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The dark side of consensus in Tunisia: Lessons from 2015-2019

Executive Summary Since the 2011 revolution, Tunisia has been considered a model for its pursuit of consensus between secular and Islamist forces. While other Arab Spring countries descended into civil war or military dictatorship, Tunisia instead chose dialogue and cooperation, forming a secular-Islamist coalition government in 2011 and approving a constitution by near unanimity in…

       




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COVID in the Maghreb: Responses and impacts

       




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Accumulating Evidence Using Crowdsourcing and Machine Learning: A Living Bibliography about Existential Risk and Global Catastrophic Risk

The study of existential risk — the risk of human extinction or the collapse of human civilization — has only recently emerged as an integrated field of research, and yet an overwhelming volume of relevant research has already been published. To provide an evidence base for policy and risk analysis, this research should be systematically reviewed. In a systematic review, one of many time-consuming tasks is to read the titles and abstracts of research publications, to see if they meet the inclusion criteria. The authors show how this task can be shared between multiple people (using crowdsourcing) and partially automated (using machine learning), as methods of handling an overwhelming volume of research.




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How Do Past Presidents Rank in Foreign Policy?

How do presidents incorporate morality into decisions involving the national interest? Moral considerations explain why Truman, who authorized the use of nuclear weapons in Japan during World War II, later refused General MacArthur's request to use them in China during the Korean War. What is contextual intelligence, and how does it explain why Bush 41 is ranked first in foreign policy, but Bush 43 is found wanting? Is it possible for a president to lie in the service of the public interest? In this episode, Professor Joseph S. Nye considers these questions as he explores the role of morality in presidential decision-making from FDR to Trump.




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COVID-19's Painful Lesson About Strategy and Power

Joseph Nye writes that while trade wars have set back economic globalization,  the environmental globalization represented by pandemics and climate change is unstoppable. Borders are becoming more porous to everything from drugs to infectious diseases to cyber terrorism, and the United States must use its soft power of attraction to develop networks and institutions that address these new threats.




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Getting Smart on Pandemics: Intelligence in the Wake of COVID-19

This episode of Horns of a Dilemma touches on whether the failure to properly anticipate and warn about the novel coronavirus constitutes an intelligence failure, what changes might be required in the intelligence community in the wake of the pandemic, and what type of investigation or inquiry might be appropriate in order to learn lessons and incorporate changes for both the intelligence community and the whole of government moving forward.




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This Virus Is Tough, but History Provides Perspective: The 1968 Pandemic and the Vietnam War

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.




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Riding the Mobile Wave: The Future of Mobile Computing


Event Information

October 5, 2012
10:00 AM - 11:30 AM EDT

Falk Auditorium
Brookings Institution
1775 Massachusetts Avenue NW
Washington, DC 20036

Register for the Event

In his new book The Mobile Wave: How Mobile Intelligence Will Change Everything (Vanguard Press, 2012), CEO of MicroStrategy Michael Saylor examines the transformative possibilities of mobile computing on business, society, economies and everyday life. Saylor argues that mobile technologies such as smartphones and tablet computers – “the fifth wave of computer technology” – will be indispensible tools for modern life and completely alter how we live.

On October 5, the Center for Technology Innovation at Brookings hosted a forum on mobile computing and its monumental impact on our future. Moderated by Vice President Darrell West, Michael Saylor discussed key highlights from his book and offered insights as to what sort of change we can expect from the macro level down to the most mundane of everyday humans tasks.

 

Audio

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Bridging Transatlantic Differences on Data and Privacy After Snowden


“Missed connections” is the personals ads category for people whose encounters are too fleeting to form any union – a lost-and-found for relationships.  I gave that title to my paper on the conversation between the United States and for Europe on data, privacy, and surveillance because I thought it provides an apt metaphor for the hopes and frustrations on both sides of that conversation.

The United States and Europe are linked by common values and overlapping heritage, an enduring security alliance, and the world’s largest trading relationship.  Europe has become the largest crossroad of the Internet and the transatlantic backbone is the global Internet’s highest capacity route.

[I]

But differences in approaches to the regulation of the privacy of personal information threaten to disrupt the vast flow of information between Europe and the U.S.  These differences have been exacerbated by the Edward Snowden disclosures, especially stories about the PRISM program and eavesdropping on Chancellor Angela Merkel’s cell phone.  The reaction has been profound enough to give momentum to calls for suspension of the “Safe Harbor” agreement that facilitates transfers of data between the U.S. Europe; and Chancellor Merkel, the European Parliament, and other EU leaders who have called for some form of European Internet that would keep data on European citizens inside EU borders.  So it can seem like the U.S. and EU are gazing at each other from trains headed in opposite directions.

My paper went to press before last week’s European Court of Justice ruling that Google must block search results showing that a Spanish citizen had property attached for debt several years ago.  What is most startling about the decision is this information was accurate and had been published in a Spanish newspaper by government mandate but – for these reasons – the newspaper was not obligated to remove the information from its website; nevertheless, Google could be required to remove links to that website from search results in Spain. That is quite different from the way the right to privacy has been applied in America.  The decision’s discussion of search as “profiling” bears out what the paper says about European attitudes toward Google and U.S. Internet companies.  So the decision heightens the differences between the U.S. and Europe.

Nonetheless, it does not have to be so desperate.  In my paper, I look at the issues that have divided the United States and Europe when it comes to data and the things they have in common, the issues currently in play, and some ways the United States can help to steer the conversation in the right direction.

[I] "Europe Emerges as Global Internet Hub," Telegeography, September 18, 2013.


Image Source: © Yves Herman / Reuters
      
 
 




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FedRAMP to Monitor Cloud Service Providers


As of today, the federal government will require that all cloud service providers have Federal Risk and Authorization Program (FedRAMP) approval. FedRAMP is a program meant to standardize the security of cloud services, thus reducing the time and effort that independent cloud providers would need to spend ensuring cloud security. According to a 2013 annual report by the General Services Administration, agencies that use FedRAMP could save 50 percent on staffing and $200,000 in costs overall. FedRAMP will operate under similar rules as the Federal Information Security Management Act (FISMA), which helps maintain security of federal IT systems, applications and databases. Both FISMA and FedRAMP will provide enhanced protection and scrutiny for federal and independent agencies.

To learn more about cloud computing, read Darrell West’s papers Saving Money Through Cloud Computing and Steps to Improve Cloud Computing in the Public Sector. Visit the FedRAMP website here.

MaryCate Most contributed to this post.

Authors

  • Hillary Schaub
Image Source: © Navesh Chitrakar / Reuters
      
 
 




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Israel and the Changing Middle East


Complexity and ambivalence are inherent in Israel’s relationship with its Middle Eastern environment. Israel’s national security agenda is shaped by the hostility of a large part of the Arab and Muslim worlds. During the past 66 years, Israel has been able to crack the wall of Arab hostility, to make peace with two Arab neighbors, and to establish semi-normal relations with several Arab states. But the Arab-Israeli conflict, and its Palestinian core in particular, rages on, and Iran has joined the fray as a powerful and determined adversary.

