The IAEA withheld a report on Iran’s weaponization activities last year, Senate Republicans failed again to get a vote on new sanctions, Iran talked with Iraq and North Korea, and more in this edition of weekly news from the Iran portfolio for February 22-28, 2014.
Elizabeth Sherwood-Randall is the White House Coordinator for Defense Policy, Countering Weapons of Mass Destruction and Arms Control, National Security Staff. Among her many responsibilities, she serves as President Obama’s principal advisor on weapons of mass destruction (WMD) proliferation and WMD terrorism. We recently had the opportunity to interview her about the Obama administration’s work on nuclear security.Read more about Five Questions with the White House WMD Advisor
William Tobey wrote a post for the Shadow Government blog at Foreign Policy detailing his concern that the Obama administration's slow progress in dealing with Bashar al-Assad and his chemical weapons stockpile sets the stage for failure in nuclear negotiations with Iran. For Tehran, Tobey said, the lesson of America's efforts in Syria is obvious:
Reach an interim agreement that deflates international pressure for action, drag your feet on implementation, and keep your illicit weapons program as the world dithers.
HarvardX's Faculty Director, Rob Lue, is kicking off Nite Owl Jam sessions, to be held bimonthly. The purpose of these evening meet-ups is to allow Rob and the course teams to have some quality time to dive into deeper discussion on course direction and vision. Read more about HarvardX Nite Owl Jams
As the P5+1 and Iran approved an agenda for future talks, Iran’s supreme leader and others tempered expectations back home, and more, in this edition of weekly news from the Iran portfolio for February 15-21, 2014.
MOOCs have gone from a distant idea to a global phenomenon in less than five years. During this period MOOCs have innovated at a dazzling speed in content creation, delivery, feedback, testing and other aspects of the knowledge delivery process. The excitement of MOOCs has been the promise of "learning at scale". As a result, the primary focus of the design of MOOCs to date has been on "scale". We believe it is now time to focus our attention on the design for "learning". Read more about Learning with MOOCs: A Practitioner's Workshop
Gary Samore sat down with Jeffrey Goldberg of Bloomberg View to discuss prospects for a final nuclear agreement with Iran. Samore was not optimistic, saying:
I don’t think the Iranians feel compelled to make these kinds of concessions [that the U.S. is demanding]... This won’t work in terms of finding a comprehensive solution. These negotiations can lead to an interim solution, so that’s what is happening now... But this is a truce. It’s a classic truce.
There is a common perception today that cost sharing for healthcare services—meaning deductibles, coinsurance, and copayments—has increased. According to the Kaiser/HRET surveys, high-deductible insurance has become more prevalent, covering 4% of insured workers in 2006, 19% in 2012, and 20% in 2013. However, the proportion of personal healthcare spending paid for out-of-pocket has barely budged—National Health Accounts data show it only increased from 13% of spending in 2006 to 14% in 2012. (Data for 2013 are not yet available.)
Of course, healthcare spending over this period went up faster than household income. So even a constant percentage paid for out-of-pocket translates into a higher share of household income going to healthcare and more risk placed on the household. Furthermore, the National Health Accounts data do not count the consumer’s share of health insurance premiums as out-of-pocket spending. The perception of an increased burden, therefore, may be fed by the fact that employers are shifting more of the premium cost, especially for family coverage, to employees.
But the amount of cost sharing is not my only concern. The issue of how cost sharing, no matter the level, should be structured is also important. Traditional cost sharing was either a deductible followed by a coinsurance rate or a copayment for each use of services. The deductible and coinsurance did not vary irrespective of which physician a patient saw or what services that physician undertook. Part B of Medicare exemplifies this cost-sharing structure. Cost sharing in private health insurance evolved such that patients paid more to see an out-of-network physician. Until recently, however, networks tended to be broad, so staying in network was not difficult.
One move away from these types of traditional cost sharing is value-based insurance design (VBID), as advocated by Mark Fendrick and Michael Chernew. Their basic idea is to lower copayments for more efficacious services, for example drugs for certain chronic conditions such as diabetes, and raise them for less effective services. Although attractive in theory, VBID so far has had limited impact for several reasons.
First, and perhaps most important, many medical services may have high benefit for one patient and minimal or no benefit for another. In this case, VBID cost sharing for the service must be further classified according to patient characteristics. Frequently, the evidence for such a classification is thin.
Second, the limited evidence to date suggests that lowering cost sharing for efficacious services can improve outcomes, but neither saves nor costs money. Improving outcomes for the same amount of spending is, of course, a good thing, but some of the hopes for VBID were that it would save money or at least reduce the rate of growth in spending. Related to this point, many if not most VBID efforts thus far have lowered cost sharing for medically effective services; far fewer have raised cost sharing for services of doubtful efficacy, which would lower costs. An important exception has been the successful effort to increase the proportion of prescribed drugs that are generic.