Gaming the Affordable Care Act (ACA)

One of the big lessons of market design is that participants have big strategy sets. Here's a new paper that explores some of what that has implied about how the Affordable Care Act is gamed by some participants.

Take-Up, Drop-Out, and Spending in ACA Marketplaces

Rebecca Diamond, Michael J. Dickstein, Timothy McQuade, Petra Persson

NBER Working Paper No. 24668
Issued in May 2018
NBER Program(s):Health Care, Public Economics, Industrial Organization 

The Affordable Care Act (ACA) established health insurance marketplaces where consumers can buy individual coverage. Leveraging novel credit card and bank account micro-data, we identify new enrollees in the California marketplace and measure their health spending and premium payments. Following enrollment, we observe dramatic spikes in individuals' health care consumption. We also document widespread attrition, with more than half of all new enrollees dropping coverage before the end of the plan year. Enrollees who drop out re-time health spending to the months of insurance coverage. This drop-out behavior generates a new type of adverse selection: insurers face high costs relative to the premiums collected when they enroll strategic consumers. We show that the pattern of attrition undermines market stability and can drive insurers to exit, even absent differences in enrollees' underlying health risks. Further, using data on plan price increases, we show that insurers largely shift the costs of attrition to non-drop-out enrollees, whose inertia generates low price sensitivity. Our results suggest that campaigns to improve use of social insurance may be more efficient when they jointly target take-up and attrition.

Parag Pathak interview on designing theories for the real world

Here's the introduction, click on the link to read more, or to hear the audio recording.

Designing theories for the real world
The AEA interviews 2018 John Bates Clark Medalist Parag Pathak.
by Chris Fleisher

He’s been hailed for pushing the boundaries of market design theory while making it practical to real-world situations.

Parag Pathak is this year’s winner of the John Bates Clark Medal. The 37-year-old MIT professor has worked to improve the assignment of students to public schools, notably in Boston, and also evaluated the impacts of school choice systems on student outcomes.

And while his theoretical work has won him widespread praise, he says his engineering-oriented approach to economics has helped him figure out which problems are of greatest practical importance.  

The AEA spoke with Pathak about his research, the influence of his mentor and former AEA president Al Roth, the criticisms against economic theorists, and the opportunities to shape public policy.

An edited transcript follows and the full-length interview can be heard by clicking on the media player..."

Salaries of new lawyers at big law firms are on the move

After a long period of stagnation, salaries of lawyers in associate positions at large law firms recently started to move, and are climbing (probably in lockstep) once again.

Above the Law has the story:
New York To $190K — No, Cravath Didn’t Make The First Move
The next associate salary war is beginning.

and here:
Salary Wars Scorecard: Which Firms Have Announced Raises? (2018)

and here

The Billion-Dollar Biglaw Firms That Have NOT Raised Associate Salaries

See earlier posts:

Sunday, July 3, 2016

The market for first year lawyers: some top salaries are moving to 180K

Wednesday, August 15, 2012

Salaries of new law grads

Repugnant markets: listen to my Philosophy Talk chat with Ken Taylor and Debra Satz

Below is a link to the audio recording of my Sunday radio chat on Philosophy Talk:

Repugnant Markets: Should Everything Be For Sale?

• by Philosophy Talk
• Length: 53:58

Airbnb in Paris

The FT has an informative story about Airbnb's large footprint in Paris, the nuanced effects this has on the city, and French attempts at regulation:

 Airbnb: ‘It’s a cash machine. It’s magical. You are paid to go on holiday’

"The home-sharing site’s number one destination is Paris, where it stands accused of driving up rents and house prices"

The job market(s) for professional psychologists: history and current issues

Various parts of the psychology job market resolved problems of thickness, congestion and incentives by adopting centralized clearinghouses. For other parts of the job market, those issues persist. Here's a recent article, and some snippets from it regarding this history.