In Israel, debates over the state’s identity, its place and role in the region, and the more specific issues of the future of the West Bank and Israel’s relationship with the Palestinians, govern the country’s politics and national discourse. The March 2015 Israeli elections are being conducted over a wide range of issues, but they are seen first and foremost as a referendum on these key questions. Politics and policy can hardly be separated. Appearances can be misleading. Currently, the focus of the election campaign seems to be on socio-economic issues. The main challenger of Netanyahu’s current government and potential right-wing coalition is “The Zionist Camp” led by Isaac Herzog and Tzipi Livni. They are strong advocates of reviving a peace process with the Palestinians, but they realize that the Israeli public has drifted to the right. Furthermore, the primaries in the Labor Party produced a left-leaning list of candidates. But whatever the current drift of the campaign, in the elections’ immediate aftermath, whoever forms the next government will have to deal primarily with the Palestinian issue and the national security challenges facing the country.

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Image Source: © Ronen Zvulun / Reuters
      
 
 




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On April 13, 2020, Suzanne Maloney discussed “Why the Middle East Matters” via video conference with IHS Markit.  

On April 13, 2020, Suzanne Maloney discussed "Why the Middle East Matters" via video conference with IHS Markit.

       




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COVID-19 and military readiness: Preparing for the long game

With the saga over the U.S.S. Teddy Roosevelt aircraft carrier starting to fade from the headlines, a larger question about the American armed forces and COVID-19 remains. How will we keep our military combat-ready, and thus fully capable of deterrence globally, until a vaccine is available to our troops? It will also be crucial to…

       




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Webinar: What role will the Army play in great power competition after COVID-19?

Two years after the National Defense Strategy was published, it’s time to take stock of where the Army stands. On an immediate level, the age of COVID-19 presents the Army with an unprecedented set of challenges. From ensuring high levels of readiness to keeping up recruitment, the pandemic has forced the Army to adapt quickly…

       




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Webinar: Policing in the era of COVID-19

The consequences of the novel coronavirus pandemic stretch across the entirety of government services. Major police agencies have reported absentee rates as high as 20% due to officers who are either themselves afflicted with the virus or in need of self-quarantine. Reported crimes are generally down in America’s cities as a result of the many…

       




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Turning back the Poverty Clock: How will COVID-19 impact the world’s poorest people?

The release of the IMF’s World Economic Outlook provides an initial country-by-country assessment of what might happen to the world economy in 2020 and 2021. Using the methods described in the World Poverty Clock, we ask what will happen to the number of poor people in the world—those living in households with less than $1.90…

       




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Addressing COVID-19 in resource-poor and fragile countries

Responding to the coronavirus as individuals, society, and governments is challenging enough in the United States and other developed countries with modern infrastructure and stable systems, but what happens when a pandemic strikes poor and unstable countries that have few hospitals, lack reliable electricity, water, and food supplies, don’t have refrigeration, and suffer from social…

       




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Webinar: The impact of COVID-19 on prisons

Across America, incarcerated people are being hit hard by COVID-19. The infection rate in Washington, D.C., jails is 14 times higher than the general population of the city. In one Michigan correctional facility, more than 600 incarcerated people have tested positive — almost 50% of the prison's total population. In Arkansas, about 40% of the…

       




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How close is President Trump to his goal of record-setting judicial appointments?

President Trump threatened during an April 15 pandemic briefing to “adjourn both chambers of Congress” because the Senate’s pro forma sessions prevented his making recess appointments. The threat will go nowhere for constitutional and practical reasons, and he has not pressed it. The administration and Senate Republicans, though, remain committed to confirming as many judges…

       




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Get rid of the White House Coronavirus Task Force before it kills again

As news began to leak out that the White House was thinking about winding down the coronavirus task force, it was greeted with some consternation. After all, we are still in the midst of a pandemic—we need the president’s leadership, don’t we? And then, in an abrupt turnaround, President Trump reversed himself and stated that…

       




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How instability and high turnover on the Trump staff hindered the response to COVID-19

On Jan. 14, 2017, the Obama White House hosted 30 incoming staff members of the Trump team for a role-playing scenario. A readout of the event said, “The exercise provided a high-level perspective on a series of challenges that the next administration may face and introduced the key authorities, policies, capabilities, and structures that are…

       




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In the Republican Party establishment, Trump finds tepid support

For the past three years the Republican Party leadership have stood by the president through thick and thin. Previous harsh critics and opponents in the race for the Republican nomination like Senator Lindsey Graham and Senator Ted Cruz fell in line, declining to say anything negative about the president even while, at times, taking action…

       




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Removing regulatory barriers to telehealth before and after COVID-19

Introduction A combination of escalating costs, an aging population, and rising chronic health-care conditions that account for 75% of the nation’s health-care costs paint a bleak picture of the current state of American health care.1 In 2018, national health expenditures grew to $3.6 trillion and accounted for 17.7% of GDP.2 Under current laws, national health…

       




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How to increase financial support during COVID-19 by investing in worker training

It took just two weeks to exhaust one of the largest bailout packages in American history. Even the most generous financial support has limits in a recession. However, I am optimistic that a pandemic-fueled recession and mass underemployment could be an important opportunity to upskill the American workforce through loans for vocational training. Financially supporting…

       




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COVID-19 misinformation is a crisis of content mediation

Amid a catastrophe, new information is often revealed at a faster pace than leaders can manage it, experts can analyze it, and the public can integrate it. In the case of the COVID-19 pandemic, the resulting lag in making sense of the crisis has had a profound impact. Public health authorities have warned of the…

       




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Life expectancy and the Republican candidates' Social Security proposals


In last Thursday’s GOP debate, Marco Rubio, Ted Cruz, Jeb Bush and Chris Christie managed to avoid mentioning their common proposal to “reform entitlements” by raising the Social Security retirement age from 67 to 70. That was probably a good idea. Their proposal only demonstrates their lack of understanding about the demographics of older Americans, especially the dramatic disparities in their life expectancy associated with education and race. Recent research on life expectancy indicates that their proposed change would effectively nullify Social Security for millions of Americans and sharply limit benefits for many millions more.. While many people in their 30s and 40s today can look forward to living into their 80s, the average life expectancy for the majority of Americans who do not hold a college degree hovers closer to 70, or the average life expectancy for all Americans in 1950.

