Tuesday, October 26, 2010

Sorry for Being so Social

Remember the Facebook blackout of this summer? Maybe you don't but I do. In July Facebook suspended my personal account which in turn took down the Policy Diary Facebook page. It lasted for about two weeks. And until I contacted the Advertising team (you know, the folks responsible for bringing in ad revenue of the sort I have contributed to), I didn't even receive a reason for the blackout. Nothing.

Thankfully the Ad team used some common sense and got me up and running again. Facebook has a pretty simple problem, though: They use strict security software to determine who is proliferating "spam" on the site and who isn't. What they haven't figured out is that people, regular folks like you and me, are just using the site a lot. And happily so. Until that is we get thrown off because we do what they want us to do - um, actually be social.

So in any event PC World interviewed me for a story the did on Facebook's nonsensical behavior. It's below in PDF. Scroll down a couple of paragraphs past the angry moms. No kidding.


Facebook Suspends without Reason -

What Racism Sounds Like

I went back to where I grew up this week. Most of those I grew up with never left. I rarely go back.
Returning to ones roots is comforting. To be surrounded with those who knew you then and know how
you became who you are now, is comfortable.

One friend in particular has always been more comfortable than the others. He always seemed to see
things the way I saw them, felt the way I felt, as if we were both working off the same operating system.
We are different people but we function the same way.

This is why the conversation was important.

“How long till it’s not my fault anymore? It’s like I can’t even talk about it. If I say something I’m wrong.
We can’t have an honest conversation because I’m always the racist. It’s inherently unfair; I’m always
wrong.”

He isn’t the only white person who feels this way. Most all of us do. However, this particular white guy
is one of the “good ones”. He gives people the benefit of the doubt, was taught by parents to not judge
people by race or appearance, and unlike so many of us, he actually knows some black people.

He played football at a division one college. He practiced with, ate with, even roomed with black
teammates. He trusted and was trusted by his teammates. They had a common bond, they were
friends, and he loved these guys. But he still claimed to be the victim, unable to express himself on
matters of race. He felt completely stifled.

“Who called you a racist?” I asked.

“I’m always the racist. It’s like I can’t say anything. Every time.”

“Right. So by whom, and when, were you called a racist? I mean you personally.” I asked again.

Again he expressed his exasperation but finally realizing my question, admitted he had never been
directly called a racist. He was expressing what most all of us non-pigmented people feel when race
is discussed. We, the good ones, have never oppressed, maybe never even hated, anyone, yet we are
always the bad guy.

Or so we feel.

How ludicrous that because the existence of white racism is pointed out, that all white people would
feel pointed at. If you were not hurling insults at Ruby Bridges, if you weren’t even born yet, why would
you assume that you are being blamed? To be offended at the discussion of racism perpetrated by
whites is to insinuate that it never really happened. If no one said you did it, why do you assume the
accusation is unfair? We have either become collectively thin-skinned, or have simply never stopped to
consider reality. I claim we are guilty of both.

Let’s talk about unfair.

My friend and I established that no individual had accused him personally of racism. Yet he felt accused.

The greater discussion and its tone cause him to feel unallowed to proffer an opinion. He also admitted
that this theoretical oppression had no real affect on his day to day life. He simply felt oppressed by
some abstract; by an idea.

How would he feel if he was repeatedly pulled over by police for no cause? How would he feel if he was
tailed by store security as a preventative measure? How would he feel if someone called him racial slur?

How does this compare to an abstract idea?

Reality is that racism does still exist and it does in fact affect the day to day lives of African-Americans.
It need not be that you are barred from a school or forced to the back of the bus; it can simply be
that you are the only dark face in a sea of white. It can simply be that all your actions are seen as the
representation of some greater whole. It can simply be the nagging feeling that when mistreated, you
never really know if race was why. You aren’t sure, but you can’t escape that feeling.

Does this compare to the feeling that white people are always the collective bad guy? That is the real
question.

Of course such broad accusations are both unfair and inaccurate, but does this inequity compare to the
real life reality of a minority?

My friend had never really considered this. I would assume most of us haven’t.

“So what do I do? How long do I stay the bad guy?” he asked, not in protest but more in resignation. He
wanted a real answer. I didn’t have one.

