COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes During 2020

Link: https://oig.hhs.gov/oei/reports/OEI-02-20-00490.pdf

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The overall mortality rate in nursing homes rose 32 percent in 2020. The pandemic had far-reaching implications for all nursing home beneficiaries, beyond those who had or likely had COVID-19. Among all Medicare beneficiaries in nursing homes, 22.5 percent died in 2020, which is an increase of one-third from 2019 when 17.0 percent of Medicare beneficiaries in nursing homes died. This 32-percent increase amounts to 169,291 more deaths in 2020 than if the mortality rate had remained the same as in 2019. Each month of 2020 had a higher mortality rate than the corresponding month a year earlier.

Almost 1,000 more beneficiaries died per day in April 2020 than in the previous year. In April 2020 alone, a total of 81,484 Medicare beneficiaries in nursing homes died. This is almost 30,000 more deaths—an average of about 1,000 per day—compared to the previous year. This increase in number occurred even though the nursing home population was smaller in April 2020. Overall, Medicare beneficiaries in nursing homes were almost twice as likely to die in April 2020 than in April 2019. In April 2020, 6.3 percent of all Medicare beneficiaries in nursing homes died, whereas 3.5 percent died in April 2019.

The mortality rates also rose at the end of 2020. In November, 5.1 percent of all Medicare beneficiaries in nursing homes died, and in December that increased to 6.2 percent. Again, these rates are markedly higher than the previous year. In November 2019, 3.6 percent of all Medicare beneficiaries in nursing homes died, and, in December 2019, 3.8 percent did.

Author(s): Jenell Clarke-Whyte and team

Publication Date: June 2021

Publication Site: Office of Inspector General, HHS

How (not) to deal with missing data: An economist’s take on a controversial study

Link: https://retractionwatch.com/2024/02/21/how-not-to-deal-with-missing-data-an-economists-take-on-a-controversial-study/

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I was reminded of this student’s clever ploy when Frederik Joelving, a journalist with Retraction Watch, recently contacted me about a published paper written by two prominent economists, Almas Heshmati and Mike Tsionas, on green innovations in 27 countries during the years 1990 through 2018. Joelving had been contacted by a PhD student who had been working with the same data used by Heshmati and Tsionas. The student knew the data in the article had large gaps and was “dumbstruck” by the paper’s assertion these data came from a “balanced panel.” Panel data are cross-sectional data for, say, individuals, businesses, or countries at different points in time. A “balanced panel” has complete cross-section data at every point in time; an unbalanced panel has missing observations. This student knew firsthand there were lots of missing observations in these data.

The student contacted Heshmati and eventually obtained spreadsheets of the data he had used in the paper. Heshmati acknowledged that, although he and his coauthor had not mentioned this fact in the paper, the data had gaps. He revealed in an email that these gaps had been filled by using Excel’s autofill function: “We used (forward and) backward trend imputations to replace the few missing unit values….using 2, 3, or 4 observed units before or after the missing units.”  

That statement is striking for two reasons. First, far from being a “few” missing values, nearly 2,000 observations for the 19 variables that appear in their paper are missing (13% of the data set). Second, the flexibility of using two, three, or four adjacent values is concerning. Joelving played around with Excel’s autofill function and found that changing the number of adjacent units had a large effect on the estimates of missing values.

Joelving also found that Excel’s autofill function sometimes generated negative values, which were, in theory, impossible for some data. For example, Korea is missing R&Dinv (green R&D investments) data for 1990-1998. Heshmati and Tsionas used Excel’s autofill with three years of data (1999, 2000, and 2001) to create data for the nine missing years. The imputed values for 1990-1996 were negative, so the authors set these equal to the positive 1997 value.

Author(s): Gary Smith

Publication Date: 21 Feb 2024

Publication Site: Retraction Watch

Exclusive: Elsevier to retract paper by economist who failed to disclose data tinkering

Link: https://retractionwatch.com/2024/02/22/exclusive-elsevier-to-retract-paper-by-economist-who-failed-to-disclose-data-tinkering/

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A paper on green innovation that drew sharp rebuke for using questionable and undisclosed methods to replace missing data will be retracted, its publisher told Retraction Watch.

