolivar Meza, Rosendo , Tendencias actuales de la izquierda en México: The index lists pp.
Maslow's journals are full of critical references to Herbert, and ambivalent to Frank whom he sees as "betraying" him at the time of Herbert's departure to San Diego but Manuel remained a friend, and delivered a eulogy at Maslow's funeral. Maslow's biography describes Herbert's leaving of Brandeis or non-renewal of contract as a political act by its president, and Manuel's departure, along with others as one of solidarity with Marcuse.
But then I see that later Manuel is professor emeritus at Brandeis, Heinz Jansohn [et al. Joan Nordquist , Herbert Marcuse: A Bibliography Santa Cruz, Calif.: Reference and Research Services, , 60p. Introduction to social theory: Pippin, Andrew Feenberg, Charles Webel eds.
Critical Theory and the Promise of Utopia Basingstoke: Michael Walzer , The company of critics: Ssocial criticism and political commitment in the twentieth century New York: Basic Books, , p. Dobson , The concepts of reason and essence in the writings of Herbert Marcuse: With special emphasis on the period , Thesis Ph. Gvozden Flego und Wolfdietrich Schmied-Kowarzik eds. Marcuse-Symposion in Dubrovnik Giessen: Germinal, , p.
Arbeiterbewegung und Gesellschaftswissenschaft, , p. Reich y Marcuse Cuernavaca, Mor.: Surrealist Subversion [Chicago] 4 , ; includes correspondence by Marcuse to the Chicago Surrealist group in as appendix pages Zur Aktualität von Herbert Marcuse. Mit Beiträgen von O. Pauline Aweto Oghominene , Man in the technological society: Verlag , [2nd, corrected edition].
Olafson, Frederick, "Irrtum oder Verrat an der Philosophie: Cites literature up to summer Publications page, Mellen, , S. Berkeley Journal of Sociology 35 , Theorie bei Marcuse, Habermas u. Gerhard Schweppenhäuser , Emanzipationstheorie und Ideologiekritik: Benjamin, Marcuse, Habermas und die politische Theologie Düsseldorf: Patmos, , p. Bernard Görlich , Die Wette mit Freud: Drei Studien zu Herbert Marcuse Frankfurt: Nexus, , S.
Ilan Gur-Ze'ev , "Art and utopia: Friedrich Schiller and Herbert Marcuse," in: Collections for Socialist Thought. Weimarer Beiträge , Bd. Heidegger Studies 7 , Studies in Soviet Thought Ben Agger , The Discourse of Domination: Northwestern University Press, , p.
André Clergue , Mon père, je m'arcuse Nîmes: Lacour, , S.: Institut für Sozialforschung ed. Revised papers from a conference held in Frankfurt am Main on the occasion of the opening of the Herbert-Marcuse-Archiv. Schmidt, Alfred, "Herbert Marcuse: Versuch einer Vergegenwärtigung seiner sozialphilosophischen und politischen Ideen. Flego, Gvozden, "Erotisieren statt sublimieren. Douglas Kellner, "Marcuse in the s: Some New Textual Discoveries. Negative Responses to Technology," in: Science Fiction Studies Gérard Raulet , Herbert Marcuse: Presses universitaires de France, , p amazon.
John Abromeit , Existential Marxism: Herbert Marcuse's critical confrontation with Martin Heidegger, to and beyond Stanford Univ. Sharpe, Partial text available at Questia. Western Marxism and Soviet-Type Societies 1. Authoritarian Socialism and the Frankfurt School 3 2. Between Apology and Critique: Marcuse's Soviet Marxism 22 3.
Critical Sociology and Authoritarian State Socialism 59 4. From Western to Eastern Marxism: Rudolf Bahro 84 5. Immanent Critique and Authoritarian Socialism: Poland 9. Poland The Democratic Theory of the Polish Opposition: Normative Intentions and Strategic Ambiguities Revolution, Civil Society, and Democracy Partial text available from Questia.
Bernstein's Search for an Audience, 49 Lenin: Time, Place, and Cultural Studies: Rhetoric Between System and Lifeworld: Ecología Política , No. Clemens Knobloch , "'68 verweht?: Herbert Marcuse, Theoretiker der Revolte," in: Blätter für deutsche und internationale Politik , Bonn, 38 , S. Dariusz Aleksandrowicz , "Marx, Stalin, Marcuse: Die kritische Theorie in ideengeschichtlicher Sicht," in: Studies in East European Thought John Bokina and Timothy J.
University Press of Kansas, Collection of 9 essays about Marcuse's work. A Hindsight Look at Soviet Marxism. Douglas Kellner, "A Marcuse Renaissance? Pencek, formerly, Northern Arizona University, in Dec. The contributors generally seek to apply the critical, self-consciously political spirit of Marcuse's Freudian-Heideggerian-Neomarxism in the context of post-Soviet, postmodern s radical relativisms.
Contributors were invited to write on topics of their choice, which the editors have divided, with inevitably mixed success, into five sections: The 14 essays and useful introduction are notably free of the jargon that characterizes contemporary theorizing, but they also rely on the reader's prior familiarity with that theoretical literature. Moreover, this collection's unconcealed longing for intellectual and social revolution, as well as the often nostalgic view of '60s radicalism which includes, interestingly, disdain for political correctness as antipolitical and frivolous , may restrict its appeal to readers already of renascent New Left inclinations.
Expósito García , Mercedes. Heinz Otto Münch , Repression und Emanzipation: Zvi Tauber , Befreiung und das "Absurde": Bleicher, , S. Joan Alway , Critical Theory and Political possibilities: A49 Partial access at Questia. Departures from Traditional Marxism: The Eclipse of the Emancipatory Vision 31 -- Ch.
Despair and Possibility in a Time of Eclipse 49 -- Ch. Marcuse's Search for a Subject 71 -- Ch. Reconstructing Critical Theory 99 -- Conclusion: Reconceptualizing Radical Politics Notes Works cited Guilford Press, , pages extended discussion of Aronson's encounter with Herbert in the "Marxist Itinerary" chapter as well as a coming to grips with Herbert's heritage in the final chapter.
Oxford University Press, , pp. Rolf Wiggershaus , The Frankfurt School: Andrew Feenberg , "Marcuse or Habermas: Inquiry , Elmont, NY, Ivrit, , , iv p. Donald Ipperciel , Freud als Aufklärer: Paul Alexander Juutilainen , Herbert's Hippopotamus: Cinema Guild, , 1 videocassette 70 min.
Philosopher and teacher, Herbert Marcuse, and the student movement of the late 's are described. Marcuse's effect on the University of California, San Diego is also explored. George Katsiaficas, "Marcuse as an Activist: Reminiscences of His Theory and Practice," in: New Political Science Moran also wrote an entry on Herbert Marcuse for "Modern Germany: An Encyclopedia of History, People and Culture, Herbert Marcuse's The Aesthetic Dimension " in: Hinman rethinks "the bourgeois subject" following Marcuse's lead.
