Category Archives: Uncategorized

Winning Hearts and Minds: Making the Case for the Labor Movement

Source: Topos Partnership, Labor Day, 2012

The Problem
After decades of bad press, average Americans – if they think of unions at all – regard them too often with a hostile or skeptical eye. Yet, as union membership has declined, so too have the clout and prosperity of American workers. Reversing this trend will require a long-term commitment to rebuilding people’s understanding of the role of labor organizing in creating more widespread prosperity.

The Solution
When people understand that unions are not meddlesome outside institutions, but instead an expression of their own ability to stick together with other employees; when they understand that unions are not just about dues and services, but about a collective voice; when they see that the fundamental right to stick together is being attacked, then their whole perspective on the labor movement shifts. People turn away from the familiar caricatures to a much more constructive and supportive engagement.

Risk factors associated with bus accident severity in the United States: A generalized ordered logit model

Source: Sigal Kaplan, Carlo Giacomo Prato, Journal of Safety Research, Volume 43, Issue 3, July 2012
(subscription required)

From the abstract:
► Generalized ordered logit model for bus accident severity in the United States ► Marginal effects of risk factors on bus accident severity are identified ► Bus severity is linked to driver’s age, gender and risky behavior ► Bus severity is linked with intersections, low-speed areas and road curves ► Driver training, career length, vehicle standards and education are proposed…

Results show that accident severity increases: (i) for young bus drivers under the age of 25; (ii) for drivers beyond the age of 55, and most prominently for drivers over 65 years old; (iii) for female drivers; (iv) for very high (over 65 mph) and very low (under 20 mph) speed limits; (v) at intersections; (vi) because of inattentive and risky driving….

Set in Stone: Building America’s New Generation of Arts Facilities, 1994-2008

Source: University of Chicago, Cultural Policy Center, June 2012

From the summary:
This study of cultural building began in 2006 as a response to inquiries from arts consultants who had for some time been working on dozens of building projects across the country and found themselves confronting the same sets of problems with each new client. In many cases, the actual need for a new facility had not been demonstrated (even though there was often great enthusiasm about getting underway with construction); the connection between a new facility and delivering more effectively on mission was in many instances quite murky; realism about how a new facility could be sustained once built was frequently missing – both in terms of the financial resources and staff needed to successfully run a new facility. The list goes on. New facilities would open, organizations would then run into financial problems because of insufficient revenue, or an inadequate endowment, or because they couldn’t service the debt they incurred to build, or because the building was too costly to operate, or it turned out to be beyond the organization’s capacity to administer and sustain.

The need to move beyond anecdotes and newspaper articles and toward an in-depth, empirical study based on the entire cohort of buildings constructed over the last few decades seemed obvious. Without such a study, institutions had no clear and systematic way to learn from one another’s experiences, both positive and negative. While it emerges that there is no single ‘right way’ to undertake a cultural building project, from conducting analyses of more than 800 cultural facilities built since 1994 there emerges a long list of things to avoid, and things to make sure to do.
The Determinants of Cultural Building
The Feasibility of Cultural Building Projects
An Overview of Cultural Building in the United States: 1994–2008
A Quick Overview
Case Studies
Follow the Money

Private Medicare Drug Plans: Seniors and Taxpayers Hurt by High Expenses, Low Rebates

Source: U.S. House of Representatives, Committee on Oversight and Government Reform

The report has five principal findings:

The Part D insurers have high administrative expenses. The administrative expenses, sales costs, and profits of the private insurers offering Medicare Part D coverage will cost taxpayers and beneficiaries $180 per beneficiary in 2007. Taking into account the costs to the government of monitoring the private insurers, total administrative expenses, sales costs, and profits will reach $4.6 billion in 2007, with the profits of the Part D insurers alone accounting for $1 billion. The administrative expenses, sales costs, and profits of the privatized Part D program are almost six times higher than the administrative expenses of traditional Medicare. These high expenses do not appear to be due to one-time “start-up” costs because the total expenses increased from 2006 to 2007.