Previous work by one of the authors, a professor of economics in Sweden, is also facing scrutiny, according to another publisher. 

As we reported earlier this month, Almas Heshmati of Jönköping University mended a dataset full of gaps by liberally applying Excel’s autofill function and copying data between countries – operations other experts described as “horrendous” and “beyond concern.”

Heshmati and his coauthor, Mike Tsionas, a professor of economics at Lancaster University in the UK who died recently, made no mention of missing data or how they dealt with them in their 2023 article, “Green innovations and patents in OECD countries.” Instead, the paper gave the impression of a complete dataset. One economist argued in a guest post on our site that there was “no justification” for such lack of disclosure.

Elsevier, in whose Journal of Cleaner Production the study appeared, moved quickly on the new information. A spokesperson for the publisher told us yesterday: “We have investigated the paper and can confirm that it will be retracted.”

Author(s): Frederik Joelving

Publication Date: 22 Feb 2024

Publication Site: Retraction Watch

The Limits of Taxing the Rich

Link:https://manhattan.institute/article/the-limits-of-taxing-the-rich

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Sanders’s agenda is not limited to taxes on corporations and wealthy families. The campaign also proposed to partially finance Medicare-for-All through 4.6% of GDP in new tax revenues from broad-based payroll taxes and tax-preference eliminations (within health care). However, even if one uses the inflated revenue figure of 8.6% of GDP (4.0% from the wealthy and 4.6% from broad-based taxes), it still falls far short of financing Sanders’s spending promises. Sanders proposed $23 trillion in new taxes over the 2021–30 period, yet also proposed a $30 trillion Medicare-for-All plan, $30 trillion government job guarantee, $16 trillion climate initiative, and $11 trillion for free public college tuition, full student-loan forgiveness, Social Security expansion, housing, infrastructure, paid family leave, and K–12 education. That is $87 trillion in spending promises, on top of a baseline budget deficit that, at the time, was forecast at $13 trillion over the decade.[104] Even the rosiest revenue estimates of Sanders’s tax policies would cover only a small fraction of his spending promises (see Figure 9).

At the same time, Sanders has obfuscated the funding shortfall by: 1) regularly claiming that his tax policies can cover all his spending promises, even as official scores show otherwise; and 2) proposing most spending increases separately, in order to make each one appear individually affordable within his broader tax agenda.

SummarySome progressives suggest that Bernie Sanders has identified extraordinary potential revenues from taxing the rich. However, his proposed tax increases on corporations and wealthy individuals show revenues of 4% of GDP—and that is before accounting for constitutional challenges and unrealistic tax rates that far exceed the consensus of revenue-maximizing rates. Given behavioral and economic responses, the total potential tax revenues are (at most) 2% of GDP, and possibly far less. Indeed, leading progressive tax officials assume plausible tax rates and revenues far below those of Sanders’s proposals. Even assuming Sanders’s full static revenue estimate and including his steep middle-class tax proposals would not come close to paying for his spending agenda. The contention that Sanders has unlocked an enormous tax-the-rich revenue source is false.

Author(s): Brian Riedl

Publication Date: 21 Sept 2023

Publication Site: Manhattan Institute

The Rich Aren’t Rich Enough to Balance the Federal Budget

Link:https://www.wsj.com/articles/the-rich-arent-rich-enough-to-balance-the-federal-budget-with-tax-increases-60969410

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As budget deficits surge toward the stratosphere, Congress will soon have to get serious about savings proposals. Yet reforming Social Security and Medicare—the leading drivers of long-term deficits—remains a political nonstarter. Neither party is willing to raise middle-class taxes. And cutting defense and social spending would save at most $200 billion annually from deficits that are projected to approach $3 trillion by 2034.

That leaves one option: Tax the rich. It won’t be nearly enough.

