Marketplace - American Public Media

How Obamacare will change the emergency room

Thu, 2014-01-02 12:32

A new report looking at the Oregon Medicaid program compares emergency room use between the uninsured and people with Medicaid – the healthcare program for primarily low income and disabled people.

And the report already has pundits worked up, especially with 9 million Americans projected to newly sign up for Medicaid this year under the Affordable Care Act.

The reason this is so hot – at least politically - is because the report over turns conventional healthcare thinking. Harvard health economist Amitabh Chandra describes the theory.

“If we insure the uninsured, they are not going to use the emergency room and they are going to use less healthcare. So in the long run, insuring the uninsured saves us money,” says Chandra.

Affordable Care Act advocates have used this argument to say insurance should be expanded.

There’s just one thing: that’s not what happens.

“Its basic economics that I would teach my students,” says MIT economist Amy Finkelstein – one of the report’s authors.

“When you lower the price of something, people buy more of it," says Finkelstein. "That’s true of apples and bananas and it turns out it’s true of healthcare too.”

Finkelstein explains in Oregon the emergency room is free if you are enrolled in Medicaid. What she and her team found is that people on Medicaid use the emergency room 40 percent more than people without insurance. But it’s not just emergency room use that’s up.

Co-author Katherine Baicker says its primary care, preventative care, prescription drugs.

“That doesn’t mean that it’s inefficient, good or bad. It just means that insurance makes healthcare more affordable," Baicker says. "And that has both financial consequences and health consequences."

Based on this report, there are already estimates that increased ER use will cost taxpayers half a billion dollars a year. This is the very definition of a political football, which is why details in this report matter.

First, nearly 60 percent of all the people on Medicaid in the study didn’t go to the emergency room at all over 18 months.

Second, when people with private insurance were given more generous private health coverage they healthcare use went up, too. And perhaps most important, Harvard’s Amitabh Chandra says when it comes to money, this isn’t where the action is.

“The spending is not in the emergency room. The spending is on high cost patients. These are cancer patients. Many of them in the end of life,” he says.

The Oregon report found emergency room use accounted for between 10 and 15 percent of patient costs.

Chandra says it would be easy to use this report and argue that the Affordable Care Act is too costly.

He says the big question – the tough question – is how to limit the care everyone agrees is inefficient and expensive, regardless of who gets it or where that care is received.

Holocracy: How Zappos could change corporate America

Thu, 2014-01-02 12:27

First it was open office space, and now its open management.

The tech world continues to turn traditional office structure on its head with a radical operational system of self-governing with no job titles and no managers. It's called holocracy and the term derives from the greek word 'holon,' which means a whole that's part of a greater whole.

Nancy Koehn, historian at Harvard Business School, relates the organizational structure to an early tech startup.

"[They] work like little villages, everyone pitches in, everyone is responsible for solving the next problem or putting out the next bonfire," Koehn says. "There's very little attention and very little formal structure around things like job titles, the purview of one's responsibility, or how one's measuring up."

Holocracy is not a new concept in the tech world. Twitter co-founder Evan Williams uses the system to run his 50-employee publishing platform Medium. But this doesn't end the role of bosses entirely, especially when it comes to pay.

According to Koehn, CEO's are going to have to "give up some of the gold and some of the scepter."

Pope Francis drew 6.6 million to Vatican in 2013

Thu, 2014-01-02 11:47


Lizzie O'Leary at Palm Sunday Mass, 2013.

Our final note on the show today is about a CEO, of sorts, who had a banner year revitalizing a brand and essentially tripling business.

Pope Francis isn't always thought of as an executive, but these numbers are pretty startling. Pope Francis drew more than 6.6 million people to his masses, audiences and events in Vatican City from March 2013 until the end of the year. That contrasts with 2.3 million for Pope Benedict in all of 2012.

I was there for Francis's Palm Sunday Mass. Crowds farther than I could see.

New Year's resolution: Don't get hacked

Thu, 2014-01-02 08:07

For some tech companies, hopes to not get hacked in 2014 have already been dashed.