Recruitment and selection in health service psychology postdoctoral training: A review of the history and current issues. 
Bodin, Doug; Schmidt, Joel P.; Lemle, Russell B.; Roper, Brad L.; Goldberg, Robert W.; Hill, Kimberly R.; Perry-Parrish, Carisa; Williams, Sharon E.; Kuemmel, Angela; Siegel, Wayne.
Training and Education in Professional Psychology © 2017 American Psychological Association

2018, Vol. 12, No. 2, 74 – 81

"Pursuing a career in health service psychology involves navigating three broad stages of training: graduate school, doctoral internship, and postdoctoral training. Each stage involves distinct procedures for recruitment and selection. The purpose of this article is to review the history of and current issues involved in the recruitment and selection process for postdoctoral training in health service psychology. In this review, we will discuss the specialty of clinical neuropsychology separately as that specialty has a formal computerized match and therefore faces subsequent challenges that are distinct from, but in some ways mirror, the  faced broadly by health service psychology postdoctoral training programs.
...
"The current computerized matching psychology internship selection process began in 1998–1999, 10 years after an earlier trial, rejection, and reintroduction (Keilin, 2000). Prior to the introduction of computerized matching, the internship selection process relied on the “uniform notification day” (UND) system for more than 25 years. This process of internship offers and acceptances shortened from an initial offer and acceptance period of 9 days to 4 hours (Keilin, 1998). In 1988–1989, there was a trial period to evaluate the effectiveness of a computer-based algorithm match process. Although the outcomes showed a significant improvement over the UND, there was a lack of full participation by internship sites that appeared to have a detrimental impact on the outcomes observed (Keilin, 1998). Recurrent discussion within the Association of Psychology Postdoctoral and Internship Centers (APPIC) reflected gradually shifting approval, from a vote of 55% to 45% to retain the UND in 1990, to 77% approval to move to a computer-based match system by May 1998 for immediate implementation for the 1998–1999 recruitment year.
...
"There were wide-spread reports of both applicants and programs accepting less preferred choices due to the fear of not securing or filling a position within the UND window. APPIC responded by clarifying the rules with a prohibition against sites soliciting rank information (Constantine & Keilin, 1996). APPIC voted to proceed with a computer-based match process in 1998 using a match algorithm similar to the National Residency Match Program (Roth & Peranson, 1999). The computer-match system transcends difficulties on both sides by providing an equitable solution designed to provide the best possible match for all parties involved (Keilin, 1998). This solution reduces the pressure associated with short decision-making times and has the benefit of reducing the gridlock associated with UND (Roth & Xing, 1997).
...
"The computerized match has been used every year since, and it is now widely considered the optimal process for doctoral internship selection.

"The recruitment and selection process at the postdoctoral level remains in an evolutionary stage at the present time. Coordination of the psychology postdoctoral selection market is complicated by the fact that it is actually made up of multiple submarkets. Psychology interns may consider several options for their next professional experience, including an entry-level job, a research fellowship, a general clinical psychology fellowship, or a postdoctoral fellowship in a specialty practice area (e.g., neuropsychology, health psychology, clinical child psychology, or forensic psychology). Several of these submarkets have different timelines. For example, entry-level jobs and research fellowships are dependent on idiosyncratic funding streams and employment needs and, as such, may not realistically be expected to adhere to a coordinated timeline. 
...
"In 2003, there was renewed effort to establish more systemization to protect applicants from being forced into making decisions about early offers that did not reflect their true preferences. 
...
"As part of a 2009 APPIC biennial conference presentation, Lemle proposed a modified selection process with an additional feature intended to make participation more attractive to programs. The additional feature would allow applicants who received an early offer from a nonparticipating site to contact a preferred program to pledge they would accept a “reciprocal offer” should one be extended. A UND with reciprocal offer option (UNDr) assured programs that their top applicants who also wished to come to their site would not be lost to competing offers.
...
" Beginning in Fall, 2016, the APPIC postdoctoral workgroup took strides to address several proximal recommendations borne in the summit. First, the workgroup further refined the Postdoctoral Selection Guidelines (PSG) for positions starting in 2017–2018 as a step toward developing a clear and transparent system that would allow applicants sufficient time to consider offers (applicants were allowed 24 hr to consider offers) and allow programs the time needed to interview applicants. A primary aim of the PSG is to decrease the significant stress on both applicants and training directors. The PSG address multiple stages of the selection process impacting trainees including reasonable interview notification timing, consideration of remote interview formats, postponing offers until the UND, and proper use of the reciprocal offer option (UNDr).
...
"The APPIC postdoctoral workgroup also followed the summit recommendation to spearhead the development of a centralized listing of postdoctoral positions, the Universal Psychology Postdoctoral Directory (UPPD), that is free for both APPIC and non-APPIC member programs. 
...
"Clinical neuropsychology has a distinct history that is informative when considering the issues discussed in this article. Most notably, there is currently a formal computerized match for postdoctoral selection in clinical neuropsychology (Belanger et al., 2013; Bodin, Roper, O’Toole, & Haines, 2016). Prior to 1994, there was no organized process for recruitment and selection in clinical neuropsychology. 
...
"In 2001, APPCN partnered with NMS to conduct a computerized match for postdoctoral selection in clinical neuropsychology that has continued to the present day. The APPCN match employs the same algorithm used for the psychology internship match, but dissimilarities across the two recruiting environments have contributed to differences in the success of the two systems over the years. Since its inception, the internship match has enjoyed virtually universal participation by programs. Importantly, the APPCN match was introduced without a clear understanding of the total universe of positions being offered by neuropsychology postdoctoral programs, and those outside of APPCN were not a part of an organized group interested in centralized recruitment. Years later, Belanger et al. (2013) estimated that roughly two thirds of available positions were offered in the APPCN match. Withdrawal rates for applicants initially registering for the APPCN match have ranged from 26% to 37% over the past 10 years and have been stable from 34 and 36% for the last five years. Although some applicants withdraw for personal reasons, the most common reason has been to accept offers from independent programs prior to the rank-order list (ROL) deadline for the APPCN match.

