Give While You Live, and Texas-Size Bail Reform

By Ashley Winstead, Director of Strategic Communications

Debates over statewide bail reform are yet again heating up in Texas, with several House and Senate bills introduced in the state Legislature, each with different approaches to reform — and some, as advocates have pointed out, offering a vision that's actually more regressive than the status quo. 

What’s Happening: Bail reform has long been on Texans' minds: Chief Justice Nathan Hecht has called for reform for years, pointing out that not only are current bail practices "illegal" and unfair, but also ineffective and expensive. State legislators have considered the issue in the past, but legislation has always fizzled. Now, with strong bipartisan support for reform — and against the backdrop of recent federal court cases in Houston, Galveston, and Dallas that have ruled those jurisdictions' bail practices illegal — the issue is once again on the floor.

Why It Matters: On a daily basis, there are more than 40,000 people sitting in jails in Texas, the majority of whom are there simply because they can't afford the bail to leave. It's unfair to make such a profound difference in someone's life — the difference between whether they stay imprisoned and risk losing their jobs, rent payments, custody, and more, or are released and keep their life stable — based on whether or not they have access to money. 

Bottom Line: Our criminal justice system is supposed to be governed by justice, individual rights, and accountability — after due process. Yet across the country, current bail systems fly in the face of those values, and in doing so harm millions, disproportionately Black people and people of color. Texas is no exception, and it's past time for change.

By Rhiannon Meyers Collette, Communications Manager

It's been more than a decade since Congress cleared the way for biosimilars to gain a greater foothold in the market. But uptake of these less expensive generic alternatives to biologic drugs — which are made from living organisms — has been slower than most expected, and as a result, savings haven't been as significant as hoped by now.

What’s Happening: We may be reaching a tipping point. A new survey of doctors and patients released by AV grantee NORC at the University of Chicago shows that confidence in biosimilars is growing. Nearly 9 out of the 10 doctors surveyed said they were somewhat or very likely to prescribe a biosimilar to new patients who needed the drugs. And 71 percent of patients said they would trust their doctors' decision to prescribe them one.

Why It Matters: Prescription drugs are expensive, and policymakers across the country are exploring a number of different solutions to rein in costs. One thing we know for sure: More competition leads to lower spending, writes my colleague Kevin Love, manager of drug pricing. How do we know competition works? In the decades since Congress helped open the door for a more robust generic drug market, less expensive generic drugs have gained notable traction. Generics now represent 90 percent of all prescriptions dispensed in America, but comprise only 20 percent of the spending.
 

Bottom Line: Generic drugs weren't an overnight success, but they have become a central part of our drug pricing system and continue to reap significant savings, Love writes. Similarly, the biosimilars market needs time to grow and flourish, and these survey results indicate that a brighter future is ahead.

Chye-Ching Huang, executive director of new AV grantee The Tax Law Center, which launched in January at NYU Law School. The Center aims to act as a public-interest voice in the complex process of making tax law, in order to avoid lost revenue and tilt the tax code in a fairer, more equitable direction. We talk with Huang about how private interests currently shape tax law in their favor, why lost tax revenue makes it harder to fund urgent needs, and how the old view of the IRS as the big bad guy doesn’t reflect reality. 

Read the Q&A >
 

Related: New analysis from Penn Wharton Budget Model looks at the budgetary and macroeconomic impacts of President Biden’s $2.7 trillion American Jobs Plan.

When we talk about second chances in the criminal justice system, often it’s around life after conviction and barriers to housing and employment. But a slew of progressive-minded prosecutors are working to keep people from ever entering the system in the first place. In honor of Second Chance Month this April, we’re spotlighting four restorative justice and diversion programs across the U.S. that are giving people charged with low-level and non-violent crimes a chance at redemption. The programs are targeted at youth, veterans, and “high-crime” zones.

Read the story >

Related: Read this thought-provoking op-ed from writer and lawyer Reginald Dwayne Betts about the power of parole for those who have spent decades in prison: “If we truly believe in redemption and second chances, parole should be celebrated”

Join the conversation: Prison Fellowship is hosting a Twitter chat, “Unlocking Second Chances,” at 1 p.m. ET April 14. You can catch up on this week’s chat here.