Self-destructing messaging app Snapchat is on the defensive this week. 4.6 million user names -- and their associated phone numbers -- were leaked in a security breach. And Microsoft calling service Skype has become the latest victim of the hacking unit calling itself the Syrian Electronic Army. That's after the S.E.A. apparently hacked into Skype's Twitter and Facebook accounts and started broadcasting messages telling people not to use Microsoft because the company sells data to governments. The BBC's Dave Lee joins us to help explain.

Click the audio player above to hear more.

After rescue, a question: Who owns Antarctica?

Thu, 2014-01-02 07:33

Down in Antarctica, those researchers trapped in the ice are finally on their way home.

The rescue operation was an international one. A Chinese helicopter shuttled stranded researchers from the Russian ship to an Australian icebreaker.

International cooperation is sort of the theme in Antarctica; a place for science, not business. But considering its untapped natural resources, can Antarctica remain unpolluted by economic interests?

For a long time, there’s been speculation about the natural resources buried under Antarctica. It remains only speculation for a good reason.

“At the South Pole, the ice is over 9,000 feet thick. So even getting down to terra firma to find out whether or not there were minerals or resources there would be very difficult,” says Frank Klotz, a senior fellow at the Council on Foreign Relations.

Klotz says the U.S. should keep a presence in Antarctica in order to maintain influence over how the continent is governed.

Under an international treaty, Antarctica is kept as an icy lab for scientists.

Ohio State University geologist Berry Lyons is headed to Antarctica next week.

“The international cooperation is probably unique. And a really good model for international cooperation,” says Lyons.

But that international model cuts both ways. For example, the governing body in Antarctica works on consensus.

“Their version of consensus is that everyone unanimously has to agree to a proposal in order for it to move forward,” says Andrea Kavanagh, director of The Pew Charitable Trusts’ Southern Ocean sanctuaries project.

She’s been working to extend protections for the marine life around Antarctica because fishing boats are finding their local waters are all fished-out.

“And that’s why Antarctica has become a great, new, lucrative fishing ground,” says Kavanagh.

The big prize in those waters is Chilean sea bass. Because of its high price per pound, fishermen call it ‘white gold.’

Instead of cooperation, there’s international competition to net the Antarctic fish.

Who owns Antarctica?

Thu, 2014-01-02 07:33

Down in Antarctica, those researchers trapped in the ice are finally on their way home.

The rescue operation was an international one. A Chinese helicopter shuttled stranded researchers from the Russian ship to an Australian icebreaker.

International cooperation is sort of the theme in Antarctica; a place for science, not business. But considering its untapped natural resources, can Antarctica remain unpolluted by economic interests?

For a long time, there’s been speculation about the natural resources buried under Antarctica. It remains only speculation for a good reason.

“At the South Pole, the ice is over 9,000 feet thick. So even getting down to terra firma to find out whether or not there were minerals or resources there would be very difficult,” says Frank Klotz, a senior fellow at the Council on Foreign Relations.

Klotz says the U.S. should keep a presence in Antarctica in order to maintain influence over how the continent is governed.

Under an international treaty, Antarctica is kept as an icy lab for scientists.

Ohio State University geologist Berry Lyons is headed to Antarctica next week.

“The international cooperation is probably unique. And a really good model for international cooperation,” says Lyons.

But that international model cuts both ways. For example, the governing body in Antarctica works on consensus.

“Their version of consensus is that everyone unanimously has to agree to a proposal in order for it to move forward,” says Andrea Kavanagh, director of The Pew Charitable Trusts’ Southern Ocean sanctuaries project.

She’s been working to extend protections for the marine life around Antarctica because fishing boats are finding their local waters are all fished-out.

“And that’s why Antarctica has become a great, new, lucrative fishing ground,” says Kavanagh.

The big prize in those waters is Chilean sea bass. Because of its high price per pound, fishermen call it ‘white gold.’

Instead of cooperation, there’s international competition to net the Antarctic fish.

PODCAST: Fiat buys the rest of Chrysler

Thu, 2014-01-02 06:39

The FT100 in London is down about a tenth percent on this first day of trading in 2014. Dow, S&P and Nasdaq futures are all down. The number of people signing up for unemployment benefits dipped slightly in the last week, a hint that the job market is holding steady.

The Italian carmaker Fiat has reached a deal to buy the rest of American automaker Chrysler, something it has wanted to do for years. Fiat hopes the deal will make it easier for them to compete with companies like Toyota and Volkswagen. Perhaps more importantly, Fiat desperately needs some of Chrysler’s cash.

