Archive for November, 2009

James Adler: JOBS 1.01: Creating Jobs Quickly and Cheaply

The TARP and Stimulus programs have stabilized the economy, but not the American family. Job loss continues, albeit at a slower pace. Now the Administration should focus its attention on actual job creation, for with a job can come not only income, but also dignity and the chance at a better job. The upcoming White House Conference on Jobs must, accordingly, focus on mechanisms for actually creating jobs.

This is the second of four posts dealing with such mechanisms for actual job creation. The key to creating jobs quickly is to utilize existing employers, particularly non-profits who have seen their resources diminish precisely at the time of maximum need for their services. The key to creating jobs cheaply is to limit the rate paid per hour and to employ person who would otherwise be on welfare or unemployment insurance, thus gaining a substantial offset in cost.

A program with these features is underway in Los Angeles with the goal of creating by March 2010 10,000 transitional jobs paying $10.00 per hour for up to 40 hours per week. Spearheaded by Supervisor Don Knabe and the Los Angeles County Department of Public Social services, this program uses federal Stimulus money and the County's Transitional Subsidized Employment (TSE) program, which was developed for participants who remain unemployed or underemployed after receiving services and job search assistance.

To simply the administration of the program for both the County and the participating employers, participants will be on the payroll of a County contractor. Participants will be placed into subsidized jobs in all sectors of the economy (non-profit (including faith-based), for profit and governmental) and will be matched with jobs that complement their employment goals. The "host" employer must provide supervision equal to 20% of the wage cost and create jobs that do not displace existing employees.

Because this program utilizes existing employers who are supplementing their work forces in order to better serve their clients or customers, job creation can be rapid and will not require creating additional governmental agencies. Because most of the participants would otherwise be receiving a TANF stipend, the incremental cost of creating such jobs is relatively low.

Although the cost of replicating this program throughout the Country would vary by state and family size, in Los Angeles, where the welfare stipend averages approximately $700 per month, the net additional out of pocket cost of this program is quite modest. In Los Angeles, $20,000 a year transitional jobs are being created at virtually no cost to the County and at an incremental cost to the Federal government of under $16,000 per year per participant. This low cost is possible because the savings in the welfare grant of approximately $8,400 per year more than offsets the increased costs due to administration, FICA taxes and workers' compensation insurance. The savings would be even greater if the person offered TSE was receiving extended unemployment insurance which is paid for with 100% federal Treasury dollars.

The true costs of such a program are undoubtedly still less because there are substantial savings (in food stamps, health care, criminal justice, housing and other governmental costs) when persons are employed. By way of comparison, a recent County study found that approximately $3.50 was saved for every dollar spent to relieve homelessness through rental subsidies for those on general relief. While the return from an employment program would be less, there would nevertheless be substantial aggregate long term savings achieved if our Nation would replace its welfare, extended unemployment and related programs with programs providing jobs, a paycheck and dignity.

If this program were replicated elsewhere, thousands of transitional jobs could be created more quickly and at a lower cost than in virtually any other way. The unemployment rolls would be reduced while our communities--and especially the non-profits which have been so adversely affected by this recession--would greatly benefit from the work of the program's participants. More importantly, the participants themselves would gain the dignity and income of a job as well as the training and job experience. Perhaps most important of all, a job well done will earn the participants a reference which will lead to a better job as soon as the economy once again begins to create new jobs.


More on Careers


Comments off

Jonathan Handel: Little-Noticed Music Deal

Everyone listens to music, but musicians unions may not attract the same attention. Several people, including myself, reported on the composers and lyricists recently, but this time I’m talking about the musicians themselves, i.e., the performers. Turns out their union, the American Federation of Musicians, made a deal three weeks ago with the studios — but it appears (correct me if I’m mistaken) that no one reported it (though the LA Times did mention that the deal was in negotiation).

Let’s correct the omission. According to the AFM website, the two agreements (one theatrical, the other television) run through February 2013 and establish jurisdiction over productions made for new media, increase residuals for traditional product exhibited in new media (move-over product), and  “provide a new income stream when music is used in New Media other than in New Media productions.” The agreements also include wage increases and “protect musicians’ health benefits.”

