National News

PODCAST: Think of it as a conscious uncoupling

Marketplace - American Public Media - Tue, 2014-09-30 07:00

EBay decides it's time for PayPal to be pushed back out of the nest: There's news this morning that the auction company eBay will spin off its payment system, PayPal. Plus, tomorrow is the first of October, one year since the rollout of Healthcare.gov, and the texture of health care in America is changing. For instance, there's been disruption in the old pattern of health care providers sending bills and the insurance companies paying their portion. Now, some insurers are tying what they pay to how well the doctors, hospitals and labs are doing their jobs. And call it social and environmental investing, call it impact investing, applying our personal values to our portfolios is not a new idea. One big example in the 1980s was college students forcing their universities to sell their stakes in companies that did business with apartheid South Africa. But now some influential countries have come together to recommend that governments help impact investing become an even more powerful force for making the world a better place. 

Push for IUDs comes from many sides

Marketplace - American Public Media - Tue, 2014-09-30 02:30

Last year, drugmaker Bayer introduced the first new IUD in 13 years. And this week, the American Academy of Pediatrics (AAP) updated its guidelines to say long-acting reversible contraceptives, including IUDs, should be the first line of defense to prevent teen pregnancies.

It's been a long road for the IUD. It’s been some 40 years since the Dalkon Shield hit the market. The intrauterine contraceptive device was one of many IUDs at the time, but it is still remembered decades later as a spectacular disaster. 

Many women developed pelvic inflammatory disease from the device, which had not been vetted by the FDA. The Shield also had a high failure rate, leading to infections, miscarriages and death.  

The Dalkon Shield was pulled off the market, and a federally funded study in 1981 said IUDs were dangerous. 

Some two decades later, when Jenna Sauers, then in her late teens, went to her doctor asking for an IUD as an alternative form of contraception to taking pills with hormones, her doctor would not prescribe it. She tried a second doctor, and then a third who, she recalled, told her: “That’s only an option for women who have completed their families.” 

“The damage done was the perception that all IUDs are dangerous,” says Dr. Jill Schwartz, medical director at CONRAD, an organization that focuses on reproductive health research.

Sauers, who is now 28, finally succeeded after visiting yet another doctor. 

“I do think that everybody should have the choice. I think they can be a great option, especially for people who, for whatever reason, don’t like taking hormonal birth control,” Sauers says. 

Sauers is confident that her IUD poses little risk, because in the last few decades more research has shown that it was the faulty design of the Shield, not IUDs themselves, that was dangerous. Still, it has taken some time to undo the damage done by the Dalkon Shield. In the 1990s, new research came out that called into question the 1981 study condemning all IUDs. In 2012, the New England Journal of Medicine published a study saying IUDs are 20 times more effective than birth-control pills, the patch or the vaginal ring. 

“In the intervening 40 years, there’s been increasing scrutiny and increasing requirements by the FDA and other organizations,” says Dr. Mary Ott, one of the co-authors of the new AAP guidelines for teenage girls. “All the modern devices have at least a decade of safety and effectiveness data in the United States, and 20 years or more internationally.” 

Ott says IUDs are now so safe that teenage girls face more health dangers from complications from pregnancy than they do from the IUDs themselves. 

“It’s been not only drug companies, it’s academics, it’s the whole community” that’s been behind the effort to make IUDs more available, says Schwartz. 

World health groups and nonprofits have also been a part of that effort, with Planned Parenthood launching a nationwide educational campaign last year. 

When you die, who gets your digital assets?

Marketplace - American Public Media - Tue, 2014-09-30 02:00

John Ajemian was riding his bike on a perfect sunny day in the Boston suburbs in 2006 when he was struck and killed by a car. He was 43.

“After his death, we wanted to plan a memorial service,” says Marianne Ajemian, John’s sister and one of the executors of his estate. “And he kept all his correspondence and records on his email account.”

In addition to his contacts, Marianne wanted the financial records and correspondence it might hold. But the provider refused to give the family access to the account, so she’s suing them. The case is ongoing.

“If you have a diary, if you have letters, your personal representatives are entitled to see that,” she argues.

As people store increasing amounts of information online in email, social media and cloud storage accounts, what happens to those digital accounts has become a more pressing issue. A recent study by MacAfee found that the average person has $35,000 in digital assets stored online or on their devices. 

This summer, the Uniform Law Commission, a group that writes laws for states, drafted legislation that would give executors or other personal representatives access to digital accounts when someone dies. Delaware became the first state to pass a version of it last month, joining only a handful of states that already have more limited laws.