And, foreclosures are way down from the worst of the housing crisis. But as we start this new year, don’t be surprised if some places see a rise in foreclosure sales. That’s because foreclosures that have been slowly working their way through judicial pipelines are now coming to market. That may prove a rude awakening in some areas.

Fiat hopes Chrysler deal will help it compete with VW, Toyota

Thu, 2014-01-02 06:07

The Italian carmaker Fiat has reached a deal to buy the rest of American automaker Chrysler, something it has wanted to do for years.

“The main reason is it will allow them to fully integrate as one company,” says Michelle Krebs, senior analyst with Edmunds.com.

Fiat hopes the deal will make it easier for them to compete with companies like Toyota and Volkswagen. Perhaps more importantly, Fiat desperately needs some of Chrysler’s cash.

According to analyst Dave Sullivan, with AutoPacific, Europe’s anemic economy hasn’t been good for auto sales.

“Chrysler is really helping to keep Fiat afloat during these difficult times,” he says.

Fiat’s relationship with Chrysler goes back to 2009, when Chrysler was in bankruptcy.

“I mean, you could say that Fiat was basically gifted a stake in Chrysler,” Sullivan says.

The rest of the company went to the UAW Retiree Medical Benefits Trust, which had considered an IPO to sell its shares.

With this agreement, that won’t happen. The UAW will sell its ownership stake in a deal valued at more than $4 billion.

Fiat reaches deal to buy rest of Chrysler

Thu, 2014-01-02 06:07

The Italian carmaker Fiat has reached a deal to buy the rest of American automaker Chrysler, something it has wanted to do for years.

“The main reason is it will allow them to fully integrate as one company,” says Michelle Krebs, senior analyst with Edmunds.com.

Fiat hopes the deal will make it easier for them to compete with companies like Toyota and Volkswagen. Perhaps more importantly, Fiat desperately needs some of Chrysler’s cash.

According to analyst Dave Sullivan, with AutoPacific, Europe’s anemic economy hasn’t been good for auto sales.

“Chrysler is really helping to keep Fiat afloat during these difficult times,” he says.

Fiat’s relationship with Chrysler goes back to 2009, when Chrysler was in bankruptcy.

“I mean, you could say that Fiat was basically gifted a stake in Chrysler,” Sullivan says.

The rest of the company went to the UAW Retiree Medical Benefits Trust, which had considered an IPO to sell its shares.

With this agreement, that won’t happen. The UAW will sell its ownership stake in a deal valued at more than $4 billion.

Challenging new GED exams go all digital

Thu, 2014-01-02 05:35

Starting today, people who take the high school equivalency exam will face a test that's supposedly tougher and will only be offered via computer, no more paper and number two pencil. The test was created in 1942 at first to help military veterans get higher education without forcing them to return to high school after the experience of war. Emily Hanford, Education Correspondent for our documentary unit, American Radio Works, joins us to help explain.

Stocks in 2013: All sugar rush, no substance?

Thu, 2014-01-02 04:58

The S&P 500 went up 29 percent in the year gone by. The Nasdaq Composite rose nearly 40 percent. But this has prompted an argument that stock prices in 2013 were like cotton candy, lots of size, but not a lot of substance. Marketplace's Economics guy Chris Farrell has been considering this.

The argument comes down to the idea that the gains of 2013 reflected more of the Fed's quantitative easing rather than any real economic improvement, and that prices are bound to come tumbling back down sooner or later. But does the claim that the stock markets' gains have no substance, hold up?

Click the audio player above to hear more.

TV news paywalls are coming

Thu, 2014-01-02 04:01

Never paid for local TV news?  Well, that may be changing.  Cincinnati’s  WCPO-TV is going to offer local investigative stories behind a paywall.  It’s added 30 digital staffers.

“What they’re saying is, don’t think of us as TV, think of us as your best local digital news source,” says Ken Doctor, a media consultant.

The way WCPO-TV sees it, it’s go digital and dominate -- or die.  Adam Symson, who is chief digital officer for the station's owner, E.W. Scripps, says Cincinnati’s many TV and radio stations won’t all survive.  Symson is hoping a beefed up web presence will ensure market dominance.