That’s all the detail I have at this point. A ratification package is going out to members shortly, or already has. More info to come when I have it.

———————

Subscribe to my blog (jhandel.com) for more about entertainment law and digital media law. Go to the blog itself to subscribe via RSS or email. Or, follow me on Twitter, friend me on Facebook, or subscribe to my Huffington Post articles. If you work in tech, check out my book How to Write LOIs and Term Sheets.


Comments off

Senate opens debate on sweeping health care bill

Sen. Harry Reid launched what is expected to be a rancorous legislative battle by hailing the health care debate as one of the most important in U.S. history.

Comments off

Health Care Progress Report: November 30

As Senate Debate Begins, Democrats and the White House Are Strategizing to Get a Health Bill Passed as Quickly as Possible

Comments off

Bill Mann: Hey, Handgun Fans: These Gun Victims WERE Heavily Armed

This weekend's tragic murder of four Seattle-area police officers has blown away one of the NRA and gun nuts' major -- if ancient and tired -- arguments.

A few weeks ago, we asked here why there were few media stories about where - and why - the Fort Hood shooter got his gun.

But the media these days isn't interested in doing gun-control stories. Flashing police lights and heavily armed officers scurrying around make far better video.

Predictably, after my blog appeared, I was swamped with impassioned - and usually absurd -- arguments from gun owners and other pistoleros. People who not only need to GET a life, but to start thinking about other people's lives and personal safety realistically, if that's even possible.

Sunday, I watched six hours of Seattle TV coverage up here about the tragic killing of four cops in a Tacoma coffee shop.

All were armed and in uniform, and all were wearing flak jackets.

I got scores of angry e-mails after my HuffPost blogs from handgun lovers, but one argument remained central.

"If those soldiers (or Virginia Tech students, yadda yadda yadda) had been armed, the killer would have been stopped cold. There wouldn't have been a massacre."

The four Seattle-cops were armed, and it didn't stop them from being shot.

The "if-only everyone-were-armed" argument was crazy and reckless before this. Now it's been proven beyond a doubt to be absolutely ridiculous.

Time to retire that one for good, Handgun Nation. Re-staging Tombstone, Ariz., circa 1889 is an irrational, wild fantasy at best.

The problem remains crazy, embittered people - and this country has no shortage of them - getting access to handguns far too easily.

This cycle will keep repeating itself until we finally get serious about gun control - which, along with health care, is truly our biggest life-and-death issue.

I know the politics of this are difficult at best, but a serious, adult dialogue about our national gun sickness has to start at some point.

Otherwise, we'll probably continue to see one or two of these mass shootings a month.

And having everyone packing heat, as we've just seen up here in Seattle, isn't going to stop it. It's a dangerous -- and ridiculous -- idea.


Comments off

Video: Face The Nation, 11.29.09

Sen. Carl Levin (D-Mich.) discusses Afghanistan and health care reform. Plus; Former Majority Leader Dick Army, Former RNC Chairman Ed Gillespie and Moderate Republican Dede Scozzafava debate the future of the Republican Party.

Comments off

Joseph B. Treaster: United Nations Food Leader On Defeating Hunger

WASHINGTON - This year the number of poor people around the world struggling to get enough food for survival for themselves and their families has risen to a little more than a billion - the highest level in 30 years.

Food supplies have been reduced by floods and droughts. But more importantly, they have been hit by financial pressures. High oil prices pushed farmers to sell food crops for use as alternative fuels. Traders bid up prices on commodities like corn and wheat. A worldwide recession led to lost jobs and less money going back to relatives in developing countries from the United States and other places.

The economic stress has eased somewhat and aid agencies, the United States and a few other countries have upped their efforts to feed the poor and under-nourished - especially in Africa and south Asia where the situation has chronically been the worst. But the mass of hungry people in what is often referred to the "world food crisis" has continued to rise. Experts say the picture is expected to be bleak for several years.