McCarthy , Romancing antiquity: German critique of the enlightenment from Weber to Habermas Lanham: Bompiani, , p. A C65 Kletsmeier, , 86 p published on CD in Stephan Bundschuh , "Und weil der Mensch ein Mensch ist Black Hawk Hancock , After the eclipse: Theoretical Background and Political Praxis," in: Negations 3 Winter , available on-line at: Paul Alexander Juutilainen , Twilights of Paradise 2 pts.
Von der Flaschenpost zum Molotowcocktail , 3 vols. Hamburger Edition, Ulf Liedke , "Freiheit: Anmerkungen zu Marcuses Lutherkritik," in: Günter Servais , Arbeit, Vernunft, Glück: Haag und Herchen, , S. Shapiro and Valerie Malhotra Bentz , Mindful Inquiry in Social Research Sage An introduction to research in the social sciences and humanities in which critical theory plays an important role Trudy Steuernagel, "Marcuse and Biotechnology," in: Clemens Albrecht , "Marcuse, Horkheimer und der Tod: Social Text 58 Spring, , pp.
International Journal of Political Economy Leonardo Casini , Eros e utopia: Carocci, , S. Helmut Fahrenbach , "Existenzialismus und Marxismus: Ein frühes Projekt Herbert Marcuses," In: Zur Problematik menschlicher Emanzipation , S.
David John Farmer , "Anti-Admin: With Help from Herbert Marcuse," in: This paper selects from a longer chapter which recapitulates and extends discussions on antiadministration anti-admin from the perspective of discourse theory. First, it discusses discourse theory, explaining that the discourses of anti-admin aim toward the inclusion of marginalized or excluded perspectives.
Second, it outlines some anti-admin theory. Parallel to the action of antimatter and matter, the interaction of freshly demarginalized discourse perspectives and traditional discourse can yield anti-admin resultants.
Third, the paper offers macro and micro examples of anti-admin gains in terms of problem definition and response resources. It underscores that antiadmin can recognize its affinity not only to the postmodern but also to critical theory perspectives. Peter-Erwin Jansen und Redaktion "Perspektiven" eds. Texte zu Herbert Marcuse Frankfurt: Neue Kritik, , S. He is a specialist on theories of race and ethnicity. Jorge Coelho Soares, Marcuse.
Thesis, University of Minnesota. Uri Zilbersheid , Jenseits der Arbeit: Centre of Universalism, , S. Ventil, , p. Roger Behrens überprüft die emanzipatorische Praxis bei Herbert Marcuse. Michael Buckmiller ed. Offizin, , S. Antonino Firenze , Sapienza della natura: Jürgen Habermas , "Marcuse: Psychic thermidor and the rebirth of rebellious subjectivity," in: The Frankfurt School New York: Continuum, , xx, p. This book illustrates how Marcuse's theory sheds new light on current debates in both education and society involving issues of multiculturalism, postmodernism, civic education, the "culture wars," critical thinking, and critical literacy.
Reitz wrote on Apr. His notions of repressive desublimation and repressive tolerance are especially useful. I try to defend both of these contributions in my recent book " Art, Alienation, and the Humanities: I deal there also with the latest attack on Marcuse from the academic right, that of Kors and Silverglate, whose tolerance for racism and sexism on campus is disguised as a defense of free speech.
Reitz is the first to connect studies of Marcuse's concept of art with conceptions of aesthetic education and the only one who connects Marcuse's thought more broadly with the problematics of education.
The result is an original and engaging study of Marcuse's work that provides fresh insight into one of the most important thinkers of our century. Be sure to read it. Many thanks to Peter Marcuse and Harold Marcuse for making this available. It should be even more widely published.
Gitai, himself a veteran of the war, has apparently followed his own experiences closely. His hero, Weinraub Liron Levo , is an earnest young bohemian who lectures his friend Ruso Tomer Ruso on Herbert Marcuse and, in the opening and closing scenes, smears paint on his girlfriend while they're making love. The arty eroticism of these sequences stands in visual and emotional contrast to the rest of the movie, which shows men writhing in pain and covered in mud.
A Bibliography Santa Cruz: See also Soares' essay on Doug Kellner's Illuminations site: Wilson, Allan Roy , One-dimensional society revisited an analysis of Herbert Marcuse's One dimensional man 34 years later Ottawa: National Library of Canada, , 3 microfiches. Zur Aktualität der Philosophie Herbert Marcuses' presentation falsely dated at philo. Kevin Floyd , "Rethinking Reification: Marcuse, Psychoanalysis, and Gay Liberation," in: Social Text , No.
Peter Wakefield , "Class in the Classroom: Engaging Hidden Identities," Metaphilosophy A seductive classroom presence, he attracted Germany's brightest young intellects during the s.
Many were Jews, who ultimately would have to reconcile their philosophical and, often, personal commitments to Heidegger with his nefarious political views. Looking closely at four of the most talented of their number, Richard Wolin, with the provocative directness his readers have come to expect, argues that troubling residues remain not far beneath the surface of their influential work.
Heidegger's Children is a book that many will seek to refute, but none can ignore. Dirk Röpcke und Raimund Bahr eds. Raffaele Laudani , Lo spettro della totalita: Universita degli studi di Torino, , p.
Raffaella Gherardi, Andre Tosel; co-tutor: Carlo Galli Note Generali: Universita degli studi di Torino, Dottorato di ricerca in storia del pensiero politico e delle istituzioni politiche, Herbert Marcuse and the Holocaust, ," in: New German Critique 85 Winter , Ein Beitrag zur zeitgenössischen Wahrnehmung der nationalsozialistischen Vernichtungspolitik" full text on this site and his project at the Humboldt-Universität: Hans-Georg Pott , "Marcuses später Widerruf," in: Studien zur Ästhetik und Poetik.
Matthew Sharpe , "Do universals have a reference? On the critical theory of Herbert Marcuse," Philosophy Today The views on universals and reference of Herbert Marcuse are discussed. Topics include the critique of pure analytic reason and universality in relation to negation. Soysal, Soner, Technological rationality and one-dimensional man: Herbert Marcuse's critique of advanced industrial society.
Thesis for the degree of Master of Science in the Department of Philosophy. Richard Wolin , " ," in: Political and Social Theory from Nietzsche to Habermas. Duke University Press, , pp. Marcuse developed this idea in the context of his critique of what he called, in an eponymous essay, the "repressive tolerance" of American technological society. Marcuse's disturbing tendency to accept despotism for the sake of his progressive ideals, according to Wolin, was in part a consequence of his intellectual indebtedness to Plato and Rousseau, but it should also be seen in the light of his interwar experience of Weimar Germany's collapse and surrender to Hitler.
Marianne DeKoven , "Psychoanalysis and sixties utopianism," in: Laing's The Politics of Experience, Laing is a psychoanalyst who employs political, philosophical, and cultural discourses as, similarly, indispensable. There is a sense in both texts of a parallelism, almost an interchangeability among these discourses, as if each treats, in mutually reinforcing and mirroring ways, a crucial component of what is a unified whole.
I will also discuss very briefly the ways in which Luce Irigaray, writing at the end of what I would call the long Sixties, produces the same sort of totalizing, utopian project in Speculum of the Other Woman, For all of these projects, it is the utopian demand for reciprocal, mutually constitutive, total psychic, social, political, intellectual, and cultural change that creates this peculiar additive parallelism or intermeshing of discourses.