Repugnant markets on the radio

Repugnant Markets on the radio: I'll join Ken Taylor and Debra Satz on Philosophy Talk today, June 3

"We might ban buying or selling horse meat in the US not for the protection of horses, but because we find it morally repugnant. Yet this moral repugnance is clearly not universal, and on some level may even be arbitrary, given France's attitude toward horse meat. What role, if any, should moral repugnance play in determining the rules of our marketplaces? Even if we want to eliminate the influence of moral repugnance, can we? Debra and Ken hold their noses with Al Roth from Stanford University, author of Who Gets What ― and Why: The New Economics of Matchmaking and Market Design."

Get Philosophy Talk

Radio

Sunday at 11am (pacific) on KALW 91.7 FM Local Public Radio, San Francisc

Ken wrote thoughtfully about this yesterday on the Philosophy Talk blog:
REPUGNANT MARKETS,  Ken Taylor
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Update: and here we are at KALW:

Ken Taylor, Debra Satz, and Al Roth in the studio at Philosophy Talk
https://pbs.twimg.com/media/DeyV20-VQAAApPH.jpg 

And here's a link to a recording of the show:

Repugnant markets: listen to my Philosophy Talk chat with Ken Taylor and Debra Satz

The Economist on blood plasma

The Economist comments on Canada's repugnance towards paying Canadians to donate blood plasma (when you can buy as much as you need from U.S. donors..see previous posts.)

Vital fluids
America’s booming blood-plasma industry
Paid-for plasma is both less exploitative than often recognised, and invaluable

"The World Health Organisation lists immunoglobulins and coagulation factors—both plasma-derived products—as essential medicines. Yet poor countries are often desperate for them and rich countries rely on American imports. Without financial incentives, supplies are hard to come by. “It’s not in people’s nature”, says Mr From, “to let a phlebotomist poke a needle in your arm and suck your blood out.”
**********

Vein attempts
Bans on paying for human blood distort a vital global market
The market in life-saving blood-plasma products depends on Americans who are paid for it

"The global demand for plasma is growing, and cannot be met through altruistic donations alone. Global plasma exports were worth $126bn in 2016—more than exports of aeroplanes. But paid plasma raises ethical, social and medical concerns: that it will lead to health catastrophes, as in the 1980s when tainted blood spread HIV and hepatitis; that it exploits the poor; and that it reduces the supply of “whole” blood, which is almost all donated voluntarily.

