Rhetoric and Reality The Obamacare Evaluation Report: Access to Care and the Physician Shortage

President Barack Obama's first term was defined by the battle over, and the passage of, the Patient Protection and Affordable Care Act, the landmark health-reform legislation known popularly as Obamacare. Along the way, Obama, the law's supporters, and independent analysts such as the Congressional Budget Office (CBO) made specific claims or projections about how the law would affect consumers, patients, and businesses.Now, three years after Obamacare's passage, many key provisions of the legislation are beginning to be implemented. Whether implementation succeeds or fails will be strongly influenced by the reactions of states, providers, insurers, businesses, and consumers to the law's provisions and to the thousands of pages of new health-care regulations.Rhetoric and Reality is a project of the Manhattan Institute's Center for Medical Progress that is designed to offer an ongoing, objective, and accessible perspective on the law's performance in light of key claims or projections made about it. Our project will examine the law's effect on Americans in five overarching areas: health-care costs, insurance coverage, employment, access to care, and consumer-driven health plans. Additional topics may be added.Each evaluation will be based on the best available data and will be revised as new or more authoritative data become available

An open question: Are topological arguments helpful in setting initial conditions for transport problems in condensed matter physics?

The tunneling Hamiltonian is a proven method to treat particle tunneling between different states represented as wavefunctions in many-body physics. Our problem is how to apply a wave functional formulation of tunneling Hamiltonians to a driven sine-Gordon system. We apply a generalization of the tunneling Hamiltonian to charge density wave (CDW) transport problems in which we consider tunneling between states that are wavefunctionals of a scalar quantum field. We present derived I-E curves that match Zenier curves used to fit data experimentally with wavefunctionals congruent with the false vacuum hypothesis. THe open question is whether the coefficients picked in both the wavefunctionals and the magnitude of the coefficents of the driven sine Gordon physical system should be picked by topological charge arguements that in principle appear to assign values that have a tie in with the false vacuum hypothesis first presented by Sidney ColemanComment: 17 pages, 4 figures (1a to 2b) on two pages. Specific emphasis on if or not topological arguements a la Trodden, Su et al add to formulation of condensed matter transport problem

A New S-S' Pair Creation Rate Expression Improving Upon Zener Curves for I-E Plots

To simplify phenomenology modeling used for charge density wave (CDW)transport, we apply a wavefunctional formulation of tunneling Hamiltonians to a physical transport problem characterized by a perturbed washboard potential. To do so, we consider tunneing between states that are wavefunctionals of a scalar quantum field. I-E curves that match Zener curves - used to fit data experimentally with wavefunctionals congruent with the false vacuum hypothesis. This has a very strong convergence with electron-positron pair production representations.The similarities in plot behavior of the current values after the threshold electric field values argue in favor of the Bardeen pinning gap paradigm proposed for quasi-one-dimensional metallic transport problems.Comment: 22 pages,6 figures, and extensive editing of certain segments.Paper has been revised due to acceptance by World press scientific MPLB journal. This is word version of file which has been submitted to MPLBs editor for final proofing. Due for publication perhaps in mid spring to early summer 200

Eliciting Children’s Perceptions of Migration through a Puppet-Making Task

This study adopted a qualitative case study approach to investigate the perceptions of immigrant children who participated in a puppet-making workshop about the story of an immigrant puppet, called Amal. The study involved 11 participants, 5 girls and 6 boys aged between 9 and 12 years, who joined the Children Like Us puppet-making workshop organized by the Association for Solidarity with Asylum Seekers and Migrants (ASAM) Izmir Al Farah Child and Family Support Center in Turkey. The data were collected using semi-structured interviews from the children. The interviews were conducted face-to-face by the second researcher. Content analysis was used to analyze the data. The results revealed that the migrant children expressed enthusiasm and joy in participating in the puppet-making workshop and used the Little Amal character to convey their perspectives on migration. The study offers useful methodological implications; it shows how artistic experiences can facilitate the expression of thoughts and feelings for children

Gluon distribution in proton at soft and hard pp collisions

We analyze the inclusive spectra of hadrons produced in $pp$ collisions at high energies in the mid-rapidity region within the soft QCD and perturbative QCD assuming the possible creation of the soft gluons at low intrinsic transverse momenta $k_t$. From the best description of the LHC data we found the parametrization of the unintegrated gluon distribution which at low $k_t$ is different from the one obtained within the perturbative QCD.Comment: 10 pages, 5 figures. Talk given the 5th joint International HADRON STRUCTURE '11 Conference (HS'11), Tatransk\'a Strba, Slovakia, June 27th - July 1st, 201