Hauptwerke der Ungleichheitsforschung , Opladen , Zvi Tauber , "Criticizing Totalitarian Democracy: Herbert Marcuse and Alexis de Tocqueville," in: Lisa Zanetti , "Holding Contradictions: Marcuse and the Idea of Refusal," in: He also analyses the philosophical roots of the student rebellions of the sixties.
John Abromeit and W. A Critical Reader Routledge, ,. This volume is based on a conference held at UC Berkeley in , the year Herbert would have turned Eine Einführung Panorama, , pages [reprint of Junius edition] google books Elizabeth Butterfield , "Sartre and Marcuse on the relation between needs and normativity: Critical Essay 3rd paragraph: In this paper, I will investigate Sartre's claims regarding need as an element of the human condition, and I will compare them to the analysis of need found in the works of Marx and of Herbert Marcuse.
These comparisons will raise important questions, such as: Are these human needs to be considered permanent fixtures, or do they change historically? And, how might this affect their status as fundamental and truly human? Finally, is it even possible for us to recognize our real human needs, and to distinguish them from artificially created and alienated false "needs," while we exist in what Sartre identifies as the current state of subhumanity?
See also Herbert's article: Todestag ," at Socialistische Positionen , www. Franco Angeli, , p. Texts in German or Italian; Papers presented to the congress, Rome, , on the occasion of the centenary of the birth of H. Marcuse , philosopher. Maria Teresa Cardoso de Campos, Marcuse: Diego Giachetti , "Giugno Il Protagora , 4 luglio-dicembre un numero monografico dedicato a "L'immaginazione che voleva il potere.
Studi e testimonianze sul '68". Rolf Nölle , Sozialphilosophische Variablen: Monsenstein und Vannerdat, , S. Russell Rockwell , "Hegel and critical social theory: The Sociological Quarterly , Recently published archival material suggests the need to reexamine Herbert Marcuse's interpretation of Hegel's thought. Social theory generally will benefit from reflections upon Marcuse's historical attempts to understand contemporary societal domination, including its abstract forms, and his original social "translations" of Hegel's Subjective Logic.
Following sections on Being and Essence, the latter often favored by Marxists, the final part of Hegel's Science of Logic was undervalued in the development of critical social theory before Marcuse's close readings in the years Marcuse took the lead among Critical Theorists in explicating Hegel's texts.
Just as significant, Marcuse was among the first to point out the sociological relevance of key categories in the most abstract final sections of Hegel's most abstract work. The newly published materials document Marcuse's unique attempts to conceive Hegelian dialectic proper as itself a practical force of social transformations.
Most important, these articles concern the relationship between theory and social practice that Marcuse investigated in Hegel's dialectic of the idea of the true and the idea of the good--the absolute idea. Auch innerhalb der affirmativen Kultur bleibt die Kunst eine Provokation der bestehenden gesellschaftlichen Ordnung. Und gerade Schillers ästhetisches Konzept des Spieltriebs fordert die verdinglichte Logik der kapitalistischen Verhältnisse heraus, die den Menschen auf die entfremdete Existenz des Arbeiters reduziert.
Stephen Brookfield , "Undermining the very democracy we seek to create: Studies in Continuing Education Discussion has long held an honored place in the pantheon of lionized adult education practices. One of the most frequently venerated aspects of discussion is opening up conversation to include the widest possible diversity of perspectives and intellectual traditions. This democratic attempt to be open and inclusive is held to represent what is best about adult education—its humanistic concern to have all voices heard, all experiences analyzed, and all viewpoints honored.
Herbert Marcuse's concept of repressive tolerance stands directly against these sentiments. Marcuse argues that an alternative idea, concept or text can be inserted into a discussion of familiar, mainstream materials in such a way that serves only to underscore the normality of the center while positioning the alternatives as exotic others.
This paper explores how this process occurs and suggests how it might be countered. Andrew Feenberg , Heidegger and Marcuse: Routledge, , pages. Christian Fuchs , Herbert Marcuse, interkulturell gelesen. Interkulturelle Bibliothek Band 15 Nordhausen: Bautz, , Seiten. Christian Fuchs , Emanzipation! Technik und Politik bei Herbert Marcuse Aachen: Shaker, , Seiten. Raffaele Laudani , Oltre l'uomo a una dimensione: La collana, in cinque volumi, pubblicherà scritti, discorsi e carteggi del pensatore della scuola di Francoforte, attingendo ampiamente ai materiali provenienti dall'archivio Marcuse.
I temi dei volumi spazieranno dall'analisi dei movimenti alla critica della società tecnologica, dalla psicanalisi all'estetica, dal femminismo all'ambientalismo. Il primo volume della collana raccoglie gli scritti, discorsi e lettere degli anni Sessanta e Settanta, che documentano la partecipazione e la riflessione di Marcuse sui grandi conflitti politici dell'epoca: The series, in five volumes, will publish writings, speeches and correspondence of this Frankfurt school thinker, broadly including materials from the Marcuse archives.
The topics of the volumes will range from the analysis of the movements critical of technological society, to psychoanalysis, aesthetics, feminism and environmentalism.
The first volume of the series collects the writings, speeches and letters of the sixties and seventies, which document Marcuse's participation in and reflection on the great political conflicts of the age: Raffaele Laudani , Politica come movimento: Il pensiero di Herbert Marcuse Edizione del Mulino, , pages. Teoria critica del nazionalsocialismo III. Filosofia politica del movimento: Oltre l'uomo a una dimensione: Il nome di Herbert Marcuse è legato alle vicende dei movimenti antisistemici degli anni Sessanta e Settanta, ma il nesso profondo che esiste tra il suo attivismo politico e i presupposti filosofici della sua attività di ricerca è stato finora poco indagato.
Un'analisi più attenta rivela che il rapporto con quei movimenti è largamente implicito in una riflessione filosofica che, fin dai suoi esordi, ha sempre cercato di pensare la politica come "movimento". Il volume delinea lo sviluppo di questa concezione della politica attraverso un esame sistematico dell'ampia produzione scientifica di Marcuse, dai testi più noti come "Ragione e rivoluzione" , "Eros e civiltà" e "L'uomo a una dimensione" , agli interventi più marcatamente politici degli anni Sessanta e Settanta, fino ai numerosi materiali rimasti a lungo inediti e pubblicati postumi.
Allgemeiner Studierendenausschuss der Freien Universität Berlin ed. Dokumentation einer Veranstaltung an der Freien Universität Berlin am Asta, Hochschulpolitische Reihe, vol. Joshua Rayman, "Marcus e 's Metaphysics: Abstract from Telos website: The highly visible first wave of Marcuse scholarship is polarized between hostile attacks and uncritical support, especially during Marcuse's heyday in the late s and early s.
By contrast, the smaller, more marginalized, second wave of Marcuse scholarship tends toward careful, sympathetic, historically-comprehensive treatments of Vegetti, Matteo , Hegel e i confini dell'Occidente: History and Utopia in the writings of Trilling, Riesman, and Marcuse, " Harvard University, , pages google books citation Richard Wolin , "Introduction: What Is Heideggerian Marxism?