"None of these worries is well-founded. But Canadian reservations about paid plasma are shared across most of the world. America, China, parts of Canada and some European countries are among the few places that permit it. Those countries are extremely effective in securing supplies: three-quarters are collected in America alone, and another 10% in China, Germany, Hungary and Austria, where payment is also allowed. Of over 1,000 plasma-collection centres worldwide, 700 are in America. Jan Bult, head of a trade association representing companies that manufacture more than half of the world’s plasma products, says none collects plasma in countries that have banned compensation.

"Only countries that pay for plasma are self-sufficient in it. (Italy, where donors are given time off work, is close to self-sufficiency.) Half of America’s plasma is shipped to Europe—20m contributions-worth. Canada imports 80% of its plasma products from America. Australia imports 40% of its plasma products, too.

"Drug firms from countries that have banned pay-for-plasma do much of their collection in America. Three of the largest collection companies are European: Grifols of Spain, Shire of Ireland and Octapharma of Switzerland. The parent company of another big collector, CSL Behring, is Australian. Together these four firms run nearly eight out of ten plasma-collection centres. Some of their manufacturing capacity is in America, but much is located elsewhere. Switzerland, which collects very little plasma, exported $26bn-worth of plasma products in 2016.

...

It remains legal to pay for whole-blood donation in America today. But hospitals refuse to accept it. Today’s plasma, however, is safe from the contamination risks of the past. Modern screening and sanitisation are extremely effective. Graham Sher, chief executive of Canadian Blood Services, a non-profit, says plasma products from paid donors are “as safe as those from our unpaid donors”.

Other prejudices against pay-for-plasma are equally deep-seated. Some data, for example, lend weight to the suspicion that it preys on the poor. American plasma centres are concentrated in less well-off bits of the country. Typically they are in postal districts where 27.4% of the population are poor, according to The Economist’s analysis of census data. This is much higher than the average American poverty rate of 16.5%.

The other worry, shared by Dr Sher, is that paying for plasma may lead to a reduction in whole-blood donation. But, if that were true, the problem would be intensifying, as pay-for-plasma centres have nearly doubled worldwide in the past five years. But Peter Jaworski, of Georgetown University, is sceptical, suggesting that, anecdotes aside, the evidence shows paid plasma donation “does not crowd out voluntary blood-donation”. Americans, for example, continue to donate as much voluntary blood per head as do Canadians.

The aversion to paid-for plasma carries its own risks. According to Grifols, the geographic imbalance puts supplies of plasma products at risk. At the plasma industry’s main annual conference, held this year in Budapest in March, over-reliance on imports from America was a hot topic. Representatives from several countries (including Canada) recognised they must do more to diversify their supplies. Making it legal to pay for plasma is an obvious first step."

This article appeared in the International section of the print edition under the headline "Thicker than water"
 Print edition | International
May 10th 2018
*************

And here's a letter to the editor https://www.economist.com/letters/2018/06/02/letters-to-the-editor. (The highlighted sentence seems to reflect that the editor who decides what letters to publish is a different person than the economics editor  who writes that I study repugnance only to dismiss it, and whose views I remarked on here and here.)

"In your series of articles advocating for payments to plasma donors, you stress the positive supply effects that payments may have. Appeals to increased efficiency, however important, are unlikely to persuade politicians and the public when the opposition to payments resides in deep-rooted ethical concerns. Starting with the seminal work of Nobel laureate Alvin Roth, economists have begun to seriously consider how to design effective market mechanisms while respecting moral beliefs, in order to reach a virtuous balance in the trade-offs between morality and efficiency.

"Based also on our own research on ethically contentious transactions, we would suggest that policymakers collect two types of evidence before adopting extreme policies such as outright bans. First, pilot projects would help assessing the impact of various policy options. Second, policymakers should inform the public about this evidence, and take into account the ensuing prevailing opinions and ethical concerns in the population, instead of being based on pressures (in one direction or the other) from vocal but often scarcely representative groups.

NICOLA LACETERA
University of Toronto
MARIO MACIS
Johns Hopkins University
Baltimore, Maryland 

Gratitude for an organ donation

Only a curmudgeon (and I know some) would think of this as (illegal) donor compensation.