The Widening Inequalities in the Life Spans of Americans

This research, summarized recently in a study published in Health Affairs, found that life expectancy for various age cohorts of Americans is closely associated with both educational achievement and race. For example, the average life expectancy for college-educated American men who were age 25 in 2008, or age 33 today, is 81.7 years for whites and 78.2 years for blacks. (Table 1, below) By contrast, the projected, average life span of high-school educated males, also age 25 in 2008 or 33 today, is 73.2 years for whites and 69.3 years for blacks. Women on average live longer than men; but similar disparities based on education and race are evident. The average life expectancy of women age 25 in 2008, or 33 years old today, was 79 years for whites and 75.4 years for blacks for those with a high school diploma, and 84.7 years for whites and 81.6 years for blacks with college degrees. Most disturbing, the average life expectancy of Americans age 25 in 2008 without a high school diploma is just 68.6 years for white men, 68.2 years for black men, 74.2 years for white women, and 74.9 years for black women. Surprisingly, the researchers found that Hispanics in this age group have the longest life expectancies, even though they also have the lowest average levels of education. Since these data are anomalous and may reflect sampling problems, we will focus mainly on the life-expectancy gaps between African American and white Americans.

Tallying How Many People Are Adversely Affected

Census data on the distribution by education of people age 25 to 34 in 2010 (ages 30 to 39 in 2015) provide a good estimate of how many Americans are adversely affected by these growing differences. Overall, 56.3 percent of all Americans currently in their 30s fall are high school graduates or left school without a high school diploma, educational groups with much lower average life expectancies. (Table 2, below) More precisely, 10.1 percent or almost 4.8 million Americans in their 30s today lack a high school diploma, and 46.2 percent or 18.9 million thirty-somethings have high school diplomas and no further degrees. All told, they account for 23,702,000 Americans in their 30s; and among older Americans, the numbers and percentages are even higher.

Since race as well as education are major factors associated with differences in life expectancy, we turn next to education by race (Table 3, below). The totals differ modestly from Table 2, because Census data on education by race cover ages 30-39 in 2014, while Table 2 covers age 30-39 in 2015 (ages 25-34 in 2010).

  • Among people in their 30s today, 45.4 percent of whites or 10,613,000 Americans have a high school degree or less – and their average life expectancy is 9.4 years less than whites in their 30s with a college or associate degree.
  • Among people in their 30s todays, 64.4 percent of blacks or 3,436,000 Americans have a high school degree or less – and their life expectancy is 8.6 years less than blacks in their 30s with an B.A. or associate degree, and 11.6 years less than whites with a college or associate degree..
  • Among people in their 30s today, 75.6 percent of Hispanics or 6,243,000 Americans have a high school degree or less – and their life expectancy is 5.0 years less than Hispanics in their 30s with a college or associate degree.

As a policy matter, these data tell us that across all communities—white, black, Hispanic—improvements in secondary education to prepare everyone for higher education, and lower-cost access to higher education, can add years to the lives of millions of Americans.

Preserving Meaningful Access to Social Security Benefits

The widening inequalities in average life expectancy associated with race and education have more direct policy implications for Social Security, because the number of years that people can claim its benefits depends on their life spans. The growing inequalities in life expectancy translate directly into growing disparities in the years people can claim Social Security benefits, based on their education and race. Assuming that Americans in their 30s today retire at age 67 (the age for full benefits for this age group), they can expect to claim retirement benefits, on average, ranging from 1.2 years to 19.3 years, based on their education and race. (Table 4, below)

The most pressing issues of life expectancy and Social Security involve white males, black males, and black females without college degrees: Among Americans age 33 today, white and black men without high school diplomas and black males with high school degrees, on average, can expect to live long enough to collect benefits for less than three years. Similarly, white and black women without high school diplomas and black women with high school degrees, on average, can expect to collect benefits for less than eight years. Together, they account for 25.2 percent of whites and 64.4 percent of blacks in their 30s today. By contrast, male and female white college graduates age 33 today, on average, can expect to collect Social Security for between 14.7 and 17.7 years, respectively; and 33-year old black men and women with college degrees, on average, will claim benefits for 11.2 to 14.6 years, respectively.

These findings dictate that proposals to raise the Social Security retirement age should be rejected as a matter of basic fairness. Among this year’s presidential hopefuls, as noted earlier, Ted Cruz, Marco Rubio, Jeb Bush and Chris Christie all have called for raising the retirement age to 70 years. Under this policy, black men in their 30s today without a college degree and white men now in their 30s without a high school diploma, on average, would not live long enough to collect any Social Security. The change would reduce the average number of years of Social Security for Americans in their 30s today,

  • From 1.6 years to -1.4 years for white men with no high school diploma,
  • From 1.2 years to -1.8 years for black men with no high school diploma, and
  • From 2.3 years to – 0.7 years for black, male high-school graduates.

Furthermore, among Americans in their 30s today, white and black women without a high school diploma, white male high school graduates, and black female high school graduates, would live long enough, on average, to collect Social Security for just 3.2 to 5.4 years. The GOP change reduce the average number of years of Social Security for Americans in their 30s today,

  • From 6.2 years to 3.2 years for white, male high school graduates,
  • From 7.2 years to 4.2 years for white women with no high school diploma,
  • From 7.9 years to 4.9 years for black women with no high school diploma, and
  • From 8.4 years to 5.4 years for black, female high-school graduates.

All told, proposals to raise the retirement age to 70 years old would mean, based on the average life expectancy of Americans in their 30s today, that 25.2 percent of whites in their 30s and 64.4 percent of blacks of comparable age, after working for 35 years or more, would receive Social Security benefits for 5.4 years or less.

Authors

  • Robert Shapiro
Image Source: © Jim Young / Reuters
     
 
 




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What did ASEAN meetings reveal about US engagement in Southeast Asia?

Just back from Southeast Asia, Senior Fellow Jonathan Stromseth reports on the outcomes from the annual ASEAN (Association of Southeast Asian Nations) summit, including the continued delay of the Regional Comprehensive Economic Partnership, China's economic influence in the region, and how the Trump administration's rhetoric and actions are being perceived in the region. http://directory.libsyn.com/episode/index/id/11923064 Related…

       




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Africa in the news: Debt relief in Somalia, government efforts to combat COVID-19, and new Boko Haram attacks

Debt relief in Somalia and other African countries On Wednesday, the World Bank and International Monetary Fund (IMF) jointly announced that Somalia is now eligible for debt relief under the Heavily Indebted Poor Countries (HIPC) initiative. Successfully completing the HIPC program will reduce Somalia’s external debt from $5.2 billion currently to $557 million in about…

       




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What does Taiwan’s presidential election mean for relations with China?

The landslide reelection of Taiwan's President Tsai Ing-wen was in many ways a referendum on how Taiwan manages its relationship with China. Brookings Senior Fellow Richard Bush explains why Taiwan's electorate preferred President Tsai's cautious approach, how other domestic political and economic factors weighed in her favor, and possible lessons from this election on combating…

       




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After COVID-19, Taiwan will have to navigate a world that will never be the same

Unlike virtually every country in the world, Taiwan has weathered the first wave of the COVID-19 pandemic admirably well. Taiwan’s governance system has stood firm in the face of crisis, gaining international acclaim for the competence and efficiency of its response to the outbreak. And the people of Taiwan have garnered goodwill through their generosity,…

       




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Did the 2017 tax cut—the Tax Cuts and Jobs Act—pay for itself?