That is our collective problem. It is all of our problem, both black and white. Any discussion of racism
between a black and a white person will be unfair. It will be unfair for everyone. White people will be
the bad guy and black people will be discussing real life with others who are only talking about ideas.
It is our reality and anyone venturing into such a discussion should be aware of this before they begin.
The conversation will not be fair.

So what do we do?

Because equity is impossible, unfair demands must be made of all. If this discussion is to ever happen,
white people need to toughen up. We must face the fact that yes, white people were, and in many ways
still are, the bad guy. Its true. Own that fact while knowing inside yourself that just because your group
is and was, that does not mean you are. Calling white people racist is not the same as calling you a racist
so get over it. Better yet, odds are that if any white person does in fact venture into this discussion
and sticks around a bit, they will in fact be called a racist directly. Be prepared for it and get over it in
advance. No it’s not fair, so what.

Black people; no it is not fair to ask anything more of you, but it has to happen. If reducing racism is in
fact a worthy goal, we need your help. Maybe trusting us is a little too much, but maybe you can listen a
little more, explain a little more, and accuse a little less. Realize that if you want any of us to change, we
need to know how and why. We can’t come up with this how and why without you explaining it to us.
We don’t get it, and unless we get it, things will get worse. If you don’t help us how will we learn? Here
is a good place to start; admit you don’t like Jesse Jackson. I know you don’t want to, I know it’s risky,
but I also know it’s true. Admissions such as this are a step toward a discussion that has to happen.

We can no longer talk at or around each other; we have to talk to each other.

Toward the end of talking with my old friend we sort of just sat there quietly. He looked up from his
shoes and said, “You are right. It’s not the same. Racism really has nothing to do with my life, and that’s
not how it is for black people… hmmm… So what do I do?”

I didn’t have the answer to that last question. I’m not sure who does, but maybe if more of us had this
conversation, someone would come up with it. What I did learn for sure is that the conversation is
worth having. We can learn, we can grow. Let’s get to work.




Dalyn Montgomery is an artist and writer who was raised in suburban Utah; a place known for its religious, political, and racial homogeneity. In 1995 he began a two year religious mission in Atlanta’ s Afrocentric inner-city.


Not satisfied to simply dabble in these two worlds, he married an African-American woman and consequentially has a unique vantage point from which to observe the relatively separate worlds of black and white America. Dalyn continues this case study in integration by currently serving as the bishop of a Philadelphia congregation that is 50% black and 50% white. He is tasked with facilitating the side by side worship and daily interaction of two groups who are not normally united.

Dalyn has a B.S. in public relations from the University of Utah, a career in corporate sales, and two beautiful daughters. He writes with a focus on messages that communicate across racial lines to foster increased understanding. Samples of his artwork and other endeavors can be found at www.brohammas.com and articles related to race at dalynart.blogspot.com.

Monday, October 25, 2010

Homeowners Deserve Better Protection from Sloppy Foreclosures


(Author's note: Excerpt of my weekly Loop 21 column.)
The numbers are staggering: Last year there were 2.8 million foreclosures, a 21 percent increase over 2008 and a 120 percent rise compared to 2007,” according to Realtytrac, a website that specializes in foreclosures. Four states accounted for half of all foreclosures: California, Florida, Arizona, and Illinois.
Probably the most disconcerting thing about the federal government’s actions recently is their ho-hum response to the biggest lenders in the country – Bank of America, JP Morgan, and others – voluntarily stopping foreclosures due to “inaccurate paperwork.” Meanwhile, all 50 state attorneys general have started investigations. I’m not suggesting the Department of Justice get involved just yet. Instead, Obama should use it as leverage to ensure lenders are truly investing effort into the modification process and are giving homeowners due process protection when after the foreclosure process has been started. Homeowners deserve that much.
What exactly is exacerbating the foreclosure problem? In some cases it is because they are securitizing mortgages (i.e., pooling them together and selling them to investors) too fast or too often to maintain proper due diligence. In other cases, it is because banks are not the mortgage owner, someone else is -- at least on paper.

Wednesday, October 20, 2010

Prosecuting AIDS One T-Cell at a Time


By Brad Ogilvie

In the news recently, there have been increasing reports of people being prosecuted for transmitting HIV, both here in the US and abroad. On the surface, criminally prosecuting may seem reasonable. Celebrities such as Oprah Winfrey have jumped on the bandwagon of this, with her recent airing of an episode in which a woman won a legal case against her then-husband (including $12 million) after she tested positive and subsequently found out that her husband knew he had HIV but did not tell her.