There are a few excessive tax loopholes and undertaxed corporations that lawmakers could address. It’s farcical, however, to suggest that the tax-the-rich pot of gold is large enough to rein in our deficits and finance new spending programs. Seizing every dollar of income earned over $500,000 wouldn’t balance the budget. Liquidating every dollar of billionaire wealth would fund the federal government for only nine months.

In a study for the Manhattan Institute, I set upper-income tax rates at their revenue-maximizing level, while paring back tax loopholes and fighting tax evasion. As background, the Congressional Budget Office projects that our budget deficits—which currently exceed 7% of gross domestic project—will surpass 10% of GDP over the next three decades. My research shows that the “tax the rich” model would raise at most 2% of GDP in additional revenue over the long term.

Author(s): Brian Riedl

Publication Date: 22 Jan 2024

Publication Site: WSJ, op-ed

‘Fourth Wave’ of Opioid Epidemic Crashes Ashore, Propelled by Fentanyl and Meth

Link:https://kffhealthnews.org/news/article/fourth-wave-opioid-epidemic-fentanyl-millennium-health-report/

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The United States is knee-deep in what some experts call the opioid epidemic’s “fourth wave,” which is not only placing drug users at greater risk but is also complicating efforts to address the nation’s drug problem.

These waves, according to a report out today from Millennium Health, began with the crisis in prescription opioid use, followed by a significant jump in heroin use, then an increase in the use of synthetic opioids like fentanyl.

The latest wave involves using multiple substances at the same time, combining fentanyl mainly with either methamphetamine or cocaine, the report found. “And I’ve yet to see a peak,” said one of the co-authors, Eric Dawson, vice president of clinical affairs at Millennium Health, a specialty laboratory that provides drug testing services to monitor use of prescription medications and illicit drugs.

The report, which takes a deep dive into the nation’s drug trends and breaks usage patterns down by region, is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug addiction care.

Its findings offer staggering statistics and insights. Its major finding: how common polysubstance use has become. According to the report, an overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances. “And that is huge,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.

Author(s): Colleen DeGuzman

Publication Date: 21 Feb 2024

Publication Site: KFF Health News

Should a Federally Sponsored ‘Pension Dashboard’ Be Established?

Link:https://www.napa-net.org/news-info/daily-news/should-federally-sponsored-%E2%80%98pension-dashboard%E2%80%99-be-established

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A “pension dashboard” could be useful in the United States to help participants track their retirement savings when they change jobs, but Congress would need to authorize a federal agency to establish and oversee such a dashboard. It also would have to give the agency the authority to consolidate retirement account information, the GAO stated in its report—“401(k) Plans: Additional Federal Actions Would Help Participants Track and Consolidate Their Retirement Savings.”

GAO was asked to review, among other things, the challenges that 401(k) plan participants have in keeping track of their retirement savings, as well as the challenges they have in rolling over their savings from one plan to another and federal actions that can improve the process.

In fact, this issue is not new, as the dashboard concept was raised in late 2020 in a white paper (A Retirement Dashboard for the United States) by authors David John of the AARP Public Policy Institute, Grace Enda of the Urban-Brookings Tax Policy Center, and William Gale and J. Mark Iwry of the Brookings Institution who called for the creation of a retirement dashboard to help savers better manage and keep track of their savings.  

….

Consequently, GAO recommends that Congress grant authority to a federal agency to develop and oversee a comprehensive pension dashboard that can provide participants’ information to them in one location. GAO notes this “would reduce the burden on plan sponsors and providers, who must otherwise track or manage lost accounts or missing participants.” 

The report also suggests that DOL and IRS establish a system to facilitate automatic plan-to-plan rollovers to help participants maintain consolidated savings as they change jobs. GAO also recommended that the government (PBGC, Labor and Treasury) help 401(k) participants by improving the information they receive about options for their plan savings and the process they must undergo to consolidate their savings after changing jobs.

