When I started this newsletter in April — freshly locked down, socially distancing, homeschooling two kids, working from home — I never imagined I would end the year the same way. But I am not the same. None of us are. Our world has shifted in ways both unimaginable and necessary, exposing who we are as a country and fostering critical conversations on racial justice, democracy, and systemic failures in health care, criminal justice, and education. In reflection, AV has compiled 20 stories from 2020 that delve into the issues we grappled with this year: policing reform; a lack of affordable health care; online learning and student debt; the worsening opioid epidemic; economic inequality; and of course, COVID-19. These stories remind us that as we begin to turn a corner in this pandemic with the start of vaccinations, a return to normal should not be the goal. Returning to the status quo is forgetting what we bore witness to: the loss of more than 300,000 American lives; the murders of George Floyd, Breonna Taylor, and Ahmaud Arbery; the vulnerability of our democracy; and the stark economic hardships endured by so many in our communities. We cannot and should not go back to business as usual, but we can and should right these wrongs with more just and fair policies that create lasting change and better people's lives.
Programming note: We’ll be back the first week of January. Wishing all of our fellow policy nerds a restful holiday and a Happy New Year.
‘Fighting Smarter, Not Harder’
By Evan Mintz, Communications Manager
As the list of people killed at the hands of police grows longer, and calls for policing reform grow more urgent, there has been a push for agencies to adopt policies in de-escalation — asking police officers to defuse situations without force by using time, space, dialogue, and critical thinking. While the concept has had its share of critics, a groundbreaking new study is revealing just how effective — and safe — de-escalation tactics can be.
What’s Happening: A new study by the International Association of Chiefs of Police/University of Cincinnati Center for Police Research and Policy found that de-escalation training produces significant changes in officer behavior, including a decrease in the number of use-of-force incidents and injuries to citizens, as well as a substantial drop in the number of injuries to police officers.
Why It Matters: Of the average 1,000 fatal police shootings a year, 40 percent don’t involve a person armed with a gun, and about 20 percent involve people in crisis. If de-escalation training and policy were implemented in the 18,000 police departments across the country, between 200 to 300 lives could be saved each year.
What’s Next: Law enforcement has often worried that de-escalation leaves officers vulnerable to danger and increases their risk of injury. This new research, which included a modified version of a randomized control trial, demonstrates that de-escalation not only keeps civilians safer, it also keeps officers safer. This is the sort of evidence that can help overcome longtime resistance to de-escalation tactics by police groups and unions.
By Rhiannon Meyers Collette, Communications Manager
For decades, Sutter Health aggressively bought out competitors to become one of the nation’s largest, most dominant health systems in Northern California. But that growing domination and Sutter's excessive prices made the hospital chain the poster child for how hospital consolidation drives up overall health care costs for everyone.
What’s Happening: Hospital consolidation has been on the rise in recent years — 90 percent of the nation's health care markets are now highly or super concentrated. In a landmark lawsuit, the California Attorney General said that Sutter wielded its size and influence to control the market, driving up premiums and costs to patients.
Why It Matters: Despite industry trade group's claims, research shows consolidation does not lower costs, nor does it lead to improved quality or coordination of care. "While hospitals systems like Sutter Health often describe consolidation as an effort to create 'integrated health' and a patient-friendly experience, the evidence is clear that consolidation leads to higher prices, not higher quality," writes AV's Commercial Sector Prices team in an explainer piece on why the Sutter case is so important and what it means for the industry writ large.
Related: Watch this 60 Minutes report on the case, which includes an interview with Becerra, who has been tapped by President-elect Joe Biden to lead Health and Human Services, and speculates that the Sutter case will spark similar scrutiny across the U.S.
Who Are Dual-Eligibles and
Why Are They Vulnerable?
By Rhiannon Meyers Collette, Communications Manager
Long before the pandemic, a population referred to in policy circles as "dual-eligible" beneficiaries were quite vulnerable. These are the 12.2 million Americans who are simultaneously enrolled in both Medicare and Medicaid, and they have been the hardest hit by COVID-19. Who makes up this dual-eligible population, and what policy changes are needed to improve their care?
What’s Happening: Dual-eligible individuals tend to have higher-than-average complex care needs, and even though they account for a high rate of health care spending — $300 billion per year — they tend to experience worse outcomes than others. They are more likely than their Medicare-only counterparts to spend time in the hospital and ER and to report that their health is poor. But this population is not homogenous: They span young and old, as well as individuals with physical, mental, and developmental disabilities. They are also disproportionately represented by communities of color.
What’s Next: The needs of dual-eligible Americans must be taken into account when developing policy solutions, and effective policies must be steeped in an understanding of racial justice. Our Complex Care team breaks down the unique circumstances of dual-eligibles and what’s needed to improve their care and contain costs in this highly visual presentation.
This New York Times opinion piece on how Big Pharma is using vaccine development to restore its image. “Public support should mean a public vaccine, one that reaches people as quickly as possible — profitable or not. The pharmaceutical industry wouldn’t be able to rake in its profits and restore its reputation without funding that comes from our tax dollars. We shouldn’t let Big Pharma forget it.”
Related: STAT news reports that in the middle of a pandemic, Big Pharma kept building its war chest in an attempt to fight legislation that would lower drug prices and provide much-needed financial relief to patients, employers, and taxpayers.
This in-depth Vox explainer on student debt forgiveness. It explores arguments that debt cancellation will stimulate the economy and promote racial justice, as well as questions about whether loan forgiveness is the best way to get relief to those who need it. And importantly, it addresses why we need to solve underlying problems with higher education so the cycle doesn’t start anew.