But does this law really meet the smell-test when it comes to meeting its goals? Do we really understand what the goals are of such prosecutions? At a recent forum hosted by the American Bar Association, this question of the criminalization of HIV-transmission was explored more deeply, and it is worth a deeper community conversation about the implementation of this law and how it relates to public health.

First, a look at the justifications for such laws:

  1. Punishment for the person who spreads HIV.
  2. Public health. If we are going to stop the spread of HIV, people with HIV need to be held accountable for not spreading it.
  3. Restorative justice. It is a vehicle for providing solace for the victim.

Do these laws accomplish any of their objectives? Does society pair resources with these laws to effect the change it desires? What happens when the law is implemented in a society with a criminal justice and political climate that are grossly uninformed about HIV? An exploration of some of the ways these laws are being exercised, and how they filter through public health systems in some states is both telling and chilling.

As a start, consider the fact that this law is only applied when the person who is spreading HIV actually knows whether he/she has it. There are also attempts to prove that the person had malicious intent in spreading HIV, although this is a very gray area. Considering that in many relationships, power dynamics are not equal, the expectation of disclosure in a safe environment may not be realistic, but to assume that hiding the disclosure equates to malicious intent (a la Oprah) is not always true. From a public health perspective, laws like this actually serve as a disincentive to get tested for HIV. One of the studies cited by one of the presenter at the ABA indicated that women who were polled overwhelmingly said that they would not voluntarily get tested if they knew that they could risk being jailed for engaging in sex after being tested.



Beyond the public health issue, however, there are serious concerns about how this plays out in terms of basic human rights. In Arkansas, for example, after someone tests positive, he/she is asked to sign an agreement that states it is a felony to have sexual intercourse and not inform his/her partner of HIV-status. Also on this agreement is a statement of only having protected sex, regardless of partner’s HIV-status, which begs the question of: How readily-available are condoms in Arkansas? In Mississippi, a similar form is given, with this one stating the “necessity of not causing pregnancy or getting pregnant”.

This issue of reproductive rights is a big one to consider when the fact is that mother-to-child transmission of HIV can be reduced to less than 3% with treatments. Yet, in South Carolina for example, a mother was jailed for two years for giving birth to a baby with HIV. So not only was the mother punished, her children became entangled in the legal system. By making HIV-transmission a felony, it also disqualifies the person convicted of the behavior from qualifying for housing and other living supports, so again we are back to the issue of public health by increasing the vulnerability of the person who might spread HIV out of desperation to meet basic needs. As Cicero said, “Extreme justice is extreme injustice”.

Clearly, there is a need to do something big and radical to get ahead of the curve on HIV. It is understandable that people want to see a community be held responsible for its actions. The criminalization of transmission in our current climate is just not going to work. The stigma is so high, the fear so great and the ignorance so high, our culture of blame is not in any position to integrate a law like this from both a humane and a public health perspective. Sure, it will punish people, but beyond that, it is a law that does more harm than good. It reinforces the cultural stigma and fear and ignorance about HIV, and discourages HIV-testing. It also perpetuates the “victim/perpetrator” paradigm that plagues prevention efforts and our collective ability to get a handle on HIV/AIDS globally.

There are many people who look at HIV/AIDS in Africa as a plague of innocents, yet here in the US people view it as a disease of sexual and social deviants. I once met with a donor who was willing to fund scholarships for high school students with HIV as long as they were born with HIV. The problem is that it does not matter how one got HIV; the responsibility of not spreading it is the same. Criminalization of HIV-transmission drives this conversation underground, and places all the responsibility of transmission on the person who has HIV. We all need to share the burden of being educated and informed.


What is surprising here is community discussion about these laws – where is the outrage? This was a question that was posed by Catherine Hanssens, the Executive Director of The Center for HIV Law and Policy, as she presented on the myriad of legal and policy efforts to address the transmission of HIV. At best, the current laws regarding HIV-transmission are misguided; at worst, they are mean-spirited and fueled by ignorance. While it was pointed out that over 15 years, only slightly over 20 cases per year have been prosecuted, there is a concern that prosecutions are on the rise. So where are the activists demanding policy change?

