Relevant and even prescient commentary on news, politics and the economy.

The New Pharmacy Price Transparency Rule Put Forth by President Trump

The New Hospital Price Disclosure Rule Is Important, But Only A First Step,” Health Affairs, James C. Capretta, August 26, 2019

The new proposed regulation on hospital price transparency is an important step toward consumer-friendly price information. The regulation introduces into federal price transparency, requirements such as the concepts: of service standardization, consumer-friendly organization and terminology, and bundling of which all of are crucial for a marketplace to become price competitive.

As the administration acknowledges, this regulation by itself will not fully address the opacity of today’s market. Additional disruptive changes will be necessary to give consumers usable pricing information. Among which, meaningful transparency requires stricter standardization of the services being priced and “all in” pricing matching how consumers think about the services they need.

Additionally, the reform of the nation’s insurance payment system must be integrated into the price transparency effort to ensure consumers are price sensitive across a wider range of services. Suppliers of services will only compete on price when significant numbers of consumers have strong incentives to seek out low-cost alternatives.

Me: To which I would add there is a big difference between price and cost and it is not being acknowledged.

The Trump administration on Friday put forth two long-anticipated rules that increase price transparency for both hospitals and insurers.

The CMS’ hospital price transparency requirements finalize changes that require health systems to make their standard fees available on-demand and online. The “transparency in coverage” proposed rule would require health plans, including employer-based plans, and group and individual plans, to inform participants, beneficiaries and enrollees about price and cost-sharing information ahead of time.

The agency hopes increased price transparency will boost competition among hospitals and insurers to drive down healthcare spending.

Under the new price transparency rule, hospitals must publish their standard charges online in a machine-readable format. They will need to create at least 300 “shoppable” services, including 70 selected by the CMS.

Under the rule, hospitals would have to disclose the rates they negotiate with third-party payers, which some experts say could be illegal.

Hospitals get ready to fight CMS in Court over Transparency,” FierceHealthcare, Robert King, November 15, 2019

More after the leap!

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Mapping the Land

I looked at this at first, wondered what it depicted, thought it might be a piece of art, and puzzled over it a bit. It is a topographical depiction (Lidar) of the Mississippi River. If you look closely, you can see roads and various plots of land in addition to the movement of the river bed over time and the various elevations.

One of the key techniques used in modern cartography has its beginnings in 17th century map-making. Relief shading techniques as shown by the darker and lighter areas give dimensions such as height (lighter) and depth (darker) areas to maps so a viewer of the map could understand the terrain. For a hiker, an army, someone buying a piece of land, or building a fence, etc. could understand the area depicted and prepare for and not be surprised by it upon coming upon it. Today, GIS specialists can use applications like Photoshop and other digital software to create relief shading online.

 

What is this and how is this done? “Vibrant maps from aerial laser data — known as Lidar — show the position and elevations of the Mississippi river. This stretch shows historical movement and shape-shifting across three counties in Mississippi.” If you click on the link, you can also see the hand drawn topographical maps charted by Harrold Fisk in 1944 using aerial photography. In themselves, these  skillfully drawn maps are pieces of art which would depicting the same.

The National Geographic article shows similar topography maps of  “The Mississippi River, it’s hidden history, as uncovered by lasers” The laser depicted images are done by Daniel Coe a cartographer for the Washington Geological Survey using Lidar, a system of laser pulses also sent from aircraft to measure topography.

So, why the interest? Prior to leaving the Marine Corp, I had an opportunity to study surveying and also topography mapping as a way to a head start in finding a job once discharged. When I left the Corp, jobs were not plentiful, and I went to college instead. Even so, I was prepared for the transition by doing something in which I had an interest.

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Good Morning

I hope everyone had a good Thanksgiving with family, friends, or strangers.

My young and pretty 20 – something year-old wife and I were traveling years ago. We were standing in a long line into the only restaurant at O’hare airport. It was a couple of days before a holiday and the airport was packed.