“Essentially, what we’re trying to do is allow the fiduciary to have access, unless the account holder didn’t want a fiduciary to have access,” says Suzanne Walsh, an estate lawyer who helped draft the ULC’s proposed legislation.

“In the old days when I began practicing law, we worked with file cabinets and paper documents,” she explains. “Yesterday’s filing cabinet is now a laptop or a computer or even a phone. Because of that, the nature of our work has changed when we’re administering an estate or assisting an incapable person.”

Balancing access and privacy can be complicated, though.

“There are sometimes third parties who have communicated with the deceased person who expect those communications to remain private,” says Jim Halpert, the general counsel of the State Privacy and Security Coalition, which represents Facebook, Google, Yahoo and others on issues like this. “[They] don’t expect somebody that they don’t know, and in some cases a person the deceased didn’t even know, to be going through the communications.”

People may not want their family reading their emails, he says, though the law commission’s version provides the option to opt out of access.

Moreover, many service providers worry that state laws granting access are in conflict with existing federal laws.

Currently, companies have varying policies about what happens when an account holder dies. For example, Yahoo says in its terms of service that accounts can’t transfer after death, but a spokesperson says the company will give access if the deceased lays out their explicit permissions in their will. Google lets people chose whether their info should be shared or deleted if they die. Facebook gives family members the option to close the account or "memorialize" it, which preserves the photos and posts already visible on the account, but doesn't give access to private messages. 

Halpert says another solution would be to give access to logs that list senders and receivers, but not the contents of emails.

For Marianne Ajemian, that’s not enough.

“John was a writer,” she says. “And so whatever was in that email account could have been very important to us.”

Until she gets into the account, she says she doesn’t know what she might be missing — and how much sentimental or financial value it could hold.

How insurers are adjusting payment to medical providers

Marketplace - American Public Media - Tue, 2014-09-30 02:00

Commercial insurers are ditching or at least tweaking the way they pay medical providers, according to a report out Tuesday from the group Catalyst for Payment Reform.

For years, commercial insurers as well as state and federal governments have paid doctors and hospitals under what’s called fee-for-service. To many in the health care world, fee-for-service is seen as one of the key drivers behind the run-up in health care costs, because it offers a financial incentive to provide extra services that may not be needed.

“I believe fee-for-service generates a lot of waste, and overuse of health care services can be not just wasteful, but harmful,” says Harvard Health Economics professor Meredith Rosenthal.

Rosenthal says, based on her research, alternatives to fee-for-service can reduce the volume of services by as much as 20 percent. Rosenthal is quick to add that there’s no great evidence yet on the effectiveness of any of the alternatives.

“How to design a payment system to obtain the best value for money and value in health care is a very complicated question. And that’s where we are really learning,” she says.

So what options are out there?

Here’s a list of four payment methods starting with the most traditional, presented with the caveat that these brief descriptions are intended for those of us who aren’t health care wonks.

Fee-for-Service: A payment model in which providers get paid for specific tests, services or procedures.

It's the granddaddy of payment models and a scourge for many health reformers.

Pay for Performance: A payment model in which on top of the usual fees providers are paid, they can earn extra money for meeting certain health care quality goals or other performance targets, like increased efficiency.

In its report, Catalyst for Payment Reform says this is by far the most popular reform this year. You can think of it as health care reform with training wheels.

Shared Risk: A payment method in which providers accept some financial liability if they spend over a targeted budget. If they go under budget, providers keep a portion of the savings.

A classic intermediate step that carries risk and reward; sort of reform with a safety net. It's not very common.

Full Capitation/Global Payment: A fixed payment to providers for care they give over a set time period, like one month or a year, no matter how much care the patient utilizes.

This is the most aggressive payment method, where providers keep all the savings and eat all costs that go above the fixed payment. Some see this as medical providers taking on the role of insurer.

Playing matchmaker in Silicon Valley

Marketplace - American Public Media - Mon, 2014-09-29 15:49

One in three couples who married recently met the web. There's sites for every conceivable niche and online dating is a billion-dollar industry. But what about the people who are out there building websites, tech companies and apps?

Sometimes the singles of Silicon Valley need individual help to try and meet "the One," and they're willing to pay top dollar for it.

For the full story, click the audio player above.

U.S. Charges Pakistani Man Of Conspiracy Over His Spyware App

NPR News - Mon, 2014-09-29 15:42

The Justice Department called this the "first-ever criminal case concerning the advertisement and sale of a mobile device spyware app."

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Washington Post: White House Intruder Made It To Doorway Of Green Room

NPR News - Mon, 2014-09-29 13:40

The Secret Service had originally said Omar Gonzalez was apprehended shortly after he burst through the front door after jumping a fence.