Unfortunately, most of the organizational-driven activism is focused solely on funding a system that has done little to address this issue. Thankfully, the Obama White House has included looking at the impact of HIV-transmission laws as part of the National HIV Strategy. Unfortunately, they are getting little support, as AIDS Activist slam Obama on funding but are silent on ineffective policies. If we don’t step up the community education around arcane HIV-transmission policies, we will continue to work against ourselves.




  About the Author

Connect: LinkedIn Facebook Twitter
Brad's articles on Policy Diary

Brad Ogilvie spent over a decade working on the "treatment" side of HIV as a clinician and program coordinator in a holistic clinic, and then running an AIDS housing program. During this time period – 1995 to 2005, he witnessed huge advances in the treatment of HIV. He also noticed that the institutions that had grown out of the early HIV/AIDS movement were slow and even resistant to change – often being competitive and divisive along demographic and geographic lines both nationally and internationally. He was increasingly convinced that the "business of AIDS" was big business that placed greater weight on keeping case loads and beds full, rather than stopping the spread of HIV. 

 As a person living with HIV, he also experienced the “spend-it-or-lose-it” policies that fostered a culture of dependency.  Armed with this knowledge and these experiences, he founded The Mosaic Initiative in 2005 to focus solely on stopping the spread of HIV through education and testing. He has worked in conservative and liberal communities in Illinois, Washington DC and rural Kenya.  As a gay man living with HIV, he has also found that by simply engaging people with open arms rather than closed fists, new alliances, friendships and community partnerships form that will, hopefully, bring a stronger grassroots voice to HIV from a place of common ground that influences better policy and action.  Brad lives in Washington, DC and works full-time for William Penn House developing programs for youth and young adults on social justice issues including HIV. His blog Mosaic Initiative is frequently updated and a wealth of information.

Treasury's Financial Rescue Cost Down to $30 Billion

Crossposted from The People's View.

So the Troubled Asset Relief Program (TARP) ended on October 3.  Demagogues on all sides of the political spectrum love to hate TARP, and decry the $700 billion the US government put on the line to rescue the financial sector and the largest banks.  The facts, however, do not square with that position.  As hard as it might be for the right wing ideologues to understand that government intervention in the market is necessary and fruitful, and as difficult as it is for the left ideologues to fathom the idea of the government helping big financial institution in a crisis (even in order to keep the entire system from collapsing), the facts contradict the narrative pushed relentlessly by both ideological extremes.

And the facts are this: with respect to TARP, the dirty dirty thing one must not be seen as supporting on the campaign trail has succeeded beyond anyone's wildest dreams at the time it was enacted, and it has done to at less than 5% of its original cost.  That's right.  Earlier this month, the Department of Treasury updated the net cost estimate of TARP and the AIG bailout to $30 billion on taxpayers.  The cost estimates have steadily declined since enactment.
The news of the shrunken cost, which comes on the two-year anniversary of the legislation that created TARP, represents a dramatic improvement. It highlights the resilience of the markets, as well as the folly of short-term financial projections. In August 2009, the TARP cost was projected to be $341 billion. In its mid-session review, released in August of this year, the Office of Management and Budget projected the total cost would come to $91 billion.

Monday, October 18, 2010

Emergence of Telemedicine

The folks over at Gen Juice, a great social media marketing firm, invited me to contribute some articles over the next 3 months or so. The first article has been published and concerns telemedicine. (I'll be doing some more writing in the area of telemedicine for the Virginia Telehealth Network very soon.) The PDF version is below. (Video referenced in the article is below at the end of this post.)


Emergence of Telemedicine -








Friday, October 15, 2010

So Educated Bloggers Wanted!

So Educated, a sister blog of Policy Diary, is launching next month. They are looking for bloggers of all stripes. Please read and share the PDF flyer below.


So Educated Bloggers Wanted -

Tuesday, October 12, 2010

The Impact of Food Marketing on Consumption Behaviors

Aggressive food marketing campaigns have become one of the hallmarks of globalization. McDonald’s seals and red Coke bottles have evolved into universal icons that are influencing both the quantity and quality of what people eat. The substitution of refined carbohydrates for fruits and vegetables has been catalyzed by a globalized food market that is promoting obesogenic diets. This “nutrition transition,” implicated in the recent rise in type 2 diabetes mellitus (T2DM), constitutes a major public health problem around the world. An estimated 285 million people, corresponding to 6.4% of the world's adult population, will live with diabetes in 2010. The number is expected to grow to 438 million by 2030, corresponding to 7.8% of the adult population. 80% of type 2 diabetes is preventable by changing diet, increasing physical activity and improving the living environment. Yet, without effective prevention and control programs, the incidence of diabetes is likely to continue rising globally (International Diabetes Foundation).