If you frequent O’Hare today, you must be thinking; “What is he thinking? O’Hare has many assorted places to dine.” Like I said this was years ago. O’Hare was not as big then as it is today.

The line was moving slow and we finally arrived at the front. There were two men dressed in suits behind us, a rarity today, unless you are traveling for business and doing a meeting that same day . . . which I have done at times. The restaurant greeter came to get us.

I asked my wife if she minded if others sat with us as we were going to have a table for 4. She did not mind which I already knew and even so, thought I had better ask first. I asked the greeter if it was ok and of course she did not care as it was two more people out of her way. I turned to the two men.

“We have a table for four and wondered if you might want to join us as the restaurant is terribly crowded.” Of course they did not mind. The one had limited time in which to eat. We were thanked for our courtesy and kindness to include them, strangers, at our table. I do not remember their names. It did not really matter to me. That we could help someone else was more important.

My daughter who looks like a young version of her mom returned from Guatemala a few days ago. Each year, she travels there. No, it was not a vacation. She is a registered nurse (ER) and travels there with a team of nurses, techs, doctors, and surgeons to render aid in this part of North America to those in need. This time they performed 400 hundred surgeries during the 8 days they were there. She sends us pictures of the area and what facilities she visits. Each volunteer pays for their own transportation to there.

My youngest son has taken on similar acts of kindness and assistance to people in need as well as my oldest son. I am sitting here in the quiet of my oldest son’s family room. Everyone is still asleep after having a nice Thanksgiving meal yesterday with my daughter-in-law’s family.

We are doing well in life. I point to two examples of showing a degree of kindness and empathy for others regardless of who they are or from where they emanated. An action of kindness can be whatever you wish it to be towards others and it does not have to be of great magnitude. What matters is whether you will extend yourself to a stranger in need.

I hope you had a good Thanksgiving Day wherever you were yesterday whether it be with family, friends, or strangers. It is a day meant to be with others no matter where you were.

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Plastic: Part of the Problem . . . Part of the Solution – Part 4: Efficient Use of Recyclates

The problem of plastic waste seems insurmountable. The good news is plastic recycling is on the rise and that is good for the circular economy. In parts 1, 2 and 3, we delved into the role of the waste management and recycling industry and how material sorting technologies can help. Part 4 is all about the increased use of recyclates as an essential part of properly closing the plastic cycle.

The plastics industry is facing a great many challenges. Harvesting recyclates from waste is only worthwhile if the plastic has been properly sorted and does not contain any metal, and if the products made from the secondary raw material are similar in quality to those made from new plastic.

Manufacturing recyclates from plastic waste is the first step. But in order to fully close the plastic cycle, more recyclates need to be used in the manufacturing of new products. This is a lucrative business for plastics processors, as recyclates are cheaper than new materials.

With material costs in the plastics industry accounting for 40% to 80% of total expense, depending on the segment, using recycled materials can significantly increase profitability. In addition, the secondary raw material in its ultra-pure state has practically the same characteristics as new plastic.

Yet there are still a number reservations in the industry when it comes to recyclates. The quality of the input material is particularly important in this regard. Recyclates must be free from any contamination to protect processes and machines from damage and ensure that the final products meet high standards of quality.

Survey on the Use of Recyclates by Processers on the Leap

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Plastic: Part of the Problem . . . Part of the Solution – Part 3: Sorting Technology

As I mentioned, this 4 part presentation is being done by Sesotec GmbH, a company which manufactures recycling equipment. Even so the information given by Sesotec is to the point on the topic of pollution by man made packaging and products which can be sued again and again and in some cases up to 8 times. Fair warning as the pitch comes with regards to Sesotec’s abilities.

Around 70 years after the first plastic product hit the market, a world without plastic waste now seems like a distant vision. It’s time for a new perspective on this supposed waste. In the third instalment of our series, we focus on how we must all manage how we deal with plastics in future, and the role materials sorting technologies and contaminant detection systems play in recycling.

