|
The Abstract
|
> By Stephanie DiCapua Getman, Arnold Ventures
|
In one of my late-night, revenge bedtime procrastination scrolling sessions, I stumbled across a reddit thread that asked, “What’s the biggest scam in America?” I should not have been surprised that sandwiched between multilevel marketing schemes and payday loans was one of America's largest industries: health care. (Insulin prices even got a mention). The individual tragedies are enraging, and the absurdity of prices for medicines, hospital stays, even doctor's visits was a common theme, but what struck me was the sense of hopelessness and resignation — the idea that our dysfunctional health care system is a fait accompli. But when you hear stories like that of Jason Dean, who was charged $6,500 for six simple stitches — a bill that scared his wife away from seeking life-saving care when she became critically ill — how could you think otherwise? Health care prices have even made their way into the musical canon: Houston artist Kam Franklin of The Suffers recently released the song "Don't Get Caught Sick," where she croons, “It’s hard to see the light, when the clouds are formed.”
Are those clouds of suffocating debt?
America prides itself on operating as a free market economy. But in a free market, competition drives down prices and allows consumers to shop for better deals and better services. Our health care system is an outlier to the free market. The care is unaffordable, bankrupts families, and doesn’t leave patients better off for all that money spent. Why? High prices are driven by a constellation of market failures that AV is working to solve, but one key reason that gets far too little attention is hospital consolidation. Large hospitals for years have been aggressively acquiring smaller hospitals and doctor practices, snuffing out lower-priced competition. They can then charge whatever they want — and it’s perfectly legal. This market consolidation has led to higher prices, which means higher premiums and out-of-pocket costs for families, employers, and taxpayers — and lower wages to make up the difference.
Bottom line: Health care is not a functioning market. But it can be fixed — if policymakers and regulators are bold enough to do what is right for American families: increase competition, rein in further consolidation, and directly limit excessive prices.
Watch our new video below to learn more about how consolidation drives higher prices — resulting in unaffordable care without better outcomes — and the solutions that should be on the table. (And feel free to share it on reddit.)
Related: The National Academy for State Health Policy recently published model legislation to strengthen state oversight of health care provider mergers that increase health care prices without improving quality of care.
|
|
|
Waukesha Tragedy Highlights
the Problem With Cash Bail
|
|
|
|
Getty Images
By Evan Mintz, communications manager
A holiday celebration turned tragic last week when an SUV was driven through a parade in Waukesha, Wisconsin, killing six and injuring 62 others. Democratic and Republican leaders issued a joint call pleading with activists and pundits not to politicize the event, but the defenders of wealth-based detention instead seized upon an opportunity to capitalize on a tragedy.
Partisan actors and analysts turned a moment of mourning into a megaphone for their own agenda, highlighting the fact that the man behind the wheel — who is now facing at least six homicide charges — had recently been freed on a $1,000 bond for prior offenses. This, they say, should spark a backlash to bail reform.
In reality, it just shows the depths to which the nationwide for-profit cash bail machine will stoop to defend a broken, unsafe system. The bloodshed was another sad example of the human toll of substituting money for a measure of public safety. In fact, the driver’s previous risk assessment had flagged a potential need for preventative detention. But instead a money bail was set.
"The problem with our money bail system is money," Insha Rahman, vice president of advocacy and partnerships at the Vera Institute of Justice, said Wednesday on Fox News. "Money is not a good determinant of whether somebody will be safe when they’re released pre-trial."
Her message was matched by David H. Safavian of the American Conservative Union, who wrote in the Washington Examiner today.
“Those employing straw-man arguments against bail reform fail to acknowledge that different people charged with different crimes pose different risks,” he wrote. “It is easier to complain on Facebook about a system that is broken than to make actual improvements.”
So much of the debate about the criminal justice system is framed as “tough-on-crime” vs. “reform.” But a system that allows the dangerous yet wealthy to buy their freedom pretrial is hardly tough on crime. It is tough on the poor and working class who get stuck behind bars simply because they can’t write a check. It is tough on the families and businesses who lose loved ones and employees to unnecessary wealth-based detentions. And it is tough on the taxpayers who have to pay for expensive, overcrowded jails. But the defenders of the cash bail status quo just don’t seem to care.
|
|
|
|
|
|
By Victoria Ludwin, communications manager
The Evidence-Based Policy team at Arnold Ventures, perhaps the most un-hyperbolic set of people you might ever meet, called the study on Bottom Line blockbuster, among the most meaningful of their entire careers. We sat down with Kim Cassel, director of evidence-based policy at Arnold Ventures, to find out why this study was so important and what this means for research and policy in higher education.
Why It Matters: As funders and followers of rigorous research, the Evidence-Based Policy team is used to playing the long game; it’s the only game they play. They know from years of reviewing reports of program evaluations that while few programs are found effective when rigorously evaluated, there are exceptional programs that really do make a meaningful, measurable difference in people’s lives.