"The numbers have gone in reverse," said Josette Sheeran, the executive director of the United Nation's World Food Program. Yet she is optimistic.

Speaking here in a series of discussions on the United Nation's Millennium Goals jointly organized by CSIS, the Center for Strategic and International Studies, and the University of Miami's Knight Center for International Media, Ms. Sheeran said the response by the United States and other countries has been encouraging. For years, financial aid for agricultural in developing countries had been declining. This year the United States increased aid for farmers to about $600 million and the Obama Administration is asking Congress for $1.3 billion next year. The United States and several other big countries are promising to provide $20 billion over the next three years.

"We know how to defeat hunger," Ms Sheeran told an audience of about 150 college students, professors, business executives and experts on food, economics and the environment. "When you have leadership in place, when you have innovations in place. This is doable."

Ms. Sheeran, who took charge of the World Food Program in early 2007 after serving as Under Secretary of State for Economic, Energy and Agricultural Affairs in the administration of George W. Bush, praised President Obama. "President Obama stepped up to the plate," she said.

For several years the ranks of the hungry and undernourished had been steady at about 850 million, according to the United Nations Food and Agriculture Organization. The situation began to get worse in 2004. The number rose to 923 million in 2007 as the crisis began to take hold. It now stands at 1.02 billion.

The joint program of CSIS and the University of Miami's Knight Center for International Media, a unit of the university's School of Communication, began with a discussion on Haiti. The next discussion, on HIV-AIDS, is scheduled for Jan 17. One of the speakers is expected to be Dr. Eric Goosby, the State Department's Global AIDS Coordinator, appointed by President Obama in June.

The discussions are being broadcast live, worldwide, over the Internet. They are designed to engage and motivate policymakers and to inspire students and people everywhere. The University of Miami is complementing the discussions with a series of student-produced multi-media reports on poverty, women's health and other components of the Millennium Goals in world cities.

In the food and hunger discussion, Dr. Daniel Benetti, the director of aquaculture at the University of Miami's Rosentiel School of Marine and Atmospheric Science, spoke of adding to the world's food supply through aquaculture or fish farming. The University of Miami is pioneering work on growing fish in small, fenced in places in the ocean.

"We have to take a closer look at the oceans," Dr. Benetti said. "Seventy percent of the world is water. We believe we are not focusing enough on that."

One of the first beneficiaries of increased fish production would be the United States, Dr. Benetti said. The United States now imports 80 percent of the fish that Americans eat, he said. The result is an annual seafood trade deficit of $10 billion.

He compared the seafood imbalance to the United States dependence on foreign oil. "We must start producing our own food and become independent," Dr. Benetti said.

The moderator, Mariam Atash Nawabi, a television anchor at America Abroad Media and the president of AMDi, an international development consulting firm, asked where aquaculture has been most successful.

"Greece," said Dr. Benetti. "Eighteen years ago Greece didn't have any aquaculture. Now it produces more than all other" European countries. Australia, he said, has also been a leader.

Johanna Nesseth Tuttle is the vice president for strategic planning at CSIS. During the discussion, she said that CSIS, a non-profit, non-partisan research and analysis center, is focusing on three aspects of global food and hunger: production, research and trade, with a focus on small farmers that includes ways to provide them access to markets, fertilizer and better seeds, and such basic infrastructure needs as roads and irrigation.

Ms. Sheeran said that news coverage of the crisis has declined somewhat recently. But she said that "food prices are higher today than a year ago" in the majority of developing countries

When food prices are high, it is not just a matter of the poor buying less. But often, she said, governments in poor countries cannot raise the money to pay for their usual food imports. So there is not enough food to meet demand at any price. At one point, she said, "Liberia and other countries couldn't put enough cash on the table to compete in very tight global markets."

Women and children suffer most in a food crisis, Ms. Sheeran said. These days, she said, more than 250 million children do not have a consistent, healthy supply of food. Many of them are receiving little or no help. The World Food Program tries to intervene in the most severe cases. But overall, she said, the agency is able to provide food for only about 10 percent of those in desperate need.