Each year, Europeans generate 25 million tonnes of plastic waste. At a global level, 78 million tonnes of plastic waste is created annually. The world has to respond to this global problem together, as recycling rates everywhere have been at a low level so far: 30% in Europe, 25% in China, and just 9% in the USA (Plastikmüll-Statistik 2017). A large portion of the supposed waste is still incinerated, or ends up in landfills and the environment, which harbors risks for our water, air, and food chain.

To achieve a Circular Economy, it’s important that all players contribute to this task: from product design and manufacture on the part of the plastics industry, along with conscious use and avoidance of plastics as well as waste separation on the part of consumers, followed by proper recycling and sorting by the waste and recycling sector, all the way up to conversion into high-quality secondary raw materials and their use in the manufacture of new products.

Past the leap, how a Circular Economy will work.

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Plastic: Part of the Problem . . . Part of the Solution – Part 2: the European Union’s Solution

As you can read for yourself, this is the second part  of the series. This part will introduce the EU’s proposed solution to plastic waste material of which Sesotec is to be a part of the solution. Since I am using Sesotec’s information, I will be stating their name as owner’s of this information from time to time.

Some 70 years after the first plastic products hit the market, a world without plastic waste still appears far off. We need a different approach to dealing with what many consider to be rubbish – and we need it fast. In this multi-part series, we will take a look at the role that the waste management and recycling industry can play in the process. Part I took us to China. Now it is time to take a look at Europe.

China is no longer taking on the world’s plastic waste, and our oceans could soon be home to more pieces of plastic than fish. The time to act is now.

There are many ways to reduce plastic waste. Banning their use is one of them. A great deal of plastic packaging is, in fact, unnecessary. Yet it also offers benefits in certain areas, such a hygiene and shelf life, making a complete ban rather unrealistic.

Another approach is to avoid plastic in many situations and to practise “plastic fasting”. Still, even that will not work everywhere, especially in the industrial sector. It is therefore essential to find an alternative solution – one that is also reflected in the EU’s plastics strategy: a circular economy.

The European Union presented its plastics strategy on 16 January 2018. Under the strategy, all plastic packaging must be either reusable or recyclable at low cost by 2030. One of the EU’s goals in its plastics strategy is to stop marine litter. The long-term goal must be to avoid marine plastic waste entirely. However, creating a circular economy and recognising the value of a material that is widely considered to be refuse will be essential to achieving this aim.

The overall EU strategy is based specifically on four basic tenets:

  • manufacturing recyclable products
  • optimising the separation and collection of plastic waste
  • increasing recycling capacities
  • reusing recyclates in production

Past the leap, the EU’s Commitment

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SECURE Act Up for Consideration in the Senate – A Rehash

I covered the House SECURE Act and the Senate RESA version last July. The House RESA Act is up for consideration in the Senate now. It does not look like it is going to make it due to the impeachment process going on and a potential trial in the Senate. There is also a small matter of a budget needing to be passed. It was to be considered under an unanimous consent vote; however, three Republican Senators (Mike Lee of Utah [unidentified reason], Ted Cruz of Texas (529 Accounts), and Pat Toomey of Pennsylvania [Gold Star tax exemption]) put holds on the bill (reasons in parenthesis). Then there is McConnell, who will not bring it to the floor for a vote.

Congress has been working on a much-needed improvement for “Middle Class” savings and growth over the span of employment in order  to boost retirement resource for citizens who can afford to save. Both the Senate and the House versions have been sitting since July. Whata surprise, heh?

Dueling bills to restructure IRAs and 401ks appear to be redundant; but, there are differences.  Better known as the “Setting Every Community Up for Retirement Act” (SECURE Act) H.R.1994 and the Senate has the “Retirement Enhancements and Savings Act” S.792 (RESA) version. Both bills were passed with bipartisan support. Both bills for the Middle Class had pluses and rather big negatives also. It appears the House RESA Act is going forward for a vote.