This sharp rise in incidence rate of diabetes parallels the growth of communication technologies that is changing the dynamics of the consumer-supplier relationship -- a phenomenon with significant implications for consumption habits in both developed and developing countries. Understanding the links between the globalization of the food market and the nutrition transition is at the crux of developing food policies that will help ameliorate the burden of chronic disease such as T2DM. Yet another issue to tackle is the lack of data on children and adolescents, which is problematic as it is during this time in life that eating behaviors, patterns, and perceptions are being formed in addition to being an important period in the etiology of obesity.

Every year, food industries spend enormous quantities of money to promote their products. Consumers, in turn, rely on the information provided by these media outlets to guide in the food-purchasing decision making. It is time that we start asking questions such as what motivates people to forgo picking up the organic apple to grab value fries through the drive-through? Is it speed, convenience, and price? Or is it the recreational theories of lifestyle and prestige that are projected through certain visual media and advertisements but not others? And whose responsibility should it be to unearth and enforce such practices? The unfortunate truth remains that people in America and around the world still lag gravely behind the recommended intake of fruits and vegetables. In 2009, for example, just 26% of adults were reported to eat 3 or more vegetables a day, including people who count tomato slice or a piece of lettuce on their burger as a vegetable. This figure is only half of the value that health officials had hoped for by this year (Centers for Disease Control and Prevention).

The way marketing strategies operate as agents for dietary change is therefore a topic that demands further attention from policy makers. Any changes that are implemented must acknowledge and coalesce within the normative social and cultural practices in any given region. The campaigns with the most effectiveness potential will likely harness the motivation and rationale behind consumer selectivity and channel it into a force for healthy eating. Efforts in this direction are already underway with changing the perceptions around eating healthier. In a 25 million dollar campaign led by one group of vegetable farmers, for instance, carrots are being advertised to teenagers as desirable – fashionable, even – as opposed to a healthy.

Beyond the marketing aspect, structural measures can be instituted to help people help themselves with the decision-making process about what to eat. The recent Child Nutrition Act is the first step towards establishing legislation that promotes more direct access to healthier foods (School Nutrition Association, 2010). The act will require public schools to provide more nutritious food options both during lunch and through vending machines. Another amendment included in the new reform bill will require restaurants of 20+ chains to add caloric counts on the menus; having the visual information on energy consumption will provide a convenient, friendly reminder for people to choose the healthier option whenever possible. Food providers, which will face more transparency in what they serve to customers, will in turn be motivated to provide healthier options (Landmark).

The key step in making these strategies useful, however, is not only implementation but sustained momentum even after the initial call for change. Motivating an entire population to invest in long term health is hard because people want immediate gratification and to see benefits firsthand. This “magic bullet” mentality that has become engrained in our society is something that policy developers are struggling to face and overcome. How we as individuals will respond to these changes and the level of commitment we are willing to invest in the state of our health will inevitably have consequences --whether we see them now 20 years from now.


Footnotes:
Landmark: The Inside Story of America’s New Health Care Law and What It Means for Us All (Publicaffairs reports) by The Staff of the Washington Post. 

Reema Dedania is currently a master's of public health candidate at the Rollins School of Public Health at Emory University where she studies health policy and management. She also earned her Bachelor of Science degree from Emory University in Anthropology & Human Biology. Her principal areas of interest include: the intersection between clinical medicine and public health practice; the creation and implementation of health policies that target underserved populations; preventative medicine; complex humanitarian emergencies and refugee population health.

Will Latinos Sit Out the Midterm Elections?

(Author's Note: Excerpt of my weekly column in The Loop 21)


Regardless of party preference, there are a host of things voters can rightfully accuse the Obama Administration of – not stemming foreclosures quick enough, jobs not returning soon enough, and punting the repeal of the Bush tax cuts until after midterm elections. And in general, a good number of voters are apathetic about voting in the midterms. For instance, polls show a significant enthusiasm gap between black and white voters that is higher than usual for midterm elections, “42 percent of whites are thinking about the November elections, whereas only 25 percent of blacks are focused on the midterms. The gap was 8 percent in 2006.”