Often, it takes time for policy-relevant findings to emerge from longitudinal studies, but they’re willing to wait for the kind of four-leaf-clover moment when a program they suspected was working (based on promising prior evidence), delivers, step by step, year by year, across populations and across sites, and is ultimately proven effective just when policy is poised to make use of it. It doesn’t happen often, but last month, it did.
What’s Next: While the Evidenced-Based Policy Team continues to celebrate this career highlight in a most highly reasonable, research-based way, it is also looking to support RCTs to identify the next impactful program. The team invites grant applications to conduct randomized controlled trials (RCTs) of social programs in any area of U.S. policy. Details are here.
Read the Q&A >
Related: Read more about how this roaring success of a study arrived at just the right time.
|
|
|
|
|
By Steven Scarborough, communications manager
Arnold Ventures recently published a research agenda detailing our strategy for how to build an evidence base that will inform our approach to transforming prisons. Our prison strategy broadly aims to increase the accountability of prisons, improve conditions of confinement, promote successful reentry, and safely reduce the number of people incarcerated. The document outlines the research objectives that align with those goals and focuses on how research can address the severe racial disparities seen throughout our nation’s prisons.
What’s Next: AV is interested in identifying and supporting projects aligned with the goals outlined in the research agenda. Going forward, we particularly intend to invest in research initiatives exploring innovation in prison conditions, looking at how to preserve safety and dignity in carceral settings, and evaluating the impact of expanding early release opportunities.
More information about AV’s approach to funding research is available here.
|
|
|
|
|
Jennifer Peirce and Madeline Bailey at the Vera Institute of Justice, who recently released a toolkit that provides a roadmap for jail decarceration for cities and counties. “There’s a growing consensus that these communities are starting to recognize this harm that jail incarceration is causing,” says Bailey, a senior program associate in the Center on Sentencing and Corrections. “And what we’ve heard, especially the last year, has been louder calls for some change and how we handle low-level offenses and real social deficits in a different way. For our toolkit, we wanted to put together a resource that would really underscore the power of local decision-makers to disrupt jail incarceration in their local communities.”
Read the Q&A >
|
|
|
|
|
7 in 10 (69%)
Number of people concerned about future access to birth control, up from 51% in 2020, according to a nationally representative survey from Power to Decide.
In conjunction with the survey, Power to Decide CEO Dr. Regan McDonald-Mosley penned an op-ed highlighting the importance of contraception and the barriers to access. “What often gets lost in polls and surveys is the impact of birth control access for real people. In my experience, I have seen how access to quality affordable care has allowed a 17-year-old to finish high school and go on to higher education and a 25-year-old to space and plan her next pregnancy for a time that worked for her and her family.”
|
|
|
|
|
Criminal Justice
- A mother and son die years apart from the same police restraint method deemed dangerous by the Justice Department 25 years ago, reports The Marshall Project, in collaboration with NBC News and the Mississippi Center for Investigative Reporting.
- The Appeal shines a light on the culture of the Rochester Police Department, where an officer involved in a shooting death faced few consequences for previous misconduct.
- All four former Minneapolis police officers will be tried together in the federal case for the murder of George Floyd that begins next month, the Star Tribune reports.
Related: Texas Gov. Greg Abbott remains silent on a posthumous pardon for George Floyd, The Texas Tribune reports.
- ICYMI: In the absence of federal oversight of troubled police departments, state attorneys general are stepping in, reports The Washington Post.
- “When public defenders rarely take cases to trial, the criminal justice system loses an important oversight mechanism.” The New York Review of Books examines three books that raise questions about the impact of more money and trials in addressing the systemic inequality in our criminal justice system.
- For many incarcerated people, phone calls remain the only way to connect with family members, but they come at a staggering price. “It’s outrageous that a billion-dollar industry exists based on skimming profits from some of society’s most vulnerable people trying to meet one of our most fundamental needs: human connection,” writes The Washington Post.
- Writing from experience, Keri Blakinger of The Marshall Project reports on the “collateral consequences” that keep punishing people long after they have left prison.
- The firearm used in the school shooting in Oxford Township, Michigan, was obtained from home — the most common source of firearms in such cases, The Conversation reports.
- A new survey from RAND highlights encouraging points of consensus on goals and policies — including child access prevention laws — that suggest America is not doomed to remain polarized on guns. Read the report here, and find a helpful thread from RAND’s Andrew Morral here.
Health
- Private equity dominates the air ambulance market, and those firms receive higher payments and generate larger and more frequent surprise bills for patients, according to a white paper from USC-Brookings Schaeffer Initiative for Health Policy.
Related: The No Surprises Act protects patients from surprise medical bills — but not for ground ambulance rides. Some states are addressing the gap, The Commonwealth Fund writes.