Richard Wolin and John Abromeit eds. Publisher's page ; blurb: During these years, Marcuse wrote a number of provocative philosophical essays experimenting with the possibilities of Heideggerian Marxism.
Ultimately, two events deterred Marcuse from completing this program: Heideggerian Marxism offers rich and fascinating testimony concerning the first attempt to fuse Marxism and existentialism. Full text and abstracts available online. Introduction, pages Tyson Lewis. Lacan, Marcuse, and the death drive, pages Richard Kahn. Marcuse, Bloch and Freire: Groundwork for the Concept of Technique in Education: Herbert Marcuse and technological society, pages Dolores Calderón.
One-Dimensionality and Whiteness, pages Ajit K. Critical Theory and Information Studies: Fumbling toward a Critical Legal Pedagogy and Practice, These papers may have been the basis of the page brochure: Douglas Kellner, Tyson E. Reviving Marcuse ," in: Review of Kellner ed. Beginning, from Telos website: The terms have been used in a variety of contexts in the political discourse, but also as more or less well-defined concepts for theoretical analysis.
Although theorists have sometimes tried to keep these spheres entirely separate, such attempts have rarely been successful, since the walls between them have been porous. Clearly, the political and moral stakes have been too high to develop a purely theoretical and detached approach.
The urge for a more elaborate theory, grounded Auf diese Weise gelingt eine verständliche und fundierte Einführung in die Kritische Theorie. Beverly James, "Teaching Marcuse," in: Journal of the European Institute for Communication and Culture This article argues that One-Dimensional Man is highly relevant to the current generation of students and provides them with theoretical concepts for understanding contemporary problems.
The trends Marcuse described in the s have accelerated, so that his basic arguments are more relevant than ever for courses in news, advertising, and contemporary culture. Marcuse relies heavily on examples to advance his arguments, and this article demonstrates for his illustrations can easily be brought up to date.
Marcus Hawel und Gregor Kritidis eds. Möglichkeiten einer anderen Welt Hannover: Offizin Verlag, , This essays contains a description of the information in Herbert's Stasi file East German secret service ; see pdf p. Telos Spring , It is not known when Herbert wrote this.
Despite all breakthroughs out of normalcy, love belongs to the temps perdu. It succumbs to the damning judgment directed at this world. Yet the terrible sentence about the " paradis perdus ," which are the only true paradise, avenges both itself and the lost time. The lost paradise is not the true one because somehow past desire [ Lust ] appears greater and clearer in memory than Stephen Brookfield, "Diversifying curriculum as the practice of repressive tolerance," in: Teaching in Higher Education Most about 65 percent of those who received excess APTC did not have to make a specific additional payment to the IRS because the excess amount was recovered from a tax refund to which they otherwise have been entitled.
See Figures 4 and 5. As of June , only 3. One simple step to smooth the functioning of the APTC and avoid burdensome reconciliations would be to improve the accuracy of the credits by providing coverage applicants with a clearer and more comprehensive explanation of how their APTC was calculated.
Currently, applicants receive a statement when they become eligible that tells them the amount of their APTC and the amount of income on which APTC were based. Eligibility may be calculated based on the income reported by the applicant or on income drawn from prior tax records or other sources.
A more transparent explanation could explain how the income was computed, including what income was considered in calculating the amount. The current notice informs the taxpayer that changes in income, available coverage alternatives, or household composition must be reported and that failure to do so may result in the taxpayer having to pay back overpayments, but the notice could include examples of how changes in household income or size might affect the amount the taxpayer would have to pay back.
Taxpayers could also be sent quarterly notices including the income projections on which their tax credits are calculated and advised to report any changes in income to avoid over- or under-payment of their APTC. Monthly premium statements from insurers could also remind enrollees of their obligation to keep enrollment information current. The issuance of the A form that enrollees are sent to assist with tax reconciliation could be moved up to mid-January to ensure that taxpayers received early notice of their need to file taxes and the amount of APTC on which their taxes would be calculated.
The reconciliation process could also be adjusted to ease the burden of reconciliation. Allowing some variance from projected to actual income at the time of reconciliation could reduce administrative complexity and taxpayer burden.
Taxpayers could be excused from having to pay back tax credits if their final household income were within a certain percentage perhaps 10 percent of their projected income, as long as the taxpayer did not intentionally underreport income.
Taxpayers who were determined to have received less in APTC than they were entitled by the same percentage of variation would not receive an additional payment unless they had intentionally foregone advance payment of the full tax credit. Taxpayers should also have the option of the IRS reconciling their APTC and actual premium tax credits rather than having to do it themselves.
If they fail to do so, however, the IRS could simply perform the reconciliation calculation for them, assuming the information on form A to be correct. Taxpayers could be notified on the form A that the IRS will perform the reconciliation calculation for them if they fail to file a form No one should lose access to premium tax credits simply because they fail to file this form. Although Medicaid, tax credits, and cost-sharing reduction payments help make insurance affordable, health insurance is still so costly for many moderate- and middle-income Americans that they refuse coverage.
Current tax credits require individuals and families with incomes below percent of FPL to pay too much before tax credits take over. One consequence is that many low-income workers are declining subsidized employer-based and marketplace-based coverage. Reducing or eliminating premiums for Medicaid-ineligible families below percent of the FPL would greatly improve take-up among those in greatest need. Affordability is also a problem among those with higher incomes.
More than 15 million uninsured Americans have incomes in excess of percent of FPL, while 5. Households with incomes above percent of FPL are not entitled to financial assistance, and few have sought coverage through the marketplaces. The full schedule of ACA subsidies could potentially particularly in combination with income limits of other federal and state anti-poverty programs create adverse work incentives.
They also impose significant burdens on middle-income Americans who lack access to employer-sponsored coverage. Blumberg and Holahan also propose allowing individuals with incomes above percent of FPL to gain access to tax credits, as long as the premiums they would have to pay for the second-lowest-cost gold plan cost more than 8.
Thus assistance would not be linked only to the amount of income but also to the cost of coverage. Adoption of this proposal would improve access to affordable health insurance for moderate- to middle-income households.
Yet its cost would not be open ended, as the number of households that would be eligible for coverage would rapidly diminish as income increased. Middle-income taxpayers without access to employer coverage would at least be entitled to a fixed-dollar tax credits even if their incomes were too high to qualify for income-based credits. From both a substantive and a political perspective, such proposals merit consideration.
Fixed-dollar tax credits have long been proposed as an alternative to the current employer-sponsored insurance tax exclusion. These proposals have come primarily from conservative or libertarian advocacy groups, but have also been put forward by many economists across the political spectrum. Under one proposed alternative, taxpayers who do not have employer-sponsored coverage could choose between income-based tax credits, which could continue to phase out at percent of FPL based on the cost of coverage, as described above, and fixed-dollar tax credits, which could be more generous than income-based tax credits at the percent of poverty level.
The amount of the credits should be set high enough to have a significant effect on affordability, but would still leave most of the responsibility for the cost of insurance with enrollees at higher income levels. Credits should be age-adjusted to ensure that they reflect age-related premium differences. Such credits should be limited to individuals who are not covered through their work, since employer-sponsored coverage is already tax subsidized.