The RESA Act is mostly for the masses who may be able to save some money for retirement in spite of stagnant wages. No worries for the for the rich in income (unless something has changed since I last looked at this).  A major outcome of the Trump tax bill were tax breaks for the wealthy and corporations. Besides much of the resulting income increases going to 1% of the household taxpayers, the same 1% were given the ability to shelter large amounts of income in gifts to their heirs. It is a great time to be rich in income and have the ability to shelter it by making gifts of it to your heirs’ tax free! Keep in mind, seven or so years out and those income tax cuts will disappear for the middle income brackets. Somebody has to pay for the overall breaks otherwise their tax relief will sunset as they were passed under reconciliation in the Senate.

A little history (past the leap) on why Congress did something which will help those who can afford to save presently, penalize those bequeathed whatever is left over after death, and pay for the IRA and 401k break.

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Plastic: Part of the Problem . . . Part of the Solution – Part 1 (of 4): A Global Problem

Introduction: I am still on the mailing lists of quite a few resin and plastics companies. This particular presentation is from Sesotec GmbH (“company with limited liability”). Sesotec was an exhibitor at the K trade fair in Düsseldorf and now is reflecting on an exciting and positive trade fair appearance (for them) with its topic of a “Circular Plastics Economy.” This is part 1 of a 4 part presentation which I believe to be done in an exemplary manner and worthy of repeating.  Having cost modeled plastic parts at SY and Yazaki NA and purchased resins for Marquardt, Flex, and Stoneridge, I enjoyed the presentation.

This is why I thought this was worthy of presentation  at Angry Bear: “The K trade fair is held every three years and is an optimal opportunity to learn about current topics in the industry and to exchange information about these topics.

Marc Setzen, CEO of Sesotec GmbH: ‘We are more than satisfied with the results of the trade fair. With concern to the focal topic of the K trade fair, the Circular Economy not only is a technical challenge but also requires a change of the way people think. The attitude of plastics being throwaway products must be abandoned and people must become aware of the fact plastics being valuable reusable materials. Our machines and systems only are one component in the material cycle; but nevertheless, they make an essential contribution because they ensure the high quality of secondary raw materials made from recyclate and guarantee that the cycle really works.'”

This fits with what we must change to and be doing today.

Some 70 years after the first plastic products hit the market, the vision of a world without plastic waste still appears far off. Yet this substance – a plague once it becomes waste – is an extremely attractive material. What we need is a different approach to dealing with plastic waste. In this multi-part series, we will take a look at the role that the waste management and recycling industry can play in the process. Part 1 takes us to a variety of destinations, including China.

The production of plastic has increased dramatically around the world in recent decades and currently stands at 200 times the amount manufactured by factories back in 1950. Europe is responsible for one-quarter of the world’s plastic consumption, mainly due to packaging that lands in the rubbish bin after being used for only a short time. Plastic is also used in construction (20%), vehicles (8.6%) and electronics (5.7%).

After the leap, how China and the EU are increasing the pressure . . .

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Italy to make climate change study compulsory in schools

Reuters: Italy will become the first nation to require all schoolchildren to study climate change and sustainable development.

Education Minister Lorenzo Fioramonti of the anti-establishment 5-Star Movement: “The entire ministry is being changed to make sustainability and climate the center of the education model. All state schools would dedicate 33 hours per year or almost one hour per school week to climate change issues from the start of the next academic year in September 2020.

I want to make the Italian education system the first education system that puts the environment and society at the core of everything we learn in school.”

Fioramonti goes on; “The entire education ministry is being changed to make sustainability and climate the center of the education model.”

Minister Fioramonti is also behind the popular proposals for taxes on airline tickets, plastics, and sugary foods to help pay for education and are being attacked by critics complaining taxes are too high already.  His progressive positions on the economy and the environment are the antithesis of Matteo Salvini’s hard-right League, which has overtaken 5-Star to become Italy’s most popular party with more than 30% of voter support. Surveys showed 70-80% of Italians backed taxing sugar and airline tickets.

The government has gotten off to a shaky start  with weeks of bickering over the budget. Fioramonti said the new government “will only last if it is brave,” and stops letting Salvini set the news agenda.