The Vitals Before and after passage of the Tax Cuts and Jobs Act (TCJA), several prominent conservatives, including Republicans in the House and Senate, former Reagan economist Art Laffer, and members of the Trump administration, claimed that the act would either increase revenues or at least pay for itself. In principle, a tax cut could…

       




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Health care market consolidations: Impacts on costs, quality and access


Editor's note: On March 16, Paul B. Ginsburg testified before the California Senate Committee on Health on fostering competition in consolidated markets. Download the full testimony here.

Mr. Chairman, Madame Vice Chairman and Members of the Committee, I am honored to be invited to testify before this committee on this very important topic. I am a professor of health policy at the University of Southern California and director of public policy at the USC Schaeffer Center for Health Policy and Economics. I am also a Senior Fellow and the Leonard D. Schaeffer Chair in Health Policy Studies at The Brookings Institution, where I direct the Center for Health Policy. Much of my time is now devoted to leading the new Schaeffer Initiative for Innovation in Health Policy, which is a partnership between USC and the Brookings Institution. I am best known in California for the numerous community site visits over many years that I led in the state while I was president of the Center for Studying Health System Change; most of those studies were funded by the California HealthCare Foundation.

The key points in my testimony today are:

    • Health care markets are becoming more consolidated, causing price increases for purchasers of health services, and this trend will continue for the foreseeable future despite anti-trust enforcement; 
    • Government can still play an effective role in addressing higher prices that come from consolidation by pursuing policies that foster increased competition in health care markets. Many of these policies can be effective even in markets with high degrees of concentration, such as in Northern California.

Consolidation in health care has been increasing for some time and is now quite extensive in many markets. Some of this comes from mergers and acquisitions, but an important part also comes from larger organizations gaining market share from smaller competitors. The degree of consolidation varies by market. In California, most observers believe that metropolitan areas in the northern part of the state have provider markets that are far more consolidated than those in the southern part of the state. Insurer markets tend to be statewide and are less consolidated than those in many other states. The research literature on hospital mergers is now substantial and shows that mergers lead to higher prices, although without any measured impact on quality.[1]

The trend is accelerating for reasons that are apparent. For providers, it is becoming an increasingly challenging environment to be a small hospital or medical practice. There is more pressure on payment rates. New contracting models, such as Accountable Care Organizations (ACOs), tend to require more scale. The system is going through a challenging transition to electronic medical records, which is expensive and requires specialized expertise to avoid pitfalls. Lifestyle choices by younger physicians lead them to pursue employment in large organizations rather than solo ownerships or partnerships in small practices.

The environment is also challenging for small insurers. Multi-state employers prefer to contract with insurers that can serve all of their employees throughout the country. Scale economies are important in building the analytic capabilities that hold so much promise for effectively managing care. Insurer scale is important to make it worthwhile for providers to contract with them under alternative payment models. The implication of these trends is an expectation of increasing consolidation. There is need for both public and private sector initiatives in addition to anti-trust enforcement to foster greater competition on price and quality.

How can competition be fostered? For the insurance market, public exchanges created under the Affordable Care Act (ACA) and private insurance exchanges that serve employers can foster competition among insurers in a number of ways. Exchanges reduce entry barriers by reducing the fixed costs of getting an insurer’s products in front of potential customers. Building a brand is less important when your products will be presented to consumers on an exchange along with information on the benefit design, the actuarial value and the provider network. Exchanges make it easier for consumers to make informed choices across plans. This, in turn, makes the insurance market more competitive. Among public exchanges, Covered California has stood out for making this segment of the insurance market more competitive and helping consumers make choices that are better informed.

The rest of my statement is devoted to fostering competition among providers. I believe that fostering competition among providers is a higher priority because the consequences of lack of competition are potentially larger. In addition, a significant regulatory tool, minimum medical loss ratios, part of the ACA, is now in place and can limit the degree to which purchasers pay too much for health insurance in markets with insufficient competition.

Fostering competition in provider markets involves two prongs—broadened anti-trust policy and other policies to foster market forces. Anti-trust policy, at least at the federal level, to date has not addressed hospital acquisitions of physician practices. These acquisitions lead to higher prices to physicians because hospitals can negotiate higher prices for their employed physicians than the physicians were getting in small practices. Although not yet extensive, a developing research literature is measuring the price impact.[2] Hospital employment of physicians can also be a barrier to physicians steering patients to high-value providers (another hospital or a freestanding provider). To the degree that it reduces the chance of larger physician groups or independent practice associations forming, hospital employment of physicians reduces potential competitors in contracting under alternative payment models.

Another area not addressed by anti-trust policy is cross-market mergers. The concern is that a “must have” hospital in a multi-market system could lead to higher rates for system hospitals elsewhere. Anti-trust enforcement agencies have tended to look at markets separately, so this issue tends not to enter their analyses.

Many have seen price and quality transparency as a tool to foster competition among providers. Clearly, transparency has become a societal value and people increasingly expect more information about organizations that are important to them in both the public and private sector. But transparency is often oversold as a strategy to foster competition in health care provider markets. For one thing, many benefit designs have few incentives to favor providers with lower prices. Copays are the same for all providers and with coinsurance, the insurer covers most of the price difference. Even high deductibles are limited in their incentives because almost all in-patient stays exceed large deductibles and out-of-pocket maximums also come into play for many who are hospitalized. Another issue is that the complexity of comparing prices is a “heavy lift” for many consumers. Insurers and employers now have excellent web tools designed to make it easier for patients to compare prices, but indications are that the tools do not get a lot of use.

Network strategies have the potential to be more effective. The concept behind them is that the insurer is acting as a purchasing agent for enrollees. To the extent that they have the potential to shift volume from high-priced providers to low-priced providers, money can be saved in three distinct ways. The first is the higher proportion of services coming from lower-priced providers. The second is the additional discounts from providers seeking to become part of the limited or preferred network. Finally, if a large enough proportion of patients are enrolled in plans with these incentives, providers will likely increase the priority given to cost containment. In creating networks, insurers are increasingly using broader and more sophisticated measures of price as well as some measures of quality. Cost per patient per year or cost for all services involved in an episode is likely to have more relevance than unit prices. Using such measures to judge providers for networks has strong analytic parallels to reformed payment approaches, such as ACOs and bundled payments for episodes of care. Network strategies also create more opportunities for integration of care. For example, a limited network or a preferred tier in a broader network could be mostly limited to providers affiliated with a large health care system. Indeed, some health systems are developing their own health plan or partnering with an insurer to offer plans that favor their own providers.