However, individuals offered coverage through their work should be able to decline that coverage and purchase coverage through the marketplace and claim tax credits if this alternative is more affordable. This program structure may lead some employers to stop offering coverage, as firms and workers compare the value of the fixed credit to the value of the tax exclusion.
As long as marketplaces offer good coverage, we regard this as an acceptable policy tradeoff. Fixed-dollar tax credits for higher-income individuals would not require reconciliation based on actual income or to repayment to the Treasury, as long as total household income remained below the maximum eligibility level.
Fixed dollar tax credits would thus be more predictable and simpler than income-based tax credits. It may not even be necessary to pay them in advance, as taxpayers could reduce withholding or estimated tax payments in anticipation of the credits and use the savings to help pay for health insurance.
A fixed-dollar tax credit such as that proposed here would come at some cost. Since it would only be available to individuals who do not enroll in employer coverage and who did not qualify for income-based credits, it would be much less costly than a universal tax credit.
One attractive pathway to finance this system would be to cap the employer-sponsored coverage tax exclusion, a proposal that has wide support in the policy research community. Further research is needed to determine the amount of tax credits, their total cost, and how they would be financed.
The ACA has reduced the financial burdens associated with injury and illness, and has made health care more affordable for millions of Americans. Although ACA provides valuable limits on total out-of-pocket spending, it has not restrained the long-term trend toward higher deductibles and copayments in employer-sponsored coverage. Higher cost-sharing indisputably reduces the volume of care received by consumers, and thus overall expenditures. Yet there is considerable and growing evidence that such cost-sharing does so indiscriminately, reducing consumption of high-value as well as low-value care.
Covered individuals increasingly seek care from narrow provider networks and find medications listed on limited or tiered formularies. While narrower networks can provide high-quality, cost-effective care, too-narrow networks or formularies can pose significant barriers to consumers getting the care they need. In-network providers are not always easily identified, and out-of-network providers are not easily avoided.
People served by out-of-network providers may therefore face large and unexpected bills. In sum, the ACA has expanded coverage, but too many Americans lack access to affordable and transparently priced health care.
This section addresses problems raised by excessive cost-sharing and networks and formularies that are too restrictive. Although the ACA implements stop-loss provisions that reduce the risk of catastrophic financial loss, out-of-pocket medical costs continue to be a major concern for many Americans. The ACA is sometimes wrongly blamed for increasing consumer out-of-pocket spending, so far the new law appears to have neither aggravated nor slowed the long-term trend toward higher deductibles and copayments in private coverage see Figure 8.
High cost-sharing is having a real impact on American families. A recent Commonwealth Fund study finds that half of underinsured adults report being contacted by collection agencies or having to change their way of life because of medical bills. Being underinsured also has medical consequences—a quarter of those responding to the Commonwealth survey reported not going to the doctor for a medical problem, not filling a prescription, or skipping medical tests or treatments recommended by a physician for financial reasons.
The ACA has a confusing array of rules governing the adequacy of coverage that can, in some circumstances, leave care essentially unaffordable. Large employers with more than fifty full-time equivalent employees are required to provide minimum essential coverage to their full-time employees or to pay a penalty for each full-time employee if any employee receives premium tax credits for non-group coverage through the marketplace.
As applied to employer coverage, the minimum essential coverage definition requires vanishingly little. Minimum value employer coverage is somewhat more comprehensive than minimum essential coverage. Minimum value employer plans must have an actuarial value of at least 60 percent that is, they must cover at least 60 percent of the costs of a standard self-insured-plan population and they must cover substantial hospitalization and physician services—but minimum value plans can still impose substantial cost-sharing on employees.
Individual and small group insurance must meet higher standards although it often in fact imposes higher cost-sharing than most large-employer plans. It must cover ten essential health benefits and provide coverage after cost-sharing set at one of four actuarial value levels—bronze 60 percent , silver 70 percent , gold 80 percent , and platinum 90 percent.
Premium tax credits are keyed to the premium of the second lowest-cost silver plan in a market. Most marketplace enrollees who depend on premium tax credits choose to purchase bronze or silver plans. Bronze, silver, and catastrophic plans bring high cost-sharing. But high cost-sharing can impose significant burdens, particularly those with modest incomes or costly health challenges. Lower-income families may face a choice between affordable coverage and affordable care. Other serious cost-sharing burdens remain.
Insurers and group health plans can cover services from out-of-network providers but are not required to do so except for emergency services and often impose higher caps on out-of-network out-of-pocket expenditures.
Out-of-pocket caps also do not apply to services that do not qualify as essential health benefits. Although a standard silver plan is one that covers 70 percent of the actuarial value of covered services, the ACA also provides cost-sharing subsidies that boost the total value of a silver plan for marketplace enrollees with incomes below percent of the FPL. Households with incomes above this threshold, particularly those who receive out-of-network care, are often responsible for far higher out-of-pocket payments, even if their household incomes are below percent of FPL and they therefore remain eligible for financial assistance with their monthly premiums.
The ACA requires the federal government to reimburse health plans for the amounts they provide modest-income consumers in reducing cost-sharing. Litigation is now pending challenging the legality of this reimbursement in the absence of explicit congressional appropriation. The ACA should be amended to make health care more affordable. Urban Institute researchers Linda Blumberg and John Holahan propose that the premium tax credits be set to cover the cost of 80 percent actuarial value gold plans rather than the 70 percent silver plans.
Health care could also be made more affordable by reducing out-of-pocket limits. As noted above, the ACA imposes an out-of-pocket limit on all forms of health coverage. The ACA provided, however, that these reductions in out-of-pocket limits should not increase the actuarial value of plans above the limits set for cost-sharing reduction payments.
Thus, while out-of-pocket limits are reduced by two-thirds for enrollees with incomes below percent of FPL, out-of-pocket limits are reduced by less than a third for individuals with incomes between and percent of FPL, and not at all for those with higher incomes. Significant cost-sharing relief could be afforded individuals with moderate incomes by effectuating the out-of-pocket limits imposed by the ACA without regard to actuarial value.
If the actuarial value of ACA benchmark plans were increased from 70 to 80 percent, as Blumberg and Holahan suggest, the out-of-pocket limit could be decreased across the board to the levels found in the original ACA, since insures could pay a larger share of total covered costs. Finally, the ACA employer responsibility regulations should be amended to improve coverage. Minimum value coverage should include substantial coverage for pharmacy and diagnostic tests as well as hospitalization and physician services.
Minimum essential coverage should require coverage of hospital, physician services, pharmacy, and diagnostic tests as well. Employers who fail to provide these services should be subject to the employer mandate penalties. Employees who are not offered minimum value coverage as redefined should have access to marketplace coverage with premium tax credit support. As noted below, principles of value-based insurance design may prove helpful in defining the scope of coverage in these areas.
Cost-sharing reduction payments are only available to individuals who purchase individual qualified health plans through the marketplaces and who are otherwise eligible for APTC assistance. This leaves millions of individuals with coverage through their employment or through the individual market with incomes above percent of FPL exposed to levels of cost-sharing that may still make health care a significant economic burden.
One way of increasing affordability for middle-income populations is through account-based programs such as health savings accounts HSAs , health reimbursement accounts, flexible spending plans, and Archer medical savings accounts.