Ms. Sheeran held up a red plastic cup, about the size of an over-large coffee mug. "This is the cup the World Food Program uses to reach over 20 million school children," she said. "It is the only guaranteed food they are going to get" on any given day. #

More on India


Comments off

Dr. Irene S. Levine: How to handle a fizzling friendship

QUESTION

Dear Irene,

I've been friends for three years with a guy at my office. We became friends after a really rough period in which I was demoted, isolated, and treated quite shabbily, though I couldn't afford to leave and wasn't in the best psychological state to do so (like, I was in need of health-insurance-paid therapy to restore myself). Only after laying a potential legal case before HR did I get the option of working in a different area at our office, with a different group, and things have stabilized. Our friendship helped me endure those dark days. We had spontaneous, one-on-one happy hours and bull sessions on the way home (since we live a few blocks from each other), dinners, etc. He's worked at our office a decade, in the somewhat protective bubble of our IT department, and has seen it all.

Just to clarify things: He is gay, and I am a heterosexual woman, so no crushes there. We are both moderate introverts who value our privacy and down time, though my friend acts way more outgoing than he really is. We tend to keep our "circles" of friends separate, and we prefer to keep our intimate (platonic) relationship at work quiet, as well as our outside interests. We work in a high-powered, hyper-aggressive, alpha male-dominated environment that is rife with sex, race, and age discrimination, and those who haven't been driven out by that know each other, though none of us really have much in common. My friend and I became friends because we did.

In any case, lately my friend has adopted this "I love you, now go away" persona that's testing my patience. Every few months I get the occasional drunk dial about how much he wants to be a good friend and sees me as a "little sister," but then, when I reach out and offer to do something nice for him, or just want to spend time, I get the wall of silence - like unreturned text messages and phone calls (like once a week), or avoidance at the office.

He said he wanted to travel to California with me for my birthday a few days, yet when it came time to commit the money a couple of weeks before, he "disappeared." Then he seemed offended after I returned, know that I took another good friend of mine with me. I didn't even give him any crap about it, though I certainly felt like it.

This back and forth has been going on for months. Still we see each other everyday, though there's more distance, but it remains cordial. It seems he's perfectly content to engage me when it's convenient for him, and while I enjoy his company when this happens, I feel kind of used. When we do talk, he dominates the conversation and listens little, either about me or about the advice that he asks me for about his own slightly frenetic life. He tends to complain that many, but not all, of his friends, some of whom are "in the life," are superficial, expect too much, and give too little. He says some judge him more harshly now because he's gained weight and is over 40.

Yet I see on Facebook and elsewhere that he has no problems "festing" with these same folks, or helping to save them from themselves in some way. Fine, that's his business, but here I am, a friend who accepts him for who he is, and I feel like I'm getting the short end of the stick. I'm trying to give him a chance, but I don't even feel like waiting around for his next "appearance" to tell him that this behavior is killing the vibe. As an introvert, it's not easy doing the emotional miner's work to cultivate rich, long-lasting friendships. I've had so-called friends treat me like this before, though some years ago, so I've developed surgical precision in cutting people off once I'm done. He's tap dancing on that edge of no-man's land, here. What would you recommend?

Signed,
Ella

ANSWER:

Dear Ella:

It sounds like you had a really close and easy relationship with your friend, which was especially important to you at a time when you were having so many difficulties at work. So I can understand your disappointment when such a satisfying and significant relationship suddenly changes and your friend becomes mercurial, distant, and not very reliable.

I suspect that something (or a series of things) has transpired in his life that he hasn't told you about; he, himself, may not even be consciously aware of what's happening. You mention that he's gained weight, is drinking too much, and is making inappropriate late-night calls. He's feeling judged by others and feels like the people around him are letting him down. He's just reached his 40th birthday, which may be a time when he's assessing what he's accomplished in his own life. He may be depressed.