Here's a story from the Greeley, Colorado Tribune

Labor of Love: Husband of former city councilwoman works to restore old car for kidney donor

Kidney exchange takes another step forward in Mexico: Pro-Renal

My recent visit was to speak about kidney transplantation in Mexico, and to raise awareness of and support for the new kidney exchange network, Pro-Renal, which has already collaborated successfully with the Alliance for Paired Donation (APD).

Kidney exchange (and international cooperation for global kidney exchange) received a lot of favorable press, here are some reports.

In Forbes Mexico:

Cada año mueren 7 millones por falta de un trasplante de riñón: Alvin E. Roth
Para el Premio Nobel, las barreras que impiden un trasplante renal deberían ser derribadas, porque los tratamientos más costosos son también los que rezagan los mejores resultados.
Jessica Martínez, mayo 23, 2018
[Google Translate: Every year 7 million die in the absence of a kidney transplant: Alvin E. Roth  ... the barriers that prevent a kidney transplant should be demolished, because the most expensive treatments are also those that lag behind the best results."
***********
Anuncian campaña para duplicar el número de trasplantes renales en México
mayo 24, 2018

Rafael Pardo, Mike Rees, Al Roth, Marisol Robles, Arturo Dib Kuri

************
Llega a Mexico la nonacion renal pareada [Paired renal donation arrives in Mexico]
*************

Premio Nobel impulsa donación de órganos en México

Alvin Roth y destacados médicos lanzan la campaña 7-14-21

**********

Un algoritmo, para salvar vidas  [An algorithm to save lives...]

En nuestro país se realizan alrededor de 3,000 trasplantes al año: 77% vivos y 23% cadavéricos.

***********
Aplicarán algoritmo en México para hallar donantes de riñón
25/05/2018 05:31  XIMENA MEJÍA
*********

***************

Buscan salvar vidas con algoritmo para trasplantes [They seek to save lives with an algorithm for transplants]

************

 En México, con algorismos de compatibilidad se buscará donación de riñones

********

Cadena de trasplantes de riñón: lo que se espera realizar pronto en México

mayo 28, 2018
*********
México ya tiene su ‘tinder’ para riñones BÁRBARA ANDERSON 08.06.2018

*****************

**********

Update: here's a story from an interview that must have been conducted during that visit that came out only in September:

ENTREVISTADOS • SEPTIEMBRE 17, 2018
Alvin Roth, Premio Nobel de Economía 2012

photos: Bruno Sánchez

Martine Quinzii, RIP

This sad news about Martine Quinzii comes from the Society for the Advancement of Economic Theory.

In Memoriam: Martine Quinzii
"Our friend and colleague passed away on May 25, 2018 after a long illness that she faced with both courage and dignity.

She was a central figure of the Mathematical Economics community, inspiring us by her powerful intellectual agenda, sharp presence in academic gatherings, and irresistible enthusiasm for the reach of General Equilibrium analysis. Her PhD thesis on the core in production economies and its decentralization by marginal cost pricing attracted early attention, and her 1984 analysis of assignment economies is the first general existence result in economies with indivisible goods and money. But her most influential contribution is to the analysis of financial markets, to which, with her husband Michael Magill, she devoted a quarter century of her immense energy. This culminated in their 2008 book on the theory of Incomplete Markets, which is widely acknowledged as the best reference on the topic. The book combines mathematical rigor, formal elegance and accessibility to non-specialists.  The most recent of Martine and Michael’s important contribution improves our understanding of the role of money in general equilibrium models with financial frictions. She was also a very talented lecturer and she had the ability to communicate complex ideas with passion, rigor, and clarity.

Martine studied at the Ecole Normale Superieure in Paris. She obtained her PhD in Mathematical Economics in 1986 and her Habilitation in 1988 at the University of Paris.  Before her departure to the US in 1986, she taught in Aix, Marseille, and Paris and was Research Associate at the Ecole Polytechnique. In the US part of her career, she taught at the University of Southern California from 1986 to 1995 and at UC Davis from 1995 to her retirement in 2016, and she chaired the Economics Department there from 1995 to 1999.