The Part D insurers have not negotiated significant drug manufacturer rebates. The rebates negotiated from drug manufacturers by the private Part D insurers will reduce Medicare drug spending by 8.1% in 2007. In contrast, the Medicaid program receives rebates from drug manufacturers that reduce drug spending by 26%, over three times as much. The small size of the Medicare rebates and the transfer of low-income dual-eligible beneficiaries from Medicaid drug coverage to Medicare drug coverage will provide a $2.8 billion windfall to pharmaceutical manufacturers in 2007.

The Part D insurers receive rebates on drug purchases made by beneficiaries in coverage gaps. The Medicare Modernization Act requires that private insurers give Medicare beneficiaries “access to their negotiated prices,” including “all discounts, … rebates, [or] other price concessions.” When the Part D insurers obtain rebates, however, they do not pass them through to beneficiaries by reducing drug prices in coverage gaps like the “donut hole.” Instead, the dollars flow in the opposite direction: the private insurers receive rebates from the drug manufacturers on purchases paid out-of-pocket by beneficiaries. In 2007, the Part D insurers are expected to receive $1.0 billion in drug rebates from transactions in which beneficiaries in coverage gaps pay 100% of the drug costs.

The Part D insurers have established drug pricing formulas that leave beneficiaries and taxpayers vulnerable to price increases. In almost all cases, the private insurers use pricing formulas that pay pharmacies the drug manufacturers’ full list prices minus a fixed percentage and a small dispensing fee. These formulas have resulted in drug prices that are generally no lower than those already available through discount pharmacies and on-line drugstores, while leaving beneficiaries and taxpayers vulnerable to repeated increases in list prices by the drug manufacturers.

The Part D insurers have a mixed record in promoting the use of generic drugs. In 2007, 59% of prescriptions filled by Medicare Part D will be filled with generic drugs. This level of use of generic drugs compares favorably with Medicaid, which fills 54% of prescriptions with generic drugs. It does not compare favorably with the experience of the Department of Veterans Affairs, which fills 68% of prescriptions with generic drugs.

Kaiser Issues New Resources Examining Medicare Part D Drug Plans

Source: Kaiser Family Foundation

As the next open enrollment period for Medicare prescription drug coverage approaches, the Kaiser Family Foundation has issued two data spotlights examining key changes and variations among the private Medicare drug plans available in 2008 across the country. More than 24 million seniors and disabled people receiving Medicare benefits are enrolled in a private Medicare drug plan, including 17 million in stand- alone drug plans and 7 million in Medicare Advantage drug plans. The first spotlight analyzes the premiums charged by the 1,824 stand-alone Medicare Part D plans that will be offered in markets across the country in 2008. The second spotlight examines the coverage gap, or “doughnut hole,” in Medicare drug plans.

In addition, Kaiser issued a new chartpack providing detailed information about Part D enrollment, by plan and by firm, in 2007.

Kaiser also has updated two relevant fact sheets — one that provides an overview of the Medicare prescription drug benefit and another that provides a state-by-state look at key features of the available 2008 stand-alone plans.

New Medicaid Drug Payment Rule

Source: U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Press Release, July 6, 2007

A new method of setting limits on what the federal government will reimburse state Medicaid agencies for prescription drug payments — aimed at reigning in inflated drug product payments — was announced today in a final rule put on display at the Federal Register.

“This new payment formula allows Medicaid to pay more appropriately for prescription drugs dispensed to Medicaid beneficiaries,” said Leslie V. Norwalk, Esq., acting administrator of the Centers for Medicare & Medicaid Services (CMS).

The new regulation is expected to save states and the federal government $8.4 billion over the next five years. Even with this change, the Medicaid program is still expected to spend $140 billion for drugs over the same time period, fiscal years 2007 through 2011.

The change, part of the Deficit Reduction Act (DRA) of 2005, is in part a reaction to a series of reports issued in 2004 by both the Government Accountability Office (GAO) and the HHS Office of the Inspector General (OIG) showing that Medicaid payments to pharmacies for generic drugs were much higher than what pharmacies were actually paying for those drugs.

Both the GAO and the OIG found that states were overpaying for drugs because they were using commercial drug pricing guides as the basis for setting state reimbursement levels. The investigation of these drug “compendia” documented that these prices were artificially inflated, especially for generic drugs. Pharmacies, the reports showed, made the most profit on those generic drugs with the highest mark-up, creating an incentive to dispense those drugs.
+ Full text of rule