You need to talk to him and communicate your concerns about him and your friendship. Let him know how these changes are affecting your relationship and that you feel badly about it. This will open the door for him to talk to you more openly if he chooses to---if not, at least he will think about what you have told him.

I know this has to hit you particularly hard because you have invested a lot of yourself in the relationship but it sounds like the issues have more to do with him than with you, per se. If you can't communicate, he may just need some time to struggle with what's bothering him and come out the other end.

Hope this is helpful.

Best,
Irene

Have a question about friendship? Send it to The Friendship Doctor.

Irene S. Levine, PhD is a freelance journalist and author. She holds an appointment as a professor of psychiatry at the New York University School of Medicine. Her new book about female friendships, Best Friends Forever: Surviving a Breakup with Your Best Friend, was recently published by Overlook Press. She also blogs about female friendships at The Friendship Blog and at PsychologyToday.com.

More on Relationships


Comments off

David Balto: Getting The Job Done Right: Strengthening The Senate Bill To Fully Protect Competition

Soon after thanksgiving the debate on health care reform begins in earnest before the Senate. Competition issues, normally a backwater concern for Congress, will be front and center. The Senate will grapple with the difficult question: how to make competition work in health care markets?

If there is anything that the health care debate has made clear, it is that there is a lack of competition in health care markets, especially health insurance. Competition is the lodestar of the free market, and a solid dose of competition is essential to making health care markets work. Competition, however, requires three components that are largely absent from our health care markets: transparency, choice, and a lack of conflicts of interest. Some markets, like the market for health insurance, fundamentally lack choice, where dominant insurer often enjoy monopoly power. Other markets such as pharmaceuticals take advantage of regulatory structures to maintain market power, as in the case of brand-name drugs paying off generic drug manufacturers to stay off the market. And in other markets, a complete lack of regulation allows health care middlemen--like pharmacy benefit managers ("PBMs") --to engage in fraudulent and deceptive practices, all while earning sky-high profits.

The Senate health care bill released this past weekend makes a solid attempt at addressing these issues, but falls short in creating the regulatory structure necessary to ensure that these markets are fully transparent and competitive. The Senate will debate the proposed health care bill in the next several weeks but at the core of this debate will be how to reform these markets to restore competition to make markets function effectively so consumers can enjoy the savings and increased quality that come with true competition. I have three suggestions.

Inject Competition in our Broken Health Insurance Markets

There is little dispute that health insurance markets are broken, with rapidly escalating premiums, egregious and deceptive practices, and skyrocketing profits. Competition is markedly absent in most health insurance markets, which are overwhelmingly concentrated across the country. A 2007 study by the American Medical Association found that, in most markets, one or two insurers dominate, and a study this year by Health Care for America Now! found that consumers pay higher premiums in the most concentrated markets for health insurance.

A robust national public plan would be the single strongest competitive force in health insurance markets. The public plan would restore competition by providing a rival to these dominant insurers whose incentives are focused on creating coverage, not profits. The public plan's practices would stand in stark contract to the deceptive and exploitative practices that are widespread in the insurance industry. It would disrupt the market and set standards for transparency, disclosure, and eliminating conflicts of interest. Both the House and Senate bills contain this essential element to reform.

Another crucial step in ensuring that health insurance markets are competitive would be to fully repeal the McCarran-Ferguson Act, which exempts the insurance industry from the federal antitrust laws. Few industries deserve antitrust exemption, and health insurance is probably the last industry that should be shielded from these laws. The original intent of the law was to give insurers the ability the exchange information on risks and claims in a way that would help inexperienced new insurers enter the market. But under current antitrust standards, exchanging information in this fashion is not illegal, as Assistant Attorney General Christine Varney has clarified, and certainly does not warrant an all-out exemption.

The House enacted a fairly broad repeal of the McCarran-Ferguson Act with Congressman Conyer's bill, H.R. 3596. The Senate bill, however, is silent. Senator Leahy's bill, S. 1681, which would repeal the exemption and was passed by the Senate Judiciary Committee, should be enacted as part of the healthcare reform bill to give the federal antitrust enforcers the ability to address anticompetitive activity by health insurers. The Senate should supplement the repeal with provisions in Congressman Conyers' bill, which takes further steps to protect against anticompetitive and anti-consumer practices by clarifying the ability of the FTC to bring enforcement actions against insurers.