“This is not just an investment in growing a digital audience,” he says. “This is an investment in the brand, WCPO, the television ratings and the digital audience.”

The question is, will people pay for something they’re used to getting for free? Other TV stations are watching WCPO’s web experiment closely, to find out.  

Apps to help keep your New Year's resolutions

Thu, 2014-01-02 03:35

Today is the second day of the new year and if you haven't started with major life changes you are already a day behind schedule. You might be hoping to get some help from apps. Whitson Gordon, editor in chief of Lifehacker, joins us to offer some advice.

Click play on the audio player above to hear more.

Tech predictions for 2014: Software and startups

Thu, 2014-01-02 03:08

All this week we've been talking to people about their predictions for tech in 2014. Today we hear from Dave McClure, founding partner at the Venture Capitol firm 500 Startups. McClure traveled all over the world last year. We asked him what kind of software everyone everyone will be using this year. He says expect more growth in messaging apps around the world. Also, don't be surprised if online and mobile video sees a big boost in parts of the world where television is restricted.

Click the audio player above to hear more.

The tech of New York's new taxi cabs

Thu, 2014-01-02 02:31

New York gets a new mayor this week -- Michael Bloomberg is being replaced by Bill De Blasio. And one of the things the new mayor will be looking at is the taxi of tomorrow:  A fleet of green Nissan vehicles that launched this fall, fitted with some custom technology absent in the usual yellow cab. Former mayor Bloomberg pushed hard for the new cars, but their future is uncertain. Nonetheless we hopped into one recently for a ride from Manhattan to the boro of Brooklyn, accompanied by Ted Mann, who covers transportation for the Wall Street Journal's greater New York section, to help detail some of the new cab's features.

Foreclosures are down, but some places may see a surge

Thu, 2014-01-02 02:12

Foreclosures are way down from the worst of the housing crisis. But as we start this new year, don’t be surprised if some places see a rise in foreclosure sales. That’s because foreclosures that have been slowly working their way through judicial pipelines are now coming to market. That may prove a rude awakening in some areas.

In almost half of states, foreclosures have to go through court. The idea is to do everything possible to protect homeowners, but these judicial foreclosures can take a long time, sometimes take years.

Tom O’Grady is CEO of Pro Teck Valuation Services, which analyzes housing data. He says foreclosure is quicker in non-judicial states.

“It’s kindof like ripping the bandaid off, instead of pulling off slowly,” O’Grady says.

He’s found that non-judicial states have bounced back from the low point of their housing crises faster than judicial states.

Non-judicial states worked through their foreclosure pain – and inventories -- up front, says Dave Stevens. He’s head of the Mortgage Bankers Association.

“The home values were depressed much quicker, much faster, but now they’re in significant recovery,” says Stevens, who points to the double digit appreciation in places like Phoenix, Arizona.

“That’s gonna be very different in states like New York, New Jersey, and Florida where they have now the backlogs that are just hitting the market,” he says.

Foreclosures tend to sell for about 30% less than non-distressed sales, Stevens says. When there are lots of foreclosures in the market, they pull down the value of the homes around them. That means some communities won’t get to share in the housing recovery just yet.

"A communist party casino" - Despite the lift of IPO ban in China, investors remain unhappy

Wed, 2014-01-01 23:44

It’s the first trading of the New Year at Shenyin Wanguo stock brokerage house in Shanghai. A gray haired man everyone calls ‘Old Chen’ watches stock prices along the floor-to-ceiling trading board. On the Shanghai stock exchange, red numbers -a symbol of communism- are good. Green numbers mean share prices are falling. "Look at the board!" screams Chen. "It’s the first day of the year and it’s all green! This is a casino - A communist party casino! We can’t possibly win against them. I gotta stop coming here," he mutters, still staring at the board.

This is not the response from investors China’s government was hoping for when they reopened the market to new listings. Securities analyst Qian Qimin says China will have to do a lot more to restore investor confidence. "The rate of return investing in stocks in China is lower than the bank deposit rate," says Qian. "Insider trading also continues to be a big problem."

Back on the trading floor, trader Jin Demin says investing in stocks in China is hopeless in a country where the markets are controlled by the state. Jin says when US stocks go up, China’s drop. When US stocks drop, China’s drop further.

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