In its written response, DOL stated that it would consider actions related to GAO’s disclosure recommendation to ensure participants “receive easily understandable, timely, and comprehensive information.” DOL also noted that it is engaged in joint agency efforts and that it would be appropriate for them to consider the recommendation as part of such efforts with Treasury, IRS, and PBGC, as required under the SECURE 2.0 Act. Under the act, the agencies are to study, analyze, and report to Congress on the effectiveness of their reporting and disclosure requirements before the end of 2025.

Author(s): Ted Godbout

Publication Date: 20 Feb 2024

Publication Site: NAPA – National Association of Plan Advisors

Bizarre Valedictory Interview by CalSTRS Investment Chief, Chris Ailman, Asks Private Equity to Be Nice and Share with Workers

Link: https://www.nakedcapitalism.com/2024/02/bizarre-valedictory-interview-by-calstrs-investment-chief-chris-ailman-asks-private-equity-to-be-nice-and-share-with-workers.html

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The Financial Times made its interview with departing CalSTRS’ Chief Investment Officer Chris Ailman its lead story yesterday: Private equity should share more wealth with workers, says US pension giant. The Financial Times was too polite to say so, but Ailman could lay claim to being the best large public pension fund chief investment officer. CalSTRS, which manages the pensions of California teachers, is in the same general size league as its Sacramento sister CalPERS, and regularly outperforms CalPERS by a meaningful margin.

….

It’s hard to know where to begin with this. Limited partners like CalSTRS, who are, in Wall Street parlance, the money, have not even been able to get basic disclosures from the general partners like how much in total the private equity firms hoover out in fees and expenses, despite many years of pleading. Mind you, it’s a requirement for a fiduciary to evaluate the costs and risks of any investment, yet these investors have accepted this abuse.

Limited partners don’t get P&Ls of portfolio companies. They don’t get independent valuations even though that is considered to be essential for every other type of investment. So it’s ludicrous to think that general partners will share money with one of the very weakest parties in the picture, mere workers, when they won’t give information to the limited partners.

Someone new to this topic might wonder why limited partners don’t say “no”. The reason is they perceive private equity to be necessary for them to earn enough to reduce their level of underfunding, which in the public pension fund world is typically pretty bad. To make up for the shortfalls, pension funds like CalPERS and CalSTRS have also been increasing the amount they charge to cities, counties, and other local government entities. These pension costs are taking up larger and larger proportions of these budgets, creating concern and anger.

Author(s): Yves Smith

Publication Date: 16 Feb 2024

Publication Site: naked capitalism

Fixing Medicare Starts With Cracking Down On A Multibillion-Dollar Catheter Scam

Link: https://thefederalist.com/2024/02/20/fixing-medicare-starts-with-cracking-down-on-a-multibillion-dollar-catheter-scam/?utm_source=feedly&utm_medium=rss&utm_campaign=fixing-medicare-starts-with-cracking-down-on-a-multibillion-dollar-catheter-scam

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The New York Times reported recently about a sharp spike in Medicare spending on catheters, amid numerous signs that scammers have targeted that benefit to bilk the government out of taxpayer funds. With Medicare rapidly approaching insolvency, the problem is twofold: Criminals still consider the program such an easy source of cash — because the feds do such a poor job at finding and catching the crooks. 

Times reporters interviewed several seniors explaining how they had been billed for catheters they never received and do not need or use. It also noted that the number of Medicare beneficiary accounts billed for catheters rose roughly nine-fold last year, from 50,000 to 450,000. 

The pattern of Medicare spending on catheters echoes the increase in beneficiaries billed. Based on this graph from the Times story, it doesn’t take a doctorate in economics to realize that something fishy has happened regarding payments for catheters — and that, assuming most or all of the increase is due to fraud, Medicare has already given the scammers billions of dollars.

Over and above whether and when the feds can catch the scammers, the real question is: How did this happen? Or, given the federal government’s history of permitting fraud in federal health care programs, how does this keep happening?

Author(s): Christopher Jacobs

Publication Date: 16 Feb 2024

Publication Site: The Federalist