That is quite ominous considering Obama's approval rating is 91 percent in the black community compared to 55 percent among Latinos. It's clear that blacks support Obama overwhelmingly but that will not necessarily translate into votes, at least not in the midterms. 
And if Latino voters express far less support, how many of them will turn out? If they do not, what is the reason behind it?



Read full article here: http://theloop21.com/politics/will-latino-voters-sit-out-the-midterm-elections

Monday, October 11, 2010

Where Pranks End and Abuse Begins

Professor Marybeth Gasman (associate professor of higher education at UPenn and Policy Diary advisory board member) and I co-wrote a piece concerning anti-bullying efforts being instituted in higher education. For sure, some colleges and universities have been on the forefront of this issue. But far too many lack practical and widespread initiatives that can make a real impact in changing students' perceptions of what is an acceptable prank and what is unacceptable, punishable abuse.

The piece "Where Pranks End and Abuse Begins" has been published here at The Chronicle of Higher Education and is also in PDF format below.


Where Pranks End and Abuse Begins -

Introducing 'So Educated' -- A Blog on Education Policy and Reform

For over two years Policy Diary has sought to deliver excellent commentary that motivates readers to cut through the noise of politics, evaluate the issues, and become more engaged in their community. We've covered an array of areas, but principally health policy and reform, education reform and higher ed.

After considerable thought, we have decided to introduce a brand new blog entitled 'So Educated' (www.soeducated.com) that will be solely dedicated to education. It will delve into education reform, charter schools, merit pay, Race to the Top, and various issues in higher education. So Educated will pay particular attention to education policy and research and how we can find ways to deliver an equitable education to all. It will do so with the keen understanding that: "An education is a gift and a responsibility."

We are hard at work recruiting excellent contributors (If interested, please email: soeducated1@gmail.com).


Join So Educated on Twitter (www.twitter.com/soeducated1)


We will be launching in early November. Stay tuned! 

Friday, October 8, 2010

Why Obama is Wrong on HIV/AIDS

(Via The Okanagan Valley Group of Newspapers)

In July of this past summer, President Obama and the White House Office on AIDS announced a new National HIV/AIDS Strategy. The development of this long-awaited was announced with much fanfare and media publicity. But, despite two years of consulting with experts and holding listening sessions throughout the country, the actual goals of this strategy are disappointing. With regards to new transmissions of HIV, the goal is to reduce new infections (currently estimated to be at about 56,000 annually) by 25% in the next five years. At the same time, on the treatment side, the goal is to get all people on treatment. The most important thing for AIDS organizations in all of this has been increased media exposure and a commitment for more funding.

Tuesday, October 5, 2010

Overuse of "hate crimes" leads to overcriminalization

(Author's Note: An excerpt of my weekly column in The Loop 21)

Tyler Clementi, an 18-year-old gay student at Rutgers, recently committed suicide because his roommate Dharun Ravi allegedly videotaped him having a sexual encounter with a man and broadcast it on the Internet. This is both tragic and senseless.

Ravi and Molly Wei, another student who was allegedly involved, are currently facing charges for invasion of privacy. But gay rights groups are urging New Jersey prosecutors to levy hate crime charges that are nearly just as senseless as Tyler’s death...

Please read more here: http://theloop21.com/politics/when-everything-looks-hate

Monday, October 4, 2010

Policy Diary Turns Two


Policy Diary recently turned two, and we were too busy working -- as usual --to actually notice. Now that we've caught our breath we figured two things were in order. First, a huge thank you to all of our readers, interviewees, contributors, and those who have helped spread the word about our work. We appreciate it beyond measure. 

Second, when we started Policy Diary it was just a one man operation. 


Um, not quite that man but you get the picture. Since then we've added four contributors, a board of advisers,  and many, many more readers. We would like to think we've found a niche in the blogosphere that suits us comfortably. What we try to do here is simple: communicate an idea in a compelling way that leaves readers more empowered than when they came. 

And we hope they keep coming back. 
 
 
Cheers,


Founder and Executive Editor

Timothy Jost on Health Care Exchanges

Professor Timothy Jost (previously interviewed on Policy Diary in April) has a great blog post on the health care exchanges outlined in the Affordable Care Act and set to go into effect in 2014. A quick glimpse of what's included is below, as is the full report.