Some have questioned the need for eliminating this exemption, because the exemption has not played a role in many cases in the past. There are two answers. First, eliminating the exemption is important to protect competition after health care reform is enacted. if the exemption is left untouched, after health care reform restores some level of competition to the health insurance market, the McCarran Ferguson Act could be used to allow insurers to collude. Second, eliminating the exemption and clarifying FTC jurisdiction is important to enable the FTC to bring consumer protection actions against insurers.

Expand Access to Affordable Generics by Banning Patent Settlements

When generic pharmaceutical manufacturers successfully challenge patents, they can introduce generic equivalents to the market before the patent expires, providing consumers an affordable alternative. In 2008 alone, consumers and the federal government saved over $120 billion thanks to generic drugs. Unfortunately, regulatory structure currently provides a fertile medium to harm competition. A branded drug manufacturer can simply pay the generic manufacturer challenging their patent to stay off the market (an "exclusion payment"), leaving the branded drug to enjoy continued profits as a monopolist. If these payments continue, the FTC has estimated that the potential loss to consumers over the next ten years will exceed $35 billion.

Unfortunately the regulatory structure creates a set of perverse incentives in which generic drug manufacturers are almost more likely to enter into these settlements than to introduce a generic drug to the market. The regulations currently give the first generic manufacturer to challenge a patent the exclusive right to sell their generic equivalent for six months, and no other challenger has the opportunity to enter the market, even if it is successful in challenging the patent. Regulations which give the exclusivity period solely to the first-to-file generic create a bottleneck to all generic competition and, not surprisingly, many generic firms are willing to share the bottleneck with the branded firm in exchange for an exclusion payment.

The Senate bill does not address this failure in the regulatory structure or the use of these exclusion payments.. The House bill appropriately addresses this problem by making exclusion payments per se illegal under the antitrust laws. The Senate Judiciary Committee has attempted to deal with exclusion payments with S. 369, which is far more complex than the House bill: the bill, proposed by Senator Kohl and others, creates a relatively elaborate litigation process for the FTC to demonstrate that a settlement is illegal. That approach is well intended, but if there is no effort to grapple with the perverse incentives of the regulatory system, patent settlements will likely continue to block affordable generics from reaching the market as quickly as possible.

The better solution is to eliminate the underlying problem: the six-month exclusivity bottleneck. The Senate should enact S. 1315, introduced by Senators Kohl and Nelson, which would eliminate the perverse incentives of the regulatory system. This bill would correct the incentives by giving a subsequent generic challenger that successfully challenges a patent the opportunity to share in the exclusivity period. Not only would this eliminate the ability of a branded drug manufacturer to pay off a single generic firm to guarantee that they maintain monopoly power, but this would also encourage more generic manufacturers to challenge patents, increasing the odds that consumers will gain access to an affordable generic alternative as soon as possible.

A Lack of Transparency Allows Health Care Middlemen to Prevent Effective Cost Control

We rely on health care intermediaries to create networks and simplify the payment process for the countless individual transactions necessary to keep the health care market moving. Pharmacy benefit managers (PBMs) are middlemen that use the purchasing power of their members and large scale to negotiate rebates on drug purchases and, in theory, lower costs for enrollees. By managing formularies and making use of their bargaining power, PBMs have the potential to negotiate significant savings for health plans, government entities, and large employers who contract with them.

This potential is unfulfilled, however, because of a lack of competition and transparency. Prescription drugs represent the most rapidly growing segment of health care spending, and yet PBMs--which are involved in the bulk of prescription drugs purchases--are the only part of the health care market that is still unregulated. Without regulation and oversight, PBMs do not provide the service corporations, unions, governments and other plan sponsors hire them to do: to secure the lowest drug costs possible.