She was a Fellow of the Econometric Society since 2000, and an Economic Theory Fellow since 2011. She served as an Associate Editor of Econometrica, Economic Theory, Journal of Mathematical Economics, and several other academic journals.

We already miss her and our thoughts go to her family and to Michael Magill, her long term partner in economics and life.

May 29, 2018

Bernard Cornet, Hervé Moulin, and Jean-Charles Rochet"

Stanford Engineering celebrates Itai Ashlagi

Faculty Spotlight: Itai Ashlagi
Itai Ashlagi joined the MS&E faculty in 2015 to continue his intensive study of market design.

"He specializes in matching markets, such as kidney exchange programs, organ allocation, school choice, and the National Resident Matching Program.

"I can't think of a better intellectual environment for my research than MS&E, where the faculty and students share a common goal of designing systems and policies that impact our lives."

Protecting and Preserving Competition in Matching Markets--Antitrust and the Medical Match (video)

Here's a video of the talk I gave in Chicago in April, at an antitrust conference at the Stigler Center.  I used as my main example the anti-trust lawsuit that was brought in 2002 against the National Resident Matching Program (NRMP) (and all the hospitals that participated in it). I end with some more general discussion of computerized marketplaces. (My talk goes for a bit less than an hour, and the video continues for another ten or fifteen minutes of Q&A)




I intended to begin the talk with a video satire of the medical match, but wasn't able to show it due to technical problems, so I just spoke about it. But here it is for those of you who missed the Harry Potter version of the medical match:

Harry Potter and the Resident Match | ZDoggMD.com

Ireland votes to repeal a constitutional ban on abortion

A vote in Ireland strikes down a consitutional ban on abortion, and will likely lead to legal abortions in at least some cases, and a reduction in black market and overseas abortions.

The NY Times has the story:
Ireland Votes to End Abortion Ban in Rebuke to Catholic Church

"DUBLIN — Ireland voted decisively to repeal one of the world’s more restrictive abortion bans, sweeping aside generations of conservative patriarchy and dealing the latest in a series of stinging rebukes to the Roman Catholic Church.

"The surprising landslide cemented the nation’s liberal shift at a time when right-wing populism is on the rise in Europe and the Trump administration is imposing curbs on abortion rights in the United States. In the past three years alone, Ireland has installed a gay man as prime minister and has voted in another referendum to allow same-sex marriage.
...
"The vote repeals the Eighth Amendment of the Constitution — a 1983 measure that conferred equal rights on the fetus and the mother and banned abortion under almost all circumstances. Before the referendum, the government had pledged to pass legislation by the end of the year to allow unrestricted terminations up to 12 weeks if the amendment was set aside.

"The outcome signaled the end of an era in which thousands of women each year had been forced either to travel abroad or to buy pills illegally online to terminate their pregnancies, risking a 14-year jail sentence.
...
"It was the latest, and harshest, in a string of rejections of the church’s authority in recent years.

"The church lost much of its credibility in the wake of scandals involving pedophile priests and thousands of unwed mothers who were placed into servitude in so-called Magdalene laundries or mental asylums as recently as the mid-1990s.
...
"Abortion supporters had campaigned heavily on so-called hard cases faced by women, such as rape or fetal abnormalities. The referendum result showed that many Irish voters agreed that women in those circumstances should be allowed a choice.

That shift in attitude was driven in part by prominent cases, such as the 2012 death of Savita Halappanavar, who had asked for a termination of her pregnancy but later died of complications from a septic miscarriage. Ms. Halappanavar’s face was printed on placards supporting abortion, and on Saturday morning people placed flowers in front of a mural of her face in Dublin.

“People started realizing that compassion didn’t fit just one side,” Ms. Reidy said.