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Spanish Court Blocks Catalonia's Independence Vote

NPR News - Mon, 2014-09-29 13:17

Spain's central government in Madrid had appealed to the court to stop the vote, which had been approved with strong support from Catalonia's parliament and local governments.

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At U.N., Iceland Announces Men-Only Conference On Gender Equality

NPR News - Mon, 2014-09-29 12:33

During a speech in front of the General Assembly Gunnar Bragi said the conference would focus on violence against women and would be "unique" because only men and boys are invited.

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Who Will Win The 2014 World Series?

NPR News - Mon, 2014-09-29 12:26

If the oddsmakers are right, two Los Angeles teams will be the only ones left standing when the World Series begins in late October. But back east, some fans are pulling for a Beltway Series.

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Silicon: Imagine life without glass

Marketplace - American Public Media - Mon, 2014-09-29 11:49

For the next installment in the BBC’s Justin Rowlatt's microscopic look at the economy: the silicon revolution.

Not only is silicon one of the major components in computer chips, but it’s also found in your windows, mirrors and wine glasses.

"Silicon is the basis of glass," Rowlatt says. "We think of the silicon revolution being computers. But actually one of the very early technological revolutions was glass."

Listen to the full conversation in the audio player above.

 

A Doctor Turned Mayor Solves A Murder Mystery In Colombia

NPR News - Mon, 2014-09-29 11:46

When Rodrigo Guerrero took office, he was shocked by the murder rate. It seemed logical to blame the drug cartels. But his epidemiologist's eye led him to a different culprit.

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4 Years Of Lessons Learned About Drugmakers' Payments To Doctors

NPR News - Mon, 2014-09-29 11:36

American doctors received at least $1.4 billion in payments from drug companies last year. What did the companies get for their money?

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Sandwich Monday: The Pizza Cake

NPR News - Mon, 2014-09-29 11:05

For this week's Sandwich Monday, we try the Pizza Cake, which is a fancy way of saying "a bunch of pizzas stacked on top of each other."

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After Fire, FAA Orders Review Of Contingency Plans, Security

NPR News - Mon, 2014-09-29 10:28

On Friday, a contractor intentionally set fire to an FAA air traffic facility that has caused flight delays and cancellations for days.

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More Active Play Equals Better Thinking Skills For Kids

NPR News - Mon, 2014-09-29 10:12

How long can you sit still in a desk? How about your 7-year-old? Maybe you could both use a break. A study shows that kids who get to run around and play after school are better at paying attention.

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This is a generic brand video

Marketplace - American Public Media - Mon, 2014-09-29 10:10

It's the ad that comes before the YouTube video you're trying to watch: a hopeful message from a company trying to sell you on its brand and outlook, usually with no shortage of inspirational imagery and plenty of metaphors.

Kendra Eash captured the language and tone brands use in a piece for McSweeneys.

Listen to the story in the player above with an active imagination (or watch the video) to see what she's talking about.

'Breaking Bad' and Albuquerque: One year later

Marketplace - American Public Media - Mon, 2014-09-29 10:06

AMC's critically acclaimed series "Breaking Bad," created by Vince Gilligan, ran its very last episode one year ago. The show takes place in Albuquerque, New Mexico, and although production has stopped, the town continues to experience an economic boom. Even tourism rates grew exponentially.

In 2013, New Mexico Gov. Susana Martinez signed what was called the "Breaking Bad bill" into law, a film incentive that increases subsidies for television crews from 25 percent to 30 percent in some areas of expenditure. The law increases New Mexico's rebate for series television production to 30 percent of a producer's total qualified spend in the state.

"We actually see people that will come here specifically to go and see the sites," says Albuquerque mayor Richard Berry. "I have been as far as Beijing where people have asked me about 'Breaking Bad,' so, yeah, it surely has put us on the map internationally."

Another positive outcome was the number of jobs the show produced. Actors and television producers weren’t the only ones to benefit job-wise from filming, Berry says.

"It’s electricians, the lumber yard selling lumber, and it is craft, and it is the local places that rent their businesses out to film," says Berry. "It really hits our economy from top to bottom."

"Breaking Bad" has a spinoff show called "Better Call Saul," also created by Gilligan, and also set in Albuquerque. It is scheduled to premiere in February 2015.

The show has already been picked up for a second season.

 "When 'Breaking Bad' filmed here, almost $70 million came into our economy," says Berry. "We think that 'Better Call Saul' is going to be another great opportunity for us."

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