Medicare advantage: provider networks, payment, and value

Medicare Advantage (MA), a private alternative to Traditional Medicare (TM), covers over 50 percent of Medicare beneficiaries and accounts for a similar share of spending (in 2023). The government pays private insurers a monthly amount to offer coverage to beneficiaries. The plans covering most MA enrollees – preferred provider organizations (PPOs), health maintenance organizations (HMOs), and point of service (POS) plans – are also required to maintain provider networks that restrict access to certain providers and meet government adequacy requirements. In paper one, we develop a method for measuring the restrictiveness of provider networks in MA without relying on provider directories. This approach relies on prescription drug event (PDE) data for MA enrollees to identify providers seen by enrollees. Focusing on primary care providers (PCPs) as a high-prescribing specialty, we use a prediction model trained on stand-alone prescription drug plans (PDPs) to estimate the number of providers that would have been seen absent network restrictions, allowing estimation of a measure of network restrictiveness for MA plans. Our findings suggest that MA plans reduced access to PCPs to 60.6% of what we would expect it to be absent network restrictions. HMOs tended to have the most restrictive networks, and rural areas were most affected by network restrictions. When developing provider networks, MA insurers seek to maximize profit while meeting regulatory standards. To make networks attractive to patients, insurers might have to include providers that are differentiated by quality, brand-name, or other characteristics. These so-called “star providers” are those that are difficult to exclude from networks due to market power, potentially driven by product differentiation or other behavior. In the second paper, we build on prior work identifying star providers in other markets, and using claims data, we develop a measure of demand for provider groups among TM beneficiaries. Using this measure, we identify star provider groups, of which 81.04% are in-network for at least one MA plan, compared to 26.3% for others (SMD: 1.31). While these groups had a larger share of beneficiaries than others (5.69% vs 1.14%, SMD: 0.57) (indicating market power), they tended to have a similar number of providers. These findings suggest that there exist provider groups that limit the ability of MA insurers to flexibly modify networks, which may affect how regulators view proposed mergers. Insurers participating in MA must offer benefits at least as valuable as TM, but typically expand benefits beyond what TM offers, and they are required to have an out-of-pocket limit on beneficiary costs. Payment changes might affect the value of these benefits. Reductions in payment might lead to narrower networks or less expansive benefits, for instance. In the third and final paper, we use a one-time reduction in government payments in 2015 to identify the extent to which payments change network breadth, benefits, and/or advertising effort. We find that less than 100% of the reduction is passed through to beneficiaries. 40.6% of the reductions are passed through as less generous benefits while 27.6% are passed through as higher premiums. We find a reduction in zero-premium plans but no effect on advertising effort or network restrictiveness. A major contribution of our analyses is the development of a novel method for measuring provider network restrictiveness, allowing regulators and researchers to evaluate the role of provider networks in affecting access without relying on provider director data. Our results are consistent with prior work suggesting that the MA market is generally non-competitive and that a less than competitive provider market may make it difficult for insurers to modify provide networks

On the ideal gas law

The air density on earth decays as a function of altitude $z$ approximately according to an $\exp(-w\,z/\theta)$-law, where $w$ denotes the weight of a nitrogen molecule and \theta=\kB T where $k_B$ is a constant and $T$ the thermodynamic temperature. To derive this law one usually invokes the Boltzmann factor, itself derived from statistical considerations. We show that this (barometric) law may be derived solely from the democritian concept of corpuscles moving in vacuum. We employ a principle of simplicity, namely that this law is \emph{independent} of the law of corpuscle motion. This view-point puts aside restrictive assumptions that are source of confusion. Similar observations apply to the ideal-gas law. In the absence of gravity, when a cylinder terminated by a piston, containing a single corpuscle and with height $h$ has temperature $\theta$, the average force that the corpuscle exerts on the piston is: \ave{F}=\theta/h. This law is valid at any temperature, except at very low temperatures when quantum effects are significant and at very high temperatures because the corpuscle may then split into smaller parts. It is usually derived under the assumption that the temperature is proportional to the corpuscle kinetic energy, or else, from a form of the quantum theory. In contradistinction, we show that it follows solely from the postulate this it is independent of the law of corpuscle motion. On the physical side we employ only the concept of potential energy. A consistent picture is offered leading to the barometric law when $w\,h\gg\theta$, and to the usual ideal-gas law when $w\,h\ll\theta$. The mathematics is elementary. The present paper should accordingly facilitate the understanding of the physical meaning of the barometric and ideal-gas laws

Unitarity Restoration in the Presence of Closed Timelike Curves

A proposal is made for a mathematically unambiguous treatment of evolution in the presence of closed timelike curves. In constrast to other proposals for handling the naively nonunitary evolution that is often present in such situations, this proposal is causal, linear in the initial density matrix and preserves probability. It provides a physically reasonable interpretation of invertible nonunitary evolution by redefining the final Hilbert space so that the evolution is unitary or equivalently by removing the nonunitary part of the evolution operator using a polar decomposition.Comment: LaTeX, 17pp, Revisions: Title change, expanded and clarified presentation of original proposal, esp. with regard to Heisenberg picture and remaining in original Hilbert spac

Atomic scale engines: Cars and wheels

We introduce a new approach to build microscopic engines on the atomic scale that move translationally or rotationally and can perform useful functions such as pulling of a cargo. Characteristic of these engines is the possibility to determine dynamically the directionality of the motion. The approach is based on the transformation of the fed energy to directed motion through a dynamical competition between the intrinsic lengths of the moving object and the supporting carrier.Comment: 4 pages, 3 figures (2 in color), Phys. Rev. Lett. (in print

Algebraic and arithmetic area for mm planar Brownian paths

The leading and next to leading terms of the average arithmetic area $< S(m)>$ enclosed by $m\to\infty$ independent closed Brownian planar paths, with a given length $t$ and starting from and ending at the same point, is calculated. The leading term is found to be $\sim {\pi t\over 2}\ln m$ and the $0$-winding sector arithmetic area inside the $m$ paths is subleading in the asymptotic regime. A closed form expression for the algebraic area distribution is also obtained and discussed.Comment: 8 pages, 2 figure