Update on the Orthopaedic Sports Medicine Fellowship Match

From the Orthopaedic Journal of Sports Medicine:
Outcomes in the Orthopaedic Sports Medicine Fellowship Match, 2010-2017
by Mary K. Mulcahey, MD*, Meghan K. Hayes, BS, Christopher M. Smith, MD, Matthew J. Kraeutler, MD, Jeffrey D. Trojan, BA, Eric C. McCarty, MD

"Together with an increase in the number of applicants for orthopaedic fellowships, the process of applying to fellowship programs has evolved over the past several years. Currently, the majority of orthopaedic fellowship programs utilize a centralized, formal matching process.2 Sports medicine fellowship programs utilized the National Resident Matching Program until 2005.2 After the discontinuation of the formal matching process, residents were often asked to commit to a position during their third year of residency, before receiving adequate exposure to all subspecialties, or they were forced to accept or reject an offer before they could compare programs.
...
"A recent study assessed the match process and the Accreditation Council for Graduate Medical Education (ACGME) status of fellowships in the 9 orthopaedic subspecialties (adult reconstructive orthopaedics, foot and ankle orthopaedics, hand surgery, musculoskeletal oncology, orthopaedic sports medicine, orthopaedic surgery of the spine, orthopaedic trauma, pediatric orthopaedics, and shoulder and elbow surgery).3 This study discovered that 25% of available orthopaedic fellowship positions are devoted to sports medicine.3,12 Sports medicine is also the most popular orthopaedic subspecialty among current AAOS members, with the percentage of members who completed a sports medicine fellowship rising from 27% in 2004 to 49% in 2010.16 Additionally, orthopaedic sports medicine was found to have the highest proportion of ACGME-accredited fellowship programs, with 93.1% of programs and 97.3% of positions receiving accreditation.
...
:A 2014 study by Daniels et al3 investigated orthopaedic subspecialty fellowships in terms of the match process, characteristics, and ACGME accreditation. Fellowships were assessed by searching subspecialty society webpages and individual program websites. This study found that among the 9 orthopaedic subspecialty fellowships, there were collectively more positions offered than there were graduating orthopaedic residents.3 In 2013, there were 792 allopathic and osteopathic resident graduates and 897 total fellowship positions.3 The current study demonstrates that the opposite trend exists for applicants to sports medicine fellowships. In each year, excluding 2014, there were more sports medicine fellowship applicants than positions available."
***********
See my previous posts on orthopaedics, most of which are about the fellowship match.

Some adult supervision of the law clerk hiring process

Kagan Says She'll 'Take Into Account' Whether Judges Follow New Clerk Hiring Plan

"U.S. Supreme Court Justice Elena Kagan recently threw her support behind the new law clerk hiring plan by saying she will “take into account” in her own hiring whether judges and law schools comply with the new process
...

"Kagan’s message for her own chambers is likely to be heard coast to coast. In her nearly eight years on the high court, Kagan has hired clerks largely from the D.C. Circuit but also from the Fourth, Sixth and Ninth circuits and from judges across the ideological spectrum.

A former Harvard Law School dean and professor, Kagan is in a position to understand the effect on students of the former hiring process in which first-year students faced pressure to make clerkship commitments and law professors make recommendations “on less and less information,” Morrison said."

***********

see my earlier post

Tuesday, March 6, 2018

Another New Federal Law Clerk Hiring (Pilot) Plan

HT: Kim Krawiec

Gambling and Sports

A class of repugnant transactions (gambling, subject to many legal restrictions designed to limit its availability) and  protected transactions (sports events, subject to many regulations designed to protect their integrity) have come a bit closer together through a recent Supreme Court decision about a complicated law.

Here's the news story from Inside Higher Ed:
Gambling on Sports Legal
The Supreme Court has opened the way for states to legalize betting on athletics, a defeat for the National Collegiate Athletic Association and professional leagues.

"The U.S. Supreme Court on Monday struck down a law that had forbidden gambling on college and professional sports outside Nevada."

The link above goes to the Supreme Court decision.
But what makes the law that they struck down complicated is that it didn't make sports betting a crime, rather it forbade States from allowing it.

Here's some legal commentary on the decision from a law firm involved in the case:
https://www.gibsondunn.com/supreme-court-strikes-down-federal-limits-on-sports-gambling/

"The Supreme Court held 7-2 that a federal law prohibiting States from authorizing sports betting violates the Tenth Amendment because it impermissibly commandeers state legislatures.

"Background: A federal law – the Professional and Amateur Sports Protection Act of 1992 (PASPA) – prohibits States from authorizing or licensing sports