 Prof. Jost outlines:
1. Governing the exchanges. In each state, the exchange should be placed within an independent agency, which should be explicitly exempted, as necessary, from specific state administrative law or government operations requirements. The governing board of the exchange could include representatives of state agencies with which the exchanges must work, interested parties, and persons with relevant expertise. Management, on the other hand, should be apolitical and professional. Exchanges should outsource those services, such as premium billing, for which competitive markets exist and for which performance can be readily monitored.

2. Deterring adverse selection. To the extent possible, each state's regulation of the individual and small-group market should be identical inside and outside the exchange so that the exchange does not include only "high-risk" individuals with costly health care needs. Some states may be able to eliminate altogether the market outside. To discourage adverse selection both against and within the exchange, federal officials should design a sophisticated but practical risk-adjustment system allowing states to adjust risk among participating and nonparticipating insurers.

3. Incorporating large employer plans, particularly formerly self-insured employee benefit plans. Because self-insured plans are not subject to all the requirements of the Affordable Care Act or to state regulation, they pose a degree of risk to exchanges. Businesses with self-insured plans may seek to remain outside the exchange, only insuring their employees through the exchange when the health of their pool deteriorates. In defining "self-insured" status, the federal government should clarify that only employers who bear substantial risk for the cost of health care for their group can be self-insured. States should consider extending the requirements of the Affordable Care Act to large plans and to grandfathered plans that qualify for exchange coverage.

4. Making exchanges attractive to employers. Exchanges should offer employers the possibility of an aggregated bill covering the premiums of all employees. The exchange should assume the task of allocating premiums among the various insurers and plans chosen by individual employees. Employers should be able either to pay a fixed percentage of the premium for a specified level of coverage, with the employee covering the remainder of the premium, or to charge employees a premium share based on the category and richness of their coverage—and, if desired, on their tobacco use and involvement in wellness incentive programs. Employers could also offer greater financial support to their lower-income workers.

5. Regulating the participating plans. Exchanges must use their certification power to ensure that health insurance plans meet the statutory requirements for qualification and that plans do not impose unreasonable premium increases on their members. Legislation authorizing state exchanges should under no circumstances require exchanges to admit all insurers in the market, but should at least give exchanges the option of being an active purchaser. Exchanges should decide whether to take a more inclusive or exclusive approach to insurer participation based on the conditions in their own state and local markets. In addition, they should use their regulatory authority to lower prices and increase value to the extent that market conditions allow, while also standardizing and limiting the range of plan choices available within each benefit tier to stimulate competition based on price and value.
 
Health Insurance Exchange Implementation -

Friday, October 1, 2010

Democrat Losses in the Midterms May Equal More Problems for the GOP

(Author's Note: Excerpt of my article in The Loop 21)

Earlier this week I wrote a piece in these pages regarding the seemingly impending GOP takeover of the U.S. House of Representatives. It didn’t take long for it to stir up some emotions, especially among passionate Democrats.

Zerlina Maxwell, a law student and frequent blogger on various sites including, most recently, this one, wrote a rebuttal article. Her belief is probably shared by many Democrats, some of whom reached out to me on Twitter. And truth be told, there is significant reason to be concerned about the GOP agenda if they retake the House of Representatives (which looks to be all but a guarantee).

Their agenda isn’t a progressive one and, clearly, will not resemble that of the Democrats. It’ll slow down the Affordable Care Act (ACA) implementation and probably lead to an extension of the Bush tax cuts for the wealthy -- at a cost of $700 billion. However, all is not lost. In fact, a GOP takeover presents some potential problems for the GOP. For instance, let’s take a look at Maxwell’s points and see why.

Read full article here: http://www.theloop21.com/politics/democrat-losses-the-midterms-may-equal-more-problems-for-the-gop

Obama Makes Good on TARP and Stimulus




The White House is releasing some good news on two fronts today. First, The New York Times is reporting that the Troubled Asset Relief Program (TARP) fund is coming in under budget and, at best, may even make money for the federal government [1]. At the worst, they are looking at a $50 billion loss. That's not chump change but it's sure better than the fears that emanated from voters and the fiscal hawks inside the GOP upon its arrival. Trouble is, is it too late? Midterm elections are just about a month away and the messaging is complete: TARP was an expansion of the federal government at levels never seen. Or insert a hyperbole of your choice.