Pushback from some states against expert recommendations that incarcerated populations be prioritized when it comes to COVID-19 vaccinations, via The Marshall Project.
California police agencies’ long history of rejecting most racial profiling complaints, a trend that can only harm the public’s trust in law enforcement, AV’s Walter Katz tells the Los Angeles Times. “There is evidence of racial bias and discriminatory policing. The challenge is how does one connect together what is evidence of systemic bias, down to the individual officer level. Two different standards are being applied.”
How COVID-19 is forcing pension managers to make tough choices between taking on increased risk or seeking more money from employers and workers, via The Wall Street Journal.
Exciting news that MacKenzie Scott has given away another $4.2 billion of her fortune this year, to more than 380 organizations including food banks, the N.A.A.C.P., United Way, HBCUs, and a group that helps people pay off medical debt. “She’s disrupting the norms around billionaire philanthropy by moving quickly.”
New findings from Straight Talk on Evidence that the “Year Up” workforce training program produced five-year earnings gains of $7,000-$8,000 per year for low-income, mainly minority young adults.
Why we need to follow the data to craft effective community responses to COVID-19 that save lives, in this Houston Chronicle opinion piece from AV’s Chris Hensman and Shao-Chee Sim of Episcopal Health Foundation.
Our Co-Founder John Arnold writing in USA Today on the need to reform charitable giving tax codes to increase and accelerate resources to working charities.
What We're Watching
“No Way Out: COVID-19 Behind Bars,” a short and somber look at how the pandemic has played out in prisons across Texas, the largest state prison system in the country. This investigation from The Marshall Project and WFAA reveals “just how broken our prison system is'' and posits that the Texas Department of Criminal Justice's poor response may have exacerbated outbreaks and put surrounding communities at risk. Hear from those working inside prisons as well as the families of loved ones who died from COVID-19, such as correctional officer Eric Johnson, a husband and father of four whose death was classified by the TDCJ as “in the line of duty.” Another state agency denied his benefits claim. The film highlights understaffing across the prison system, which resulted in officers being sent to multiple locations for shifts, and a reported lack of personal protective equipment for both officers and those incarcerated. TDCJ maintains that longstanding policies and procedures for infectious diseases are being followed, ample PPE is available, and adequate staffing is in place. “In a pandemic, people should be concerned about what goes on in prisons, because if prisons become petri dishes, and the disease keeps circulating in there, it’s gonna get back into the outside world,” says Keri Blakinger of The Marshall Project.
Related: As part of this series, WFAA and The Marshall Project report that incarcerated people are setting fires inside prisons in a desperate attempt to bring attention to conditions amid the pandemic, including a lack of access to family, decent food, and even showers. The kicker? More than 200 Texas prison buildings don't have working fire alarm systems.
What We're Listening To
A new episode of the TradeOffs podcast, where Erin Fuse Brown of Georgia State University College of Law breaks down the unanimous Supreme Court decision that surprisingly pushes back against the power of the Employee Retirement Income Security Act of 1974 (ERISA), a federal law that has hindered states from regulating health care for decades. The ruling, which could impact everything from high drug prices to costly surprise medical bills, paves the way for states to take a more active role in policy reform that could lower health care costs.
Clark Hill’s Credit Eco To Go podcast discussion on the debate over canceling up to $50,000 of student loan debt. Joann Needleman talks to Mark Goldwein of the Committee for a Responsible Federal Budget about his article arguing that the proposal is poor economic stimulus. Why? It doesn’t impact people’s cash flow, benefits mostly higher earners who would save rather than spend the money, and would return little to the economy. They also discuss the moral implications of debt cancelation and alternatives that would stimulate the economy and better help student loan borrowers in the short and long term.
Some Final Inspiration
These girls were playing chess long before “The Queen’s Gambit” (a stellar show) made it cool again.
This letter from a school superintendent directing students to “go build a snowman.” “It is a time of renewed wonder at all the beautiful things that each season holds. A reminder of how fleeting a childhood can be. An opportunity to make some memories with your family that you hold on to for life."
Dual-Eligibles Research: On Jan. 14 at 11 a.m. ET, researchers and policymakers will convene to discuss research on dual-eligible individuals, with a focus on home and community-based services. Register here for “Building the Research Pipeline: Home and Community-Based Services and the Dual-Eligible Population,” hosted by the Administration for Community Living, the Centers for Medicare & Medicaid Services and Arnold Ventures.
Grant Proposals Webinar: On Jan. 21 at 2 p.m. ET, Arnold Ventures’ Evidence-Based Policy initiative will host a 60-minute webinar on preparing a successful grant proposal to conduct a randomized controlled trial of a U.S. social program through our RCT Opportunity request for proposals. The webinar aims to expand and diversify the pool of applicants, including those from groups historically underrepresented in the research and policy communities, and to clearly convey to applicants what our reviewers look for in RCT grant proposals. Register here.
We're Seeking Proposals
Funding Opportunity: As part of efforts to to better understand how to improve the systems that deliver care to a population of more than 12 million people who are dually eligible for Medicare and Medicaid, we are seeking to fund researchers who are guided by the following principles: policy relevance, rigor and independence, and alignment with our strategy. Learn more here.
Stephanie DiCapua Getman develops and executes Arnold Ventures' digital communications strategy with a focus on multimedia storytelling and audience engagement and oversees daily editorial operations and design.
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Arnold Ventures funds projects to understand problems and identify policy solutions.