In this testimony, I discuss two distinct network strategies. One is the limited network, which includes fewer providers than has been the norm in private insurance. The other is the tiered network, where the network is broad but a subset of providers are included in a preferred tier. Patients pay less in cost sharing when they use the preferred providers. Limited networks are a more powerful tool to obtain lower prices because patient incentives are stronger. If patients opt for a provider not in the limited network, they are subject to higher cost sharing and might have to pay the provider the difference between the charge and what the plan allows. Results of these stronger incentives are seen in a number of studies by McKinsey and Co. that have shown that on the public exchanges, limited network plans have premiums about 15 percent lower than plans with broader networks.

Public and private exchanges are an ideal environment for limited network plans. The fixed contributions or subsidies to purchase coverage mean that consumers’ incentives to choose a plan with a lower premium are not diluted—they save the full difference in premium. Exchanges do not have the “one size fits all” requirement that constrains many employers in using this strategy. If an employer is offering only one or two plans, it is important that an overwhelming majority of employees find the network acceptable. But a limited network on an exchange could appeal to fewer than half of those purchasing on the exchange and still be very successful. In addition, tools provided by exchanges to support consumers facilitate comparisons of plans by having each plan’s network accessible on a single web site.

In contrast, tiered networks have the potential to appeal to a larger consumer audience. Rather than making annual choices of which providers can be accessed in network, tiered networks allow these decisions on a point-of-service basis. So the consumer always has the option to draw on the full network. Considering the greater popularity of PPOs than HMOs and the fact that tiered formularies for prescription drugs are far more popular than closed formularies, the potential market for tiered networks might be much larger. But this has not happened. In many markets, dominant providers have blocked the offering of tiered networks by refusal to contract with insurers that do not place them in the preferred tier. This phenomenon was seen in Massachusetts, where 2010 legislation prohibiting this practice led to rapid growth in insurance products with tiered networks.

Some Californians are familiar with a related approach of reference pricing due to the pioneering work that CalPERS has done in this area for state and local employees. Reference pricing is really an “extra strength” version of the tiered network approach. An insurer sets a reference price and patients using providers that charge more are responsible for the difference (although providers sometimes do not charge patients in such plans any more than the reference price). So the incentive to avoid providers whose price exceeds the reference price is quite strong. While CalPERS has had success with joint replacements and some other procedures, a key question is what proportion of medical spending might be suitable to this approach. For reference pricing to be suitable, the services must be “shoppable,” meaning that they must be discretionary with the patient and can be planned in advance. One analysis estimates that only one third of health spending is “shoppable.”[3]

While network approaches have a lot of potential for fostering competition in health care markets, including those that are consolidated, they face a number of challenges that must be addressed. First, transparency about networks must be improved. Consumers need accurate information on which providers are in a network when they choose plans and when they choose providers for care. Accommodation is needed for patients under treatment if their provider should drop out of a network or be dropped from one. Network adequacy regulations are needed to protect consumers from networks that lack access to some specialties or do not have providers close enough to their residence. They are also important to preclude strategies that create networks unlikely to be attractive to patients with expensive, chronic diseases. But if network adequacy regulation is too aggressive, it risks seriously undermining a very promising tool for cost saving. So regulators must very carefully balance consumer protection with cost containment.

Some consider the problem of “surprise” balance bills, charges by out-of-network providers that patients do not choose, to be more significant in limited networks. This may be the case, but the problem is substantial in broader networks as well, and its policy response should apply throughout private insurance.

Another approach to foster competition in provider markets involves steps to foster independent medical practices. Medicare has taken steps to ease requirements for medical practices to contract as ACOs. It recently took some steps to limit the circumstances in which hospital-employed physicians get higher Medicare rates than those in office-based practice. Private insurers have provided support to some practices to incorporate electronic medical records into their practices. To the degree that independent practice can be made more attractive relative to hospital employment, competition in provider markets is likely to increase.

Additional restrictions on anti-competitive behavior by providers can also foster competition. These behaviors include “all or nothing” contracting requirements in which a hospital system requires insurers to contract with all hospitals in the system and “most favored nation” clauses in which insurers get providers to agree not to establish lower rates for other insurers.

Although the focus of discussion about policy in this testimony has been about fostering competition, regulatory alternatives that substitute for competition should not be ignored. At this time, two states—Maryland and West Virginia—regulate hospital rates. Some states, mostly in the Northeast, have been looking at this approach. Although I respect what some states have accomplished with this approach in the past, I need to point out that the current environment poses additional challenges for rate setting. The notion that rates would be the same for all payers, a longstanding component in Maryland, is unlikely to be practical today because rate differences between private insurance, Medicare and Medicaid are so large. So differences would likely have to be “grandfathered.” More practical would be to limit regulation to commercial rates, as West Virginia has done since the 1980s.

Another challenge is that with broad enthusiasm about the prospects for reformed payment, those contemplating rate setting need to make sure that the mechanism encourages payment reform rather than blocks it. Maryland has been quite careful about this and its recent initiative to broaden its program seems promising. But with the recent emphasis on multi-provider approaches to payment, such as ACOs and bundled payment, the limitation of regulatory authority to hospital rates could be a problem.

So what are my bottom lines for legislative priorities? I have two. States should address restrictions on anti-competitive practices such as anti-tiering restrictions, all-or-none contracting restrictions, and most favored nation clauses. My second is to regulate network adequacy wisely. It is a potent tool for fostering competition, even in consolidated markets. Network strategies do have problems that need to be addressed, but it must be done while preserving much of the potency of the approach.

A concluding thought involves acknowledging that provider payment reform approaches are likely to contribute to consolidation. Small hospitals and medical practices are not well positioned to participate, although virtual approaches can often be used in place of mergers, for example as California’s independent practice associations have enabled many small practices to participate. But I see payment reform as having major potential over time to reduce costs and increase quality. So my advice is to proceed with payment reform but also take steps to foster competition. Rate setting is best seen as a “stick in the closet” to use if market approaches should fail to control costs.


[1] Gaynor, M., and R. Town, The Impact of Hospital Consolidation – Update, Robert Wood Johnson Foundation Synthesis Report (June 2012).

[2] Baker, L. C., M.K Bundorf and D.P. Kessler, “Vertical Integration: Hospital Ownership Of Physician Practices Is Associated With Higher Prices And Spending,” Health Affairs, Vol. 35, No 5 (May 2014).

[3] Chapin White and Megan Egouchi, Reference Pricing: A Small Piece of the Health Care Pricing and Quality Puzzle. National Institute for Health Care Reform, Research Brief No. 18, October 2014.

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Physician payment in Medicare is changing: Three highlights in the MACRA proposed rule that providers need to know


Editor’s Note: This analysis is part of The Leonard D. Schaeffer Initiative for Innovation in Health Policy, which is a partnership between the Center for Health Policy at Brookings and the USC Schaeffer Center for Health Policy and Economics. The Initiative aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.