Moreover, without transparency, the activities of health care middlemen are fertile for fraud, waste and abuse. Over the past five years, PBMs' fraudulent and deceptive practices have resulted in five enforcement actions against major PBMs brought by a coalition of over 30 state attorneys general. For their illegal conduct, including drug switching, deceptive trade practices, repackaging, receiving kickbacks, and illegally retaining kickbacks, these PBMs have paid over $370 million in fines and penalties. As the National Legislative Association on Prescription Drugs, a bipartisan group of state legislators, noted: "We know of no other market in which there have been such a significant number of prominent enforcement actions and investigations, especially in a market with such a significant impact on taxpayers."

At the same time, the profits of the three major PBMs have nearly tripled over the past few years from $900 million to almost $3 billion annually. No other segment of the healthcare market enjoys such high profits while maintaining a record of such deceptive, egregious and anti-consumer practices.

Fortunately, a provision in the Senate bill authored by Senator Cantwell requires a certain level of disclosure by PBMs to plan sponsors in the Exchange. Transparency would force PBMs to be accountable for their actions and for drug costs. Congress can do more, though, to ensure that the incentives of PBMs are aligned with those of plan sponsors and that they make every effort to reduce drug costs rather than seeking ways to pocket savings that should be passed on to consumers and plan sponsors.

The House health care bill has stronger language addressing specific wasteful practices by PBMs that the Senate should adopt. For example, PBMs frequently switch plan members to drugs that may be more expensive to their plan sponsor so the PBM can collect a larger rebate check from that drug's manufacturer. The House bill requires that PBMs disclose when and why they might switch prescriptions in this fashion.

The Senate should take further steps to ensure that PBMs are fully accountable to plan sponsors. Plan sponsors should have the right to audit their PBM and learn what they paid the PBM for each drug and what the PBM, in turn, paid the pharmacy that dispensed the drug. Plan sponsors should also have the right to know what rebates the PBM secured on their behalf. To rein in prescription drug spending, Congress should give plan sponsors all the tools they need to determine if their PBM is saving them money and sharing those savings. Larger plan sponsors across the country already use these tools, and they've achieved significant savings by enacting transparency: TRICARE, the Department of Defense's health plan, anticipates savings of $1.67 billion by switching to a transparent plan, and the State of Wisconsin saved over $150 million by switching to a transparent PBM. The Senate should keep these savings in mind and enact stronger transparency provisions.

Conclusion

Today, the market for health care is structured such that conflicts of interest, a lack of choice and a lack of transparency significantly hinder meaningful competition. With health care reform, we can change that. Keeping consumers' interests in mind, Congress should take advantage of this opportunity by fully addressing the regulatory structures that fail to promote genuine competition.

More on Health


Comments off

RJ Eskow: Phantom America, Thanks For Nothing!

The heart that struggles with disappointment and sadness believes too easily that hope is a lie, a fraud, another hustler's pitch to the next sucker walking down the street. Disillusionment with Obama and the Democrats can turn dark in just this way. The audacity of hope is really the asperity of a hoax, says the wounded heart, and we're just the latest crowd to fall for the same old three-card monte.

"I know thee, I have found thee, & I will not let thee go," wrote William Blake in America: A Prophecy. "Thou art the image of God who dwells in darkness of Africa; And thou art fall'n to give me life in regions of dark death." Meaning what? It could mean that we're a land born of slavery, a nation that made a Faustian bargain for its independence.

Those who are disappointed with the President's leadership - I'm often among them - might do well to remember that he had the real audacity to speak these words to our country about its beloved Declaration of Independence: "The document they produced was eventually signed but ultimately unfinished. It was stained by this nation's original sin of slavery."

The President was right - although, as Elvis Costello observed, "there's no such thing as an original sin." That cynical tradeoff, that dream of freedom bought on the slavery of others, had been made many times before 1776 and has been made many times since. Those of us who would judge the Founding Fathers (not a Mother among them) would do well to note how many times each day we purchase our freedom on the backs of slaves - in Third World sweatshops and North American ghettos, in the sinking islands of the South Pacific and the carnage of bombed wedding parties on Afghan highways.