These accounts permit tax subsidies for amounts set aside to cover medical costs, including cost-sharing imposed by health plans. HSAs are sometimes touted as an all-purpose solution to health policy problems. In fact, HSAs provide one of the most heavily subsidized investment vehicles available and are used disproportionately by affluent taxpayers, who use them to maximize retirement savings rather than simply paying for health care, as money can be withdrawn from HSAs after age 65 for non-health care expenses without a penalty.
HSAs can, however, be of value to marketplace enrollees. While it would be preferable to increase APTC and cost-sharing reduction eligibility levels and generosity, if this is not politically possible, HSA investments can provide some relief for individuals with moderate incomes or individuals who underestimate their income and are faced with high APTC repayments at tax filing time.
Some legislative changes could make HSAs even more helpful for those who actually use them to cover health care costs. First, the out-of-pocket limits under the ACA could be amended to align them with out-of-pocket maximums for HSA-linked high-deductible health plans. Although the limits were initially aligned, they increase under different inflation adjustment rules, making it possible that ACA compliant plans would not be HSA eligible.
These rules could be easily aligned. Modest direct federal contributions to HSAs for moderate-income Americans could also be considered. These could be paid as a refundable tax credit at the time of tax filing based on actual taxable income, avoiding the need for reconciliation. As with retirement accounts, modest subsidies could be implemented with a well-designed choice architecture that could overcome behavioral inertia to encourage greater savings.
Government or private plans could also assist consumers with the logistical practicalities of establishing such accounts. Consideration should also be given to allowing small employers to fund health reimbursement accounts HRAs that could be drawn upon by employees to purchase health insurance in the individual market.
This is currently illegal under administration interpretations of the ACA and preexisting tax law. Provision would also have to be made to ensure that the offer of an HRA did not disqualify employees from receiving marketplace premium subsidies unless the HRA contribution made coverage genuinely affordable.
But with these protections, found in current legislative proposals HR , a program that allowed small employer contributions for coverage through HRAs could encourage some employers who would not otherwise offer traditional small group coverage to make coverage more affordable for their employees. Even if the ACA is not amended to increase cost-sharing support, health insurers could make health care more affordable.
Some marketplace plans currently offer some services—coverage of generic drugs for example—that are not subject to the deductible. In fact, in , 80 percent of marketplace silver plan enrollees selected a plan with a primary care visit covered before the deductible while 82 percent selected a plan with generic drugs covered below the deductible.
Such plan designs carry some danger of risk selection. If these plans impose lower cost-sharing on individuals with minimum medical demands, they must make up for it by imposing higher cost-sharing elsewhere, presumably on higher-cost individuals. On the other hand, if offering some covered services to individuals with low medical needs attracts those individuals into the marketplace, this might have the effect of lowering the cost of coverage for all marketplace participants.
As noted above, accumulating evidence confirms that greater patient cost-sharing leads to reduced utilization. But there is little evidence that consumers respond to cost-sharing by effectively comparing prices for costly services, or by focusing on the highest-value care. Annual medical spending quickly dropped, with total firm-wide medical spending declining by more than 10 percent.
Brot-Goldberg and colleagues found little evidence that workers effectively distinguished wasteful from valuable care. Given a financially generous high-deductible health plan with an accompanying HSA, even this group of relatively high-income, highly educated workers markedly reduced its receipt of clinical preventive services and other valuable care. There was also little evidence that this relatively advantaged consumer group used available tools to identify cheaper services and providers, or even that consumers strategically responded to the actual economic incentives created by their insurance plan.
Researchers found especially concerning utilization declines among people with health problems, who may have foregone important forms of care.
Almost half of the spending reduction also occurred among predictably sick individuals likely to exceed their annual deductibles, for whom the true marginal cost of specific services was often quite low.
This overall pattern of findings casts doubt on the power of calibrated consumer incentives to safely and effectively improve the cost-effectiveness of medical care. Value-based insurance design VBID attempts to balance the competing goals of greater economy and cost-effectiveness with greater financial protection and improved health. Consumers require the most generous coverage and most minimal cost-sharing for high-value services likely to improve health, with less generous cost-sharing for lower-value services such as name-brand drugs for which cheaper generic substitutes are readily available.
Preventive Services Task Force based on rigorous clinical trials. Equivalent bodies could develop an evidence-based list of secondary prevention and chronic disease management services that would similarly be covered without patient out-of-pocket cost or with minimal cost.
The Center for Medicare and Medicaid Innovation recently announced an initiative to deploy VBID principles to align cost-sharing more carefully with high-value services in Medicare Advantage. Beginning in January , these programs will test the utility of structuring patient cost-sharing and other health plan design elements to promote high-value clinical services in seven states. This effort provides a promising platform to design more innovative marketplace plans, which the federal and state marketplaces should encourage.
Further steps should be taken to improve the adequacy of provider networks and formularies. Consumers also need to be protected from surprise balance billing when they unintentionally use the services of out-of-network providers. This could be done by amendments to the ACA, but could be accomplished also by the administrative actions under existing authority and by state legislatures and insurance regulators.
Narrow provider networks are a familiar feature in American health care. These have become only more common and narrower in recent years, due largely to the concurrent effects of rising costs and competitive pressure on insurers to reduce premiums.
With proper transparency, narrow networks can benefit consumers. Narrow networks provide insurers and thus their customers greater leverage to constrain prices and to maintain quality.
But narrow networks can leave consumers without necessary access to providers. If providers are too far away, if delay times to obtain appointments or the times in the waiting room after arriving for an appointment are too great, the enrollee can effectively be denied coverage.
If an enrollee has special needs—pediatric oncology or HIV therapy, for example—and a network lacks providers that can provide specialized care, the enrollee may lack practical access to the most essential benefits of their insurance coverage. Moreover, some insurers might intentionally restrict networks to deter high-cost patients from enrolling. A particular concern is that insurers may restrict drug formularies to discourage individuals who need access to high-cost specialty drugs from enrolling in their plans.
Recent analysis of plans available in six cities found that most marketplace plans include at least one marquis hospital or academic medical center. But physician network adequacy is more complex and less readily observed by consumers. Proper regulation is therefore essential to ensure access and to avoid risk selection across plans.
QHP networks must, under the federal rules, include a sufficient number and variety of types of providers, including mental health and substance abuse providers, to ensure that all services are available without unreasonable delay. QHP plans must also include essential community providers that serve low-income and medically underserved individuals. QHP insurers must make provider directories available online and in hard copy and must update their online directories monthly.
If necessary in-network care is unavailable, plans should be required to pay for out-of-network care with in-network cost-sharing. QHPs must also cover at least one drug from each U. QHPs must provide an exceptions process for enrollees who need drug not on the formulary and cannot discriminate through the use of their formulary, for example, by excluding HIV drugs.
The Department of Health and Human Services also regulates network and formulary adequacy for Medicare Advantage and Medicaid managed care plans. Regulation of Medicare Advantage plans has become quite sophisticated, with a focus on geographic accessibility of providers, 89 while regulation of Medicaid plans will be tightened up under recently proposed regulations. Regulation of network adequacy is, therefore, primarily the responsibility of state insurance regulators.