The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) just over a year ago signaled a strong and unique bipartisan agreement to move towards value-based care, but until recently, many of the details surrounding how it would be implemented remained unknown. But last week, the Centers for Medicare and Medicaid Studies (CMS) released roughly 1,000 pages that shed more light on how physician payment will hopefully dramatically change for the better.

Some Historical Context

Prior to MACRA, how doctors were paid for providing care to Medicare patients was subject to a reimbursement formula known as the Sustainable Growth Rate (SGR). Established in 1997 to control the rate of increase in spending on physician services, the SGR pegged total spending among all Medicare-participating physicians to an overall budget target. Yet in this “tragedy of the commons,” no one physician benefitted from her good stewardship of health care resources. Total physician spending often exceeded the overall budget target, triggering reimbursement rate cuts. However, lawmakers chose to push them off into the future through what were called “doc fixes,” deferring the rate cuts temporarily. The pending cut rose to over 21 percent before MACRA’s passage as a result of compounding doc fixes.

Moving Forward with MACRA

When it was signed into law on April 16, 2015, MACRA ended the SGR, its cuts, and many previous payment incentive programs. In their place, MACRA established two overarching payment incentive schemes for providers to choose from:

  1. the Merit-Based Incentive Payment System (MIPS) program, which supplants three previous payment incentives and makes positive or negative adjustments to a physician’s payment based on her performance; or

  2. the Alternative Payment Model (APM) program, which awards a 5 percent bonus through 2024—with higher annual payment updates thereafter—for having a minimum percentage of Medicare and/or all-payer revenue through eligible APMs. Base physician fee rates for all Medicare providers would be updated 0.5 percent for each of the first four years, followed by no increases until 2026, when base fees would increase at different rates depending on the payment incentive program in which a physician participates.

MIPS addresses providers’ longstanding complaints that reporting that reporting under the existing programs—the Physician Quality Reporting System, the Value-Based Modifier, and Meaningful Use — is duplicative and cumbersome. Under the new MIPS program, physicians report to the government payer directly (CMS) and receive a bonus or penalty based on performance on measures of quality, resource use, meaningful use of electronic health records, and clinical practice improvement activities. The bonus or penalty physicians may see starts at 4 percent of the fee schedule in 2019 (based on their performance two years prior—in this case 2017) and increases successively to 5 percent in 2020, 7 percent in 2021, and 9 percent from 2022 onward. From 2026 onward, MIPS providers would receive an annual increase of 0.25 percent on their base fee schedules rates.

In contrast, the APM incentive program awards qualifying physicians a fixed, annual bonus of 5 percent of their reimbursement from 2019- – 2024, and provides that their fee schedule rates grow 0.5 percentage points faster than those of MIPS in 2026 and beyond, in recognition of the risk they assume in these contracts.

Yet, according to MACRA, not all APMs are created equal. APMs eligible for this track must use quality measures similar to those of MIPS, ensure electronic health records are used, and either be an approved patient-centered medical home (PCMH) or require that the participating entity “bears more than nominal financial risk” for excessive costs. Then, in order to receive the APM track bonus, physicians must have a minimum of 25 percent of their revenue from Medicare come through eligible APMs in 2019, with the minimum increasing through 2023 up to 75 percent. In 2021, a new all-payer Advanced APM option becomes available, allowing providers in APM contracts with other payers to participate in the Advanced APM incentive. To do so, they must meet the same minimum thresholds—50 percent in 2021, 75 percent in 2023—but through all provider contracts, not solely Medicare revenue, while still meeting a significantly lower Medicare-specific threshold. By creating an all-payer option, CMS hopes to enable greater provider participation by allowing all payer revenue to count toward the same minimum threshold. Under the all-payer model in 2021, for example, providers must have no less than 25 percent of Medicare revenue through Advanced APMs and 50 percent of all revenue through Advanced APMs.

MACRA Implementation Details Revealed

The newly released proposed rule provides answers to significant questions that had been left unanswered in the law surrounding the specifics of implementation of MIPS and the APM incentives. At long last, providers are gleaning insight into how CMS intends to implement MIPS and the APM track. Given the fast-approaching MIPS performance period in January 2017, here are three key highlights providers need to know:

  1. Qualifying for the APM incentive track—and getting out of MIPS—will be difficult. In order to qualify for the bonus-awarding Advanced APM designation, APMs must meet the “nominal financial risk” criteria, which will be measured in three ways: an APM’s marginal rate sharing for losses, minimum loss ratio (the threshold above which providers would begin sharing in losses), and total potential risk as a percent of expected costs. Clinicians must further have a minimum share of revenue that comes in through the designated APMs.

  2. Providers will have fewer opportunities to see and improve their performance on MIPS. Despite calls from provider groups for more frequent reporting and feedback periods, MIPS reporting periods will be annual, not quarterly. This is true for performance feedback from CMS, as well, though they may explore more frequent feedback cycles in the future. Quarterly reporting and feedback periods could have made the incentive programs more “actionable” for providers, alerting them to their performance closer to the time the services were rendered and providing more opportunities to improve performance.

  3. MIPS allows greater flexibility than previous programs. Put simply, MIPS is the performance incentive program clinicians will participate in if not on the Advanced APM track. While compelling participation, the proposed MIPS implementation also responds to stakeholder concerns that earlier performance incentive programs were onerous and sometimes irrelevant—MIPS reduces the number of measures required in some categories and allows physicians to select from a set of measures to report on based on relevancy to their practice.

With last week’s release of the proposed rule, the Leonard D. Schaeffer Initiative for Innovation in Health Policy is kicking off a series of work products that will focus dually on further MACRA implementation issues and on translating complex policy into providers’ experience. In the blogs and publications to follow, we will dive into greater detail and discussion of the pieces of MACRA implementation highlighted here, as well as many other emerging physician payment reform issues, as the law’s implementation unfolds.

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Image Source: © Jim Bourg / Reuters
       




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Africa in the news: COVID-19 impacts African economies and daily lives; clashes in the Sahel

African governments begin borrowing from IMF, World Bank to soften hit from COVID-19 This week, several countries and multilateral organizations announced additional measures to combat the economic fallout from COVID-19 in Africa. Among the actions taken by countries, Uganda’s central bank cut its benchmark interest rate by 1 percentage point to 8 percent and directed…

       




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From “Western education is forbidden” to the world’s deadliest terrorist group

EXECUTIVE SUMMARY Boko Haram — which translates literally to “Western education is forbidden” — has, since 2009, killed tens of thousands of people in Nigeria, and has displaced more than two million others. This paper uses an interdisciplinary approach to examine the relationship between education and Boko Haram. It consists of i) a quantitative analysis…

       




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Preventing violent extremism during and after the COVID-19 pandemic

While the world’s attention appropriately focuses on the health and economic impacts of COVID-19, the threat of violent extremism remains, and has in some circumstances been exacerbated during the crisis. The moment demands new and renewed attention so that the gains made to date do not face setbacks. Headlines over the past few weeks have…

       




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On April 30, 2020, Vanda Felbab-Brown participated in an event with the Middle East Institute on the “Pandemic in Pakistan and Afghanistan: The Potential Social, Political and Economic Impact.”