I am only halfway into “Exterminate All the Brutes,” a four-part HBO Max series on the origin story of white supremacy by filmmaker Raoul Peck (of 2016’s “I am Not Your Negro”), and I am already thinking about my second viewing. He posits “there are three words that summarize the whole history of humanity: civilization, colonization, extermination,” before immersing viewers in a sweeping and meditative journey through time. Peck uses everything at his disposal — literature, film, animation, dramatic re-enactment (featuring Josh Hartnett, an old friend of Peck’s), and his own life experiences — to tell a story supported by seminal works from writers and historians Sven Lindqvist (“Exterminate All the Brutes”), Roxanne Dunbar-Ortiz (“An Indigenous Peoples' History of the United States”) and Howard Zinn (“People’s History of the United States”). I fear the lack of a traditionally linear narrative may turn off some viewers, but I urge everyone to explore this bold and thought-provoking history lesson. 


 

Plus: How can you resist an opening line like this? “Everything I need to know about politics, I learned from cheese.” That’s how Katherine Gehl, founder of The Institute for Political Innovation, begins her TEDx Talk on how our "broken" U.S. political system is working exactly as designed. The cheese is a metaphor for healthy competition, which is sorely lacking in our political system. She explains the problems with party primaries and plurality voting and makes the case for innovations such as open primaries and ranked-choice voting, which give voters more choice and incentivize politicians to work together, civilly, toward solutions that benefit the public interest — rather than just focusing on reelection. And ICYMI, Gehl was a guest on "Deep Dive With Laura Arnold," where they discussed how the structures of our electoral and legislative systems have widened political divisions.

Mark Miller, AV’s Executive Vice President of Health Care, talking about the affordability crisis in health care on The Gary Bisbee Show. Dive into how he became interested in health policy, his time as executive director of MedPAC, and what the next 10 years of health policy will look like. “Affordability from the perspective of the taxpayer, employer, or family will be the defining issue of the decade.”

Related: “President Biden is proposing to do more for long-term care recipients than any president since Lyndon Johnson and the creation of Medicaid in 1965,” says Howard Gleckman of the Urban Institute and Tax Policy Center on the latest Tradeoffs podcast. Listen for a discussion on caring for older and disabled Americans at home.

By Stuart Buck, Vice President of Research

A recent paper by Stanford professors found that among the four most common cancers (lung, breast, colon, and prostate), there is a “substantial rise nationwide in new cancer diagnoses at 65,” compared to ages 61 to 64. They claim, likely correctly, that when people become eligible for Medicare at 65, they are more likely to get access to cancer screening and treatment. 

Seems logical enough.  

But the researchers then try to look at whether Medicare availability at age 65 causes better cancer survival. Specifically, they “performed a matched analysis comparing uninsured 61- to 64-year-old patients (pre-Medicare) and insured 65- to 69-year-old patients (post-Medicare).” 
 

Hmmm. There are lots of ways to mess up when trying to compare survival times for different patient groups who are automatically of different ages and insurance status. Let’s take a look. 

First, in their sample, only around 2-5% of the 61-64 year olds were uninsured. Comparing a tiny group of uninsured people to potentially anyone on Medicare seems likely to be contaminated by selection bias, even if matched on demographics. 

Second, it looks like they just straight-up compared survival times for the two groups, even though the Medicare group is automatically a few years older (can’t match on age here!). That seems problematic. 

Third, and worst of all, they point out in Table 4 that the 61-64 year olds were much more likely to be diagnosed at Stage IV, whereas when they get access to Medicare at 65, they are more likely to be diagnosed at Stage I. 

This makes it quite suspect to say, as the paper does, that the “median survival from diagnosis to death...was longer for the older and insured post-Medicare subjects.” 

No kidding!

Whenever you diagnose people at Stage I rather than Stage IV, they will automatically live longer measured from the time of diagnosis, even if their actual lifespan remains exactly the same. 

This is such a well-known bias that it has a name: “lead time bias.” 

Yet the paper seems to be directly based on lead time bias. Hence its conclusion that “Medicare eligibility...is associated with a rise in early-stage cancer diagnoses and a resulting survival benefit.” 

As well: “The excess diagnoses at the age of 65 years are primarily stage I, and this likely contributes to the finding that insured patients beyond the age of 65 years…have lower cancer-specific mortality rates than uninsured patients before the age of 65 years.”

The researchers seem to realize that coming up with a bunch of “excess diagnoses” at Stage I will directly lead to a finding that those patients survive for 5 years from diagnosis at a higher rate than people diagnosed at Stage 4. But this is just articulating what lead time bias is, without acknowledging that they need to correct for it somehow! 
 

Once again, it’s worth looking beyond the headlines. 

Ford Foundation leader Darren Walker, who started his life growing up in poverty in East Texas, benefitting from the very programs the foundation funds, is now reimagining the philanthropy from top to bottom. He's making the fight against inequality the mission of every grant the foundation delivers. Generosity is not enough, he says — giving should be about justice. Watch the 60 Minutes interview.