Exclusive: Italy to make climate change study compulsory in schools Reuters, November 5, 2019

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Some Election Results

I am not quite sure how to begin other than say I am angry at why it has to come to this , and still not enough, before people react.

  • Loudoun County, Virginia: One election event ended positively for a woman who had given Trump’s motorcade (and supposedly Trump) a message of defiance, a one finger salute, as it passed her while she was riding her bike. Former government contractor Julie Briskman won a seat on the Loudoun County Board of Supervisors on Tuesday. Ms. Briskman defeated eight-year Republican incumbent, Suzanne Volpe and this is her first time in elected office.

 

  • Virginia House: Gaining 15 seats in the House in 2017; in 2019, Democrats added another five seats and perhaps a few more as other races are still to be decided. Democrats in Virginia  have not lost momentum in the third year of a Trump presidency. The ultimate size of the new Democratic majorities is still to be decided as a few close races were undecided. Republicans held a 51 to 48 edge going into 2019.

 

  • Virginia Senate: Ms. Ghazala Hashmi will be the first Muslim woman in the Senate, a state which was the former seat of the confederacy. Democrats have picked up at least two seats in the Senate shifting the balance from 20 to 19 favoring Republicans going into the 2019 election. Wondering if people would speak up against the assault on civil liberties, Ms. Ghazala Hashmi anxiety was relieved with her upset victory in a suburban Richmond district.

 

  • Kentucky Governorship:  Andy Beshear appears to have beaten incumbent Matt Bevin by ~5000 votes. Andy Beshear’s message in his victory “It’s a message that says our elections don’t have to be about right versus left, they are still about right versus wrong.” Other races in Kentucky went to Republicans with the Democrats losing the State AG office for the first time in 70 years with the election of an African American, Daniel Cameron.

Update: While a recanvas (less than 1% margin) will follow, the Republican dominated state legislature is poised to establish who is the winner of this election. Kentucky Republicans are going to try and steal election in favor of Bevin.

Stivers said he thought Bevin’s speech declining to concede to Beshear was “appropriate.” He said believes most of the votes that went to Libertarian John Hicks, who received about 2% of the total vote, would have gone to Bevin and made him the clear winner.

A candidate can file a formal election contest with the state legislature, but it must be filed within 30 days of the last action by the state board of elections. The state board is scheduled to certify the results of the race for governor on Nov. 25 this year.

Under this contest, the candidate challenging the results must specify the grounds for the action, such as a violation of campaign finance rules or specific problems when it comes to how ballots were cast.

Such an election contest is covered under Section 90 of the state constitution, which addresses a “contest of election for Governor or Lieutenant Governor.”

Section 90 states: “Contested elections for Governor and Lieutenant Governor shall be determined by both Houses of the General Assembly, according to such regulations as may be established by law.”

Sam Marcosson, a constitutional law professor at the University of Louisville Brandeis School of Law, told The Courier Journal that this language of the state Constitution suggests there must be procedure established by law for a review of a contested election to take place by the House and Senate.

Mr. Marcosson contends the legislature can not just make a procedure up.

“If the House and Senate were just to proceed on vague allegations without proof, that raises serious questions about disenfranchisement of the voters who voted for Attorney General Beshear. It’s an extraordinary proposition to suggest that the General Assembly would take vague allegations of unspecified irregularities and call into question a gubernatorial election.”

 

  • Arizona Tucson:  Democrat, Regina Romero appears to be victorious in the Tucson mayoral race and becomes the first woman and Latina to lead Tucson.

 

  • Mississippi: Republicans won the open Governor’s seat with former Lieutenant Governor Tate Reeves beating former Democrat AG Jim Reeves . In the Senate, Republicans have expanded their control to a super majority which they already had in the House. No surprise here.

 

  • New Jersey: Republicans appear to be to picking up two seats in the Assembly and one in the Senate due to a surge in the southern part of the state where Mr. Trump won easily in 2016.

If you have other election results from Tuesday, feel free to add them. Otherwise, we still have a long way to go to beat Trump and Republicans.

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