On April 30, 2020, Vanda Felbab-Brown participated in an event with the Middle East Institute on the "Pandemic in Pakistan and Afghanistan: The Potential Social, Political and Economic Impact."

       




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The next COVID-19 relief bill must include massive aid to states, especially the hardest-hit areas

Amid rising layoffs and rampant uncertainty during the COVID-19 pandemic, it’s a good thing that Democrats in the House of Representatives say they plan to move quickly to advance the next big coronavirus relief package. Especially important is the fact that Speaker Nancy Pelosi (D-Calif.) seems determined to build the next package around a generous infusion…

       




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President Obama and the Summit of the Americas

President Barack Obama will travel to Mexico and then to the 5th Summit of the Americas in Port of Spain, Trinidad, beginning on April 16th. He would do well to remember Ronald Reagan's seemingly obvious but fundamentally important comment on returning from his first trip to South America as President: "These Latin American countries are all very different from each other."

It's crucially important for the new U.S. government at its senior levels to take seriously the oft-repeated advice of regional experts to disaggregate "Latin America" -- to understand its complex diversity. Emphasizing this is now more important than ever.

During the past 20 years, under administrations of both parties, Washington has tended to underline the supposed convergence within the region: toward democratic governance, market-oriented economies, regional economic integration and policies of macroeconomic and fiscal balance. These convergent trends were real, though never universal, and they have been significant, though never as fully consolidated as Washington liked to claim.

Key differences persist among the many countries of Latin America and the Caribbean. Some of the differences are growing, not shrinking. And U.S. policy should focus on how different countries of the Americas cluster along five separate dimensions.

The first is the degree of demographic and economic interdependence with the United States: highest and still growing in Mexico, Central America and the Caribbean: lowest and likely to remain low in South America, and especially in the Southern Cone. Countries such as Mexico, El Salvador, Jamaica, the Dominican Republic and others, which have significant fractions of their population living and working in the United States, pose "intermestic" issues -- combining international and domestic facets -- from immigration to medical insurance, pensions to drivers licenses, remittances to youth gangs.

A second dimension is the extent to which the countries have opened their economies to international competition: by far most fully in Chile; a great deal in Brazil, Colombia, Mexico, Peru, Panama and some Central American nations; and less so in other countries. A key challenge in the current world economic crisis will be to shore up the trend toward open economies by resisting domestic pressure for protectionism in our own case.

A third distinguishing dimension is the relative advance of democratic governance (checks and balances, accountability, and the rule of law): historically strong in Chile, Uruguay, and Costa Rica; increasingly, if quite unevenly, robust in Brazil; gaining ground in Mexico over the past twenty years but with ups and downs, hard struggle and major recent setbacks; arguably declining, or at least at risk, in Argentina; under great strain in Venezuela, most of the Andean nations, much of Central America and Paraguay; and exceptionally weak in Haiti. The Obama administration can make an important positive difference on these issues by respecting the rule of law at home and internationally, and by nurturing democratic governance abroad with patience, restraint and skill, mainly through nongovernmental organizations.

A fourth dimension is the relative effectiveness of civic and political institutions beyond the state (the press, trade unions, religious organizations, and nongovernmental entities): strongest in Chile, Uruguay, Costa Rica, the Dominican Republic and perhaps Argentina; growing but still severely challenged in Brazil and Mexico; slowly regaining stature but still quite problematic in Colombia; weak in Peru, Bolivia, Ecuador, Paraguay, Venezuela, most of Central America and Haiti. Washington can help strengthen nongovernmental institutions, but it should do so as much as possible through multilateral organizations, and in strict accordance with each country's laws.

Finally, countries differ regarding the extent to which traditionally excluded populations are incorporated: this includes more than 30 million marginalized, disadvantaged, and increasingly politically mobilized indigenous people -- especially in Bolivia, Ecuador, Guatemala, the Peruvian highlands, and southern Mexico -- and Afro-Latin Americans in countries where they are still the object of racial discrimination. The very fact of President Obama's rise to the presidency has probably done more to affect this issue than years of more direct policies, but enhanced U.S. support for poverty alleviation targeted at excluded populations would also be helpful.

Hemisphere-wide summit conferences like the meeting in Trinidad have their place as a way of building communication and rapport, and they offer mutually convenient photo opportunities. But major progress on substantive issues can only be achieved with clusters of countries with comparable or complementary issues and concerns. Recognizing this reality should be the starting point for reframing U.S. policies in the Americas.

Publication: The Huffington Post
     
 
 




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A Confident and Strong Latin America


On June 29, the Latin America Initiative (LAI) at Brookings and the Corporación Andina de Fomento (CAF) hosted a panel of experts from Latin America to discuss the significance of the renewed hemispheric partnership between the U.S. and Latin America. In this video from the event, LAI director Mauricio Cárdenas discusses the challenges of U.S. foreign policy in Latin America and how the focus has changed since President Obama took office.

Image Source: © Reuters Photographer / Reuters
      
 
 




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Responding to COVID-19: Using the CARES Act’s hospital fund to help the uninsured, achieve other goals

       




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Webinar: A short- and long-term approach to COVID-19

As the COVID-19 pandemic nears 2 million confirmed infections, scientists and doctors are working on treatments for the sick as well as preventive measures to stop the spread of infection. Dr. William A. Haseltine, known for his groundbreaking work on HIV-AIDS and pioneering application of genomics to drug discovery with Human Genome Sciences, joined USC-Brookings…

       




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After COVID-19—thinking differently about running the health care system

       




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Webinar: Telehealth before and after COVID-19

The coronavirus outbreak has generated an immediate need for telehealth services to prevent further infections in the delivery of health care. Before the global pandemic, federal and state regulations around reimbursement and licensure requirements limited the use of telehealth. Private insurance programs and Medicaid have historically excluded telehealth from their coverage, and state parity laws…

       




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Estimating potential spending on COVID-19 care

The COVID-19 pandemic is causing large shifts in health care delivery as hospitals and physicians mobilize to treat COVID-19 patients and defer nonemergent care. These shifts carry major financial implications for providers, payers, and patients. This analysis seeks to quantify one dimension of these financial consequences: the amounts that will be spent on direct COVID-19…

       




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Removing regulatory barriers to telehealth before and after COVID-19

Introduction A combination of escalating costs, an aging population, and rising chronic health-care conditions that account for 75% of the nation’s health-care costs paint a bleak picture of the current state of American health care.1 In 2018, national health expenditures grew to $3.6 trillion and accounted for 17.7% of GDP.2 Under current laws, national health…

       




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International Volunteer Service: A Smart Way to Build Bridges

Introduction

President Obama has proposed expanding the Peace Corps and building a global network of volunteers, “so that Americans work side-by-side with volunteers from other countries.” Achieving this goal will require building on the success of the Peace Corps with a new combination of public and private initiatives designed to expand opportunities for volunteers to address critical global problems such as poverty, contagious diseases, climate change, and conflict.