State regulation, however, varies widely, while advocates and the news media are more focused on Washington, D. Therefore, progress on this front will require improving state regulatory efforts directed at network adequacy. Although the National Association of Insurance Commissioners NAIC has had a managed care plan network adequacy model act since , fewer than one-quarter of states had adopted the model, as of a recent survey.
Only about half the states imposed quantitative standards in place for evaluating time and distance to providers Only about one-fifth limited how long enrollees must wait for an appointment with providers or require minimum ratios of enrollees to providers. Many states did not affirmatively monitor ongoing network adequacy for non-HMO plans unless they received a complaint.
A program for regulation of network adequacy has been proposed by the consumer representatives to the NAIC. Under the program proposed by the consumer representatives, states should have to adopt network adequacy regulations governing all insured plans that use networks—that is, virtually all insurance plans. Access should be guaranteed to the full range of providers needed by plan enrollees, with an emphasis on primary care, mental health and substance abuse care, and care for children.
Failure to include providers necessary to address certain conditions should be treated as a discriminatory benefit design issue. Regulators should also ensure that formularies are adequate and non-discriminatory, and that an exceptions process is readily available. Regulations should also require insurers to enroll at least some providers that offer extended hours and weekend appointments. State regulators should pay special attention to access to essential community providers.
Regulators should also ensure that health plans not only have network contracts with hospitals, but also with physicians within those hospitals, particularly with hospital-based physicians such as anesthesiologists, radiologist, pathologists, emergency room doctors, and hospitalists.
Insurers should be required to file access plans that describe in detail their networks, how those networks adequately address the needs of their enrollees, and how pertinent and timely information about their networks is clearly communicated to consumers. The access plans should in particular address the criteria an insurer uses to select providers, including measures that address quality of care, and protocols for maintaining and updating network directories.
These access plans, and any changes to them, should be reviewed and approved by regulators before they go into effect. Regulators should regularly review compliance with network adequacy regulations, using such tools as secret shoppers and review of provider contracts to ensure adequacy. Regulators should not passively rely on complaints to ensure insurer compliance. Regulators should also not simply rely on accreditation status to ensure network adequacy.
Accreditation can provide an additional check on adequacy, but cannot substitute for public regulation. Some enrollees will inevitably be unable to receive needed care in network plans. All network plans should thus be required to provide an exceptions process for enrollees who cannot find within-network providers, either because of their specialized needs or because of network capacity. Requests for exceptions in urgent cases should be handled within twenty-four hours.
Regulators should collect routinely data to monitor the frequency of use of out-of-network providers, the cost of out-of-network services, and the use of the exceptions process.
If a provider and a plan terminate their contract or a provider is moved from one cost-sharing tier to a different tier, an enrollee who is pregnant, terminally ill, or under a course of treatment for a serious condition should be able to continue treatment at the same cost-sharing level for ninety days, or until a baby is delivered or the condition resolved.
The Centers for Medicare and Medicaid Services CMS has recently proposed regulations that would require federally facilitated marketplace qualified health plans to provide similar continuity of care protections. Consumers should be protected from balance billing unless they have freely assumed the risk by knowingly seeking care from a non-network provider fully aware that they will receive a balance bill.
Federal law now requires network plans to pay minimum provider rates and to not charge consumers higher coinsurance or copayments for out-of-network emergency care. It does not, however, ban balance billing in emergency situations. A few states have laws requiring insurers to hold consumers harmless for emergency out-of-network care, but many states do not. Protections are also needed for consumers who have exercised reasonable caution to make sure that they are receiving treatment from in-network providers but nonetheless receive out-of-network services, for example from anesthesiologists, pathologists, or surgical consultants.
CMS has recently proposed a rule under which a marketplace health plan could provide notice to an enrollee at least ten days in advance of the receipt of services from an in-network facility that there was a possibility that the enrollee might receive out-of-network services while at the facility.
This is a step in the right direction, but does not go far enough. When consumers schedule a procedure with an in-network provider in a nonemergency situation, they should be informed as to whether professionals that might be involved in the procedure are out-of-network and, if so, be offered the option of choosing in-network providers.
If consumers end up being treated by out-of-network providers despite reasonable efforts to receive only in-network care, an arbitration process should be provided to resolve the issue between the provider and insurer without involving the consumer. One goal of the ACA is to provide consumers with a range of health plan choices. Another is to encourage competition among insurers to constrain premium growth and improve quality and value.
To accomplish both of these ends, the ACA created exchanges—now called marketplaces—where consumers can shop for individual and small group coverage and insurers can compete for their business.
The ACA constrains marketplace choices and competitions in several ways. Insurers are restricted from competing in the way they have traditionally—by avoiding high-risk enrollees or charging them higher premiums. Insurers also cannot compete in the individual and small group market by offering skinny benefit packages. All insurers in these markets must cover a reasonably comprehensive package of essential health benefits.
Qualified health plans sold through the marketplaces must also meet other requirements, including inclusion of essential community providers that cover low-income and high-need enrollees, and accreditation by recognize accrediting entities. Within these constraints, insurers are free to compete for consumer business, and consumers are free to choose the plan that they think best suits their own needs and resources. Although the extent of competition, and the ways in which insurers have competed, have varied from state to state, and from one region to another within a given state, competition has been robust throughout much of the country.
Consumers have, on average, five insurers and fifty health plans to choose from per county in the open enrollment period. Insurer competition has focused intensively on premiums. In a recent Commonwealth Fund survey, 41 percent of participants reported that low premiums were the most important factor in their selection of a qualified health plan see Figure Another 25 percent identified out-of-pocket payments as most important, with only 22 percent reporting that access to a preferred provider was most important.
Narrowing provider networks provides the most common approach used by insurers to lower both premiums and out-of-pocket payments. Fifty-four percent of consumers who report that they had the opportunity to save money by enrolling in a QHP with a narrower provider network chose to do so.
Insurers also compete by offering a range of cost-sharing alternatives. Although cost-sharing packages must meet actuarial value standards, there are many different ways in which plans can be designed to meet the same actuarial standard. Different cost-sharing packages may be attractive to different consumer groups. Although, as we noted earlier, high cost-sharing may harm low-income populations, within limits, diversity and choice in cost-sharing alternatives is beneficial to consumers.
Competition in this area, however, also imposes significant possibilities for confusion, imposing large responsibilities for processing information on individual consumers. There is evidence that premiums are lower in marketplaces in which many insurers actively compete. The challenge is to improve consumer choice while managing the accompanying cognitive and informational burdens. In the run-up to the implementation of the ACA, proponents occasionally spoke of the process of buying marketplace coverage as something that could be done with the ease of selecting a book on Amazon.
That vision was over-optimistic, given the complexity of insurance products. The current consumer experience, in both the state and federal marketplaces, certainly does not approach that standard.
The sheer volume of Americans who have used the marketplace accounts for much of the technical challenge. According to a recent Commonwealth Fund report, one-quarter of all U. Fifteen percent of visitors enrolled in Medicaid; 30 percent enrolled in a private plan. Each of these individuals required extensive information processing, linking across multiple federal agencies and qualifying health plans, including identity verification, citizenship checks, and the computation of premium tax credits.