And, though this is the time where we're supposed to give thanks, even this holiday could be considered an illusion. That first settlement of 102 radical British separatists blew it from the start. Half of them died during that first winter. We idealize their Native American rescuers as kindly, Rousseauian "noble savages," but the Wampanoag only saved the colonists because they needed allies for their power struggle against the neighboring Narragansett alliance.

So those sweet cartoons we watched as kids were just another dream. This holiday was really born when a major European f**k-up collided with some indigenous realpolitik. Stephen Vincent Benét, poet laureate of the American dream, had to invoke ghosts to praise the Founding Fathers: "When Daniel Boone goes by at night/The phantom deer arise/And all lost, wild America/Is burning in their eyes."

In this idealized land even the deer are phantoms. That must mean that the USA we were raised to love and believe in is a dream, a lie, a ghost we're trained to pursue so that we'll make good and docile citizens of the Empire, right? And for that we're supposed to give thanks? Thanks for nothing, Phantom America!

Except ...

It is by dreams that we're sustained, that we survive, that we grow. Everything we perceive about our world is a conceptual and emotional construct, a mental model we build to organize and sustain ourselves in a world of nonstop information. The negative model - the one where we've always been deceived and always will be - is just as much a phantom as the positive. We need to pick a construct that reasonably reflects what is, and what can be, and use it to improve our world. As Red America rocker (and noted philosopher) Axl Rose might say, we need to "use our illusion."

Benét's "wild America" exists. I've seen it. So have you. I saw it most recently when I appeared at the Progressive Freedom Festival in Kernville, in the wild canyon country north of Bakersfield. That's native country to two of my favorite singers, Merle Haggard and Buck Owens, two poets of our phantom dreams. Bakersfield is also home to Dolores Huerta, who co-founded the United Farm Workers with Cesar Chavez and who I had the privilege of introducing at the Festival. The dream is expanding year by year.

The land in the Kern River Valley is rugged and harsh, beautiful and wild. It's a very Red America up there, an extreme right-wing nation filled with retirees and bikers and residents of the vanishing agrarian nation we were when Benét was born in 1898. Their dreams have made them "tea party" Americans, but our job isn't to condemn them. Our job is to help them understand that we share a common dream. Our job is to respect their idealism and their desire to serve something greater than themselves, even if those impulses have been deformed by twisted mental models, and to harmonize their aspirations with our own.

"My spirit gets so downhearted sometimes," sang the aforementioned (and British) Mr. Costello, using the words of his colleague Nick Lowe: "Where are the strong, in whom I trusted?" They're not in Washington, at least not often enough. But they're right here, walking among us. They are us, and they carry the dream of freedom. "Let the slave grinding at the mill, run out into the field," wrote Blake in that poem. "Let him look up into the heavens & laugh in the bright air."

"Life is not lost by dying," said Benét, "life is lost minute by minute, day by dragging day, in all the thousand small uncaring ways." That's what happens when you lose your dreams. By all means, let's keep the pressure on Barack and Rahm and Harry and all the rest. Let's play the game the way it must be played. But personally, I'll keep repeating that question of Costello's and Lowe's, as dated and naïve as it may sound to jaded ears: What is so funny about peace, love, and understanding?

America, land of phantoms and illusions, the poets and singers have read your palm. You've had hard days in the past and more are on their way. But you have your dreams and they must never be lost. They are beautiful, they are real, and at our most precious moments they are true. They sustain us.

I will love and pursue this dream. I will see reality as precisely as I can, but I will believe. And I'll offer these words of thanks:

I know thee, I have found thee, and I will not let thee go.
___________________

Related: Fourth of July post - "The Bells Say, 'You Cannot Love the Nation If You Do Not Love the Land'"

RJ Eskow blogs when he can at:

A Night Light
The Sentinel Effect: Healthcare Blog


Read more HuffPost Thanksgiving coverage and commentary

More on Thanksgiving


Comments off