We examine alternative service models, both domestic and foreign, and offer recommendations to the Obama Administration for harnessing the energy and skills of Americans eager to engage in volunteer work in foreign countries as part of a multilateral mobilization effort and smart power diplomacy.

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Presidents Obama and George H.W. Bush: Building Bridges Through Service


President Barack Obama’s visit to the George Herbert Walker Bush Library in College Station, Texas this week highlights the crucial role of America’s volunteer traditions in addressing critical issues at home and abroad. The two presidents will commemorate the 20th anniversary of the Points of Light movement, championed by the 41st president, and advance the United We Serve initiative of President Obama.

Michelle Nunn, CEO of Points of Light Institute and daughter of former Democratic Senator Sam Nunn noted in Huffington Post that “demand, idealism and presidential impact are leading American volunteerism to its…most important stage – the movement of service to a central role in our nation’s priorities.”

The bipartisan nature of America’s vibrant service movement is also reflected in the landmark Kennedy-Hatch Serve America Act signed into law by President Obama earlier this year and pending Global Service Fellowship legislation introduced by Senators Feingold and Voinovich.

In a recent Brookings Global Views policy brief, “International Volunteer Service: A Smart Way to Build Bridges,” Lex Rieffel, Kevin Quigley and I articulate policy options for the new administration to advance President Obama’s call for engaging service on the global level. President Obama’s speech in Cairo on June 4 called for turning “dialogue into interfaith service, so bridges between peoples lead to action – whether it is combating Malaria in Africa, or providing relief for a natural disaster.”

Following the president’s Cairo speech, the administration assembled a laudable Global Engagement Initiative across the administration to implement and track results in scaling up initiatives of service and interfaith action. The potency of coupling American service with foreign assistance was documented in Indonesia and Bangladesh through successive Terror Free Tomorrow polls showing increased favorable ratings for our nation and decreased support for terrorism.

The Building Bridges Coalition has organized an impressive array of over 210 organizations dedicated to expanding American volunteerism internationally, as part of a new “Service World” policy coalition gearing up for the 50th anniversary of the Peace Corps. This new “international service 2.0” incorporates NGOs and faith-based groups, universities and corporations as new development actors advocating multilateral service and achieving impacts on issues ranging from Malaria to peacebuilding and climate change.

A Foundation Strategy Group report commissioned by Brookings and Pfizer, “Volunteering for Impact” assessed best practices in the increasing array of international corporations engaging volunteers such as IBM’s Corporate Service Corps, GE Volunteers and Pfizer’s Global Health Fellows.

Around the globe, initiatives such as Cross Cultural Solutions and an emerging global service and peacebuilding alliance in hot spots from Kenya to Mindanao are giving substance to the president’s call in Cairo. The collaboration of Presidents Clinton and G.H.W. Bush on humanitarian assistance after the tsunami, and this week’s service dedication with the Obama administration and former President Bush, bode well for the bipartisan extension of our nation’s noble voluntary service traditions in the international context where they are urgently needed.

Image Source: © Jim Young / Reuters
     
 
 




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Presidential Summit on Entrepreneurship: Experts Volunteer Abroad


Over 200 delegates from 50 countries gather this week in Washington for the Presidential Summit on Entrepreneurship. The summit hosts entrepreneurs to teach and learn innovative ways to strengthen professional and social relationships between the U.S. and the Islamic world. During his first major address to the Muslim world, delivered in Cairo last June, President Obama pledged to increase engagement through entrepreneurship, exchange programs and multilateral service initiatives.

Volunteer-led development initiatives have begun to act on Obama’s call for citizen diplomacy and private-sector engagement. The Initiative on International Volunteering and Service at Brookings and the Building Bridges Coalition have fueled an emerging legislative initiative that calls for increasing the role of international volunteers in the U.S. diplomatic agenda and development programs. This Service World Initiative has drawn from Brookings research outlining options to advance the president’s call for multilateral service.

As seen last year, for the first time in history, the majority of the world’s population lived in urban areas. And this trend is accelerating at an unprecedented rate. By 2050, urban dwellers are expected to make up about 70 percent of Earth’s total population. These informed 21st century urban citizens demand 24-7 connectivity, smart electric grids, efficient transportation networks, safe food and water, and transparent social services. All these demands place a huge strain on existing city infrastructures and the global environment. Most affected by this rapid urban boom, are the emerging markets. So how do we tackle this development dilemma?

One way is for highly-skilled experts, from a range of countries, to volunteer their time in emerging markets to help improve economic development, government services and stimulate job growth. This type of pro-bono program has many benefits. It benefits the urban areas in these emerging markets by leveraging intelligence, connecting systems and providing near-term impact on critical issues such as transportation, water, food safety, education and healthcare. It benefits the expert volunteers by fostering their teamwork skills, providing a cultural learning experience, and broadening their expertise in emerging markets.

IBM, which chairs the Building Bridges Coalition’s corporate sector, hosts a range of volunteer-led global entrepreneurship programs that improve economic stability for small- and medium-sized businesses, increase technology in emerging markets and open doors for the next generation of business and social leaders. This program connects high-talent employees with growing urban centers around the world and fosters the type of leadership to help IBM in the 21st century.

Recently, IBM sent a group of experts to Ho Chi Minh City as part of its Corporate Service Corps, a business version of the Peace Corps. This was the first Corporate Service Corps mission to be made up of executives, and the first to help a city in an emerging market analyze its challenges holistically and produce a plan to manage them. As a result, the city has now adopted a 10-year redevelopment plan that includes seven pilot programs in areas ranging from transportation to food safety. IBM will also help the city set up academic programs to prepare young Vietnamese to launch careers in technology services. IBM will continue this program throughout the next couple years to evolve the next set of global business and cultural hubs utilizing the volunteer hours of some of its most seasoned experts.

The Presidential Summit this week will further Obama’s call to “turn dialogue into interfaith service, so bridges between peoples lead to action.” The policy initiative of the Building Bridges Coalition, coupled with entrepreneurial innovations such as IBMs, can foster greater prosperity and service between the U.S. and our global partners.

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Image Source: © STR New / Reuters
     
 
 




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Cities and states are on the front lines of the economic battle against COVID-19

The full economic impact of the COVID-19 pandemic came into sharp relief this week, as unemployment claims and small business closures both skyrocketed. Addressing the fallout will require a massive federal stimulus, and both Congress and the White House have proposed aid packages exceeding $1 trillion. But as we noted on Monday, immediate assistance to…