- An analysis of once-secret hospital pricing data shows that some hospitals charge up to 10 times more for standard medical scans than others, The Wall Street Journal reports. “Health economists say the disparities reveal how little influence consumers have over pricing, unlike markets for groceries or airlines, where companies vie for business by offering good deals.”
- A new report from 46brooklyn Research provides even more compelling evidence that Part D redesign is critical to realigning incentives to ensure the program works fairly for American seniors.
- “We sort of view it like a Jenga tower,” said David Mitchell, the founder of Patients for Affordable Drugs. “We're concerned that if we pull out something, the thing will collapse. … And so our position is don't change anything, pass what the House passed intact, for fear that we upset this delicate balance.” The players in the prescription drug pricing fight, via The Washington Post. (will add free link)
Higher Education
- The Hechinger Report investigates the connection between predatory schools, tuition-financing companies, and student debt in “‘It’s a shell game’: How under-the-radar companies help for-profit colleges stay in business” as part of its ongoing series on consequences of student debt.
- Inside Higher Ed profiles The Good School, a community-college-student-made podcast led by Beth Baunoch at Community College of Baltimore County. The podcast was launched in fall 2020 to explore stories of people navigating the higher education system, including students, teachers, and counselors.
Also...
- The ACLU released an interactive map and explainer on redistricting, outlining cases and why this issue will shape future elections.
- A discussion around the benefits of ranked-choice voting in D.C., which will be on the ballot in 2022, via FairVote.
- Bill Gates and Warren Buffet are building a nuclear power plant in Wyoming with the goal of replacing coal plants in the state, USA Today reports.
- Philanthropic dollars that are currently hoarded in commercial donor-advised funds would be better spent addressing worsening inequities in rural America, write Felecia Lucky of Black Belt Community Foundation, Gerry Roll of Foundation for Appalachian Kentucky and Nancy Van Milligen of Community Foundation of Greater Dubuque in Real Clear Policy.
- "In the spirit of Giving Tuesday, it’s time for Congress to fix the broken connection between charitable tax benefits and benefits to charities by getting these contributions back on the calendar." AV Co-Founder John Arnold and Boston College law professor Ray D. Madoff, founding members of the Initiative to Accelerate Charitable Giving, write in The Chronicle of Philanthropy about the need to reform America’s charitable tax laws.
|
|
|
|
|
“Shots Fired,” a collaboration between Frontline and local journalism partner The Salt Lake Tribune, investigates the use of deadly force by police in Utah, which has in recent years seen a record number of police shootings. (A 2014 Salt Lake Tribune story showed that over a five-year period, fatal police shootings were the second-leading cause of homicide in Utah.) The documentary examines a number of individual deaths with the help of body camera footage and witnesses, questioning why, in some cases, police were even called to the scene. It examines the conditions under which the vast majority of officer-involved shootings are ruled justified, as well as police training, tactics and accountability, and racial disparities in the way force is used.
|
|
|
|
|
- “This Is Ear Hustle,” a new audio book from the creators of the first podcast made entirely within prison walls. Co-hosts Nigel Poor and Earlonne Woods detail how they came to San Quentin Prison and how — under extremely challenging circumstances — they created their Peabody- and Pulitzer-nominated podcast “Ear Hustle.” Hear new personal narratives on the challenges and day-to-day realities faced by those currently incarcerated — and what happens once they leave.
- In the Just Reform podcast from Deason Center, Professor Pam Metzger talks to Professor Kami Chavis and AV’s VP of Criminal Justice Walter Katz about the barriers and solutions to police accountability, with particular attention to police culture, the power of police unions, and qualified immunity. It’s the first of a five-part series on criminal legal reform.
- The Ezra Klein Show talks to Patrick Sharkey, a sociologist at Princeton University, about the causes of the recent homicide spike and what alternative public safety approaches to addressing it could look like. It’s a wide-ranging discussion that touches on urban inequality and disinvestment, the limits of policing as a solution, and the importance of place, public spaces, and the role of community-based organizations. (h/t to my colleague Jocelyn Fontaine)
- The Gov Innovator podcast, hosted by Andy Feldman, interviews our VP of Evidence-Based Policy Dave Anderson about lessons and observations from two decades of advocating for and advancing the use of rigorous evidence in social policy. Anderson describes how the EBP strategy accounts for the challenges in identifying programs that meaningfully improve people’s lives, while striking an optimistic note by highlighting the fact that recent RCTs — including those funded by our team — have identified a growing number of such programs. (See the recent RCT of Bottom Line).
|
|
|
|
|
|
Have an evidence-based week,
– Stephanie
|
|
|
|
|
|
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.
|
|
|
|
|
|
|
|
Were you sent this briefing by a friend? Sign up here to get the AV Newsletter.
|
|
You received this message because you signed up for Arnold Ventures' newsletter.
|
|
|
|
|
|
|
|