These challenges crashed the initial launch of the federal healthcare. They still affect the consumer experience in many ways. With due allowance for inherent complexity, the human experience interacting with the new marketplaces remains mediocre.
Partly as a result of these shortcomings, consumers often err in choosing marketplace health plans. Survey data collected in —15 by the Commonwealth Fund underscores the challenge.
The low response rate Yet the overall pattern is consistent with other data and media accounts. Consumers require significant help making sense of complex provider networks; premiums, deductibles, copayments, and coinsurance; and pharmaceutical formularies. Improved decision aids could help consumers make better and more informed choices.
This is a critical concern to ensure that individuals obtain affordable coverage, and to ensure that marketplace competition disciplines premium increases across plans. The dynamics of the open enrollment process underscored the importance of active consumer comparison-shopping. An individual who purchased the cheapest silver plan and retained it in would experience an average 8. That same consumer, if she had chosen the cheapest silver plan, would have experienced only an average 1.
One-third of re-enrolling marketplace participants changed plan metal levels in The remaining two-thirds of metal plan participants retained their plan level. These likely will exhibit similar patterns. Some tools for improving consumer decision-making are emerging in the federal marketplace and across the states. This is a major advance over the initial open enrollment, which generally required individuals to establish personally identified marketplace accounts before gaining access to such information.
For the open enrollment period, healthcare. Materials recently released by CMS indicate important changes for the current marketplace. These include faster and improved browsing and account management, more user-friendly navigation, and simplified re-enrollment processes with comparisons to other local available plans.
A new out-of-pocket cost calculator helps consumers estimate overall costs, beyond the monthly premium. This feature provides further information on premiums, deductibles, and co-pays for each plan, based on different anticipated levels of health care utilization. New doctor and prescription drug lookup features will provide consumers with more readily searchable information about network and prescription-drug coverage in different plans.
By , additional data will be incorporated, including plan quality ratings and the results of consumer satisfaction surveys. A recent paper by economists Ben Handel and Jonathan Kolstad exemplifies how personalized decision supports and defaults could make marketplaces more transparent and competitive, and also less burdensome to individual consumers. These authors make several proposals to guide consumers towards plans most likely to match their projected health needs, network of providers, preferences about risk, and other factors.
More should be done to integrate decision-making and consumer support tools with the predictable needs of Americans with chronic conditions. Expert organizations such as the American Cancer Society could play a valuable role in preparing materials and automated decision aids that help consumers assess the quality of qualified health plans in treating specific conditions.
Although all of these tools will be helpful, they are not sufficient. Navigators and other types of enrollment assisters, including traditional agents and brokers, must help. The most knowledgeable consumers may already have signed up for coverage, leaving many remaining uninsured who will need outreach and other services to obtain coverage and financial help. According to one recent survey, half of uninsured adults who were potentially eligible for financial help had not heard about subsidies or looked for information on the new marketplaces.
When the ACA first launched, the federal government financed much of this human help, funding many programs that help consumers with the mechanics of plan enrollment and marketplace subsidies. During the first open enrollment period, some 4, assister programs with more than 28, staffers and volunteers helped nearly 11 million consumers.
Some policymakers had hoped that the need for such supports would decline as the ACA became a permanent fixture and the new marketplaces enrolled increasing numbers of the previously uninsured. Experience in Massachusetts and elsewhere suggests these hopes are misplaced. A particularly important challenge arises in reaching severely disadvantaged populations, such as individuals with substance use disorders or those under the supervision of the criminal justice system.
The federal government can help to fill this gap. A large city such as Chicago might have additional specialists, who would be available to assist individuals with complicated health conditions or life circumstances, and to assist others such as Medicaid-eligible indigent individuals who would otherwise remain uninsured. Such costs may be offset by the savings to states of increased Medicaid enrollment, and by savings to both individuals and the federal government if such enrollment assisters could help marketplace participants more effectively comparison-shop different plans.
Private brokers and agents can also play a useful role. Some ACA supporters were initially skeptical that brokers could still play a valuable role once state marketplaces were implemented. In part because of initial implementation difficulties, but also because of their specific expertise and experience in the insurance market, brokers and agents have played an important and continuing role.
Rather than being dis-intermediated by the new marketplaces, brokers are accounting for a surprisingly high proportion of enrollment in California, Kentucky, and other states. Such collaboration also requires regulation of potential conflicts of interest and new training regarding low-income consumers and other populations likely to participate in state marketplaces, who have rarely interacted with agents or brokers before.
Improved network and formulary transparency would greatly improve the consumer shopping experience. Federal regulations and the laws in some states require health plans to make their network directories and drug formularies available online and to update them regularly. Comprehensive federal regulations, however, apply only to qualified health plans sold through the ACA marketplaces and to Medicare Advantage and Medicaid managed care plans , and state laws and regulations do not apply to self-insured group health plans, which cover the majority of employees covered through employee benefit plans.
ERISA, which does cover employer plans, imposes less rigorous network disclosure requirements. Transparent network coverage is necessary to ensure that consumers who enroll in narrow network plans understand the constraints they are accepting and can determine whether the providers they want or need are in-network.
For example, McKinsey in its analysis of networks defines broad networks as those with 70 percent of all hospitals in the rating area participating, narrow networks with 31 percent to 70 percent of all hospitals, and ultra-narrow networks with 30 percent or less of all hospitals participating.
Plans should also describe the criteria used for determining network participation, the cost differentials for enrollees who use in- or out-of-network providers, and how balance bills are handled.
Provider directories should be readily available online and in paper form. These must be easily searchable and understood by the general public. Consumers should be able to determine whether specific providers with whom they have established relationships, specific types of specialties that they need, providers in their geographic location, or providers who speak their language or are accepting patients, are available in a network before they sign up for it.
Directories for individual and small group plans should be available to the public online without the need to log-in or to provide a password. Directories for all individual market plans should also be provided by insurers in machine-readable form to permit private companies to create search tools. Directories should include, and be searchable by, information on providers including name, contact information, location, specialty, languages spoken, and whether or not the provider is accepting patients.
The recently launched federally facilitated marketplace doctor lookup tool should be supplemented by private marketplace search tools.
If a network is tiered, providers should be identified and be searchable by tier. The directory should clearly define the ramifications of tiered status in terms comprehensible to ordinary consumers. Consumers should also be able to trust the accuracy of provider directories. Directories should be updated monthly.
Only a handful of states currently require this, although CMS now require monthly updates from QHPs in the federally facilitated marketplaces. Network directory updates should be filed with state insurance regulators, who should make reviewing network directories part of their regular market conduct analysis, as well as respond to complaints about directories. Trusted consumer organizations such as Consumers Union or Consumer Checkbook could also rate plan networks for their comprehensiveness and quality.
Formularies should be available online and in machine-readable form and regularly updated. Insurers and group health plans should not be allowed to remove drugs from a formulary or change its tier status within a plan year unless the drug is determined to not be safe or effective, a generic form of a previously brand-name only drug becomes available, or an over-the-counter equivalent of the drug becomes available.
Nevada has recently considered a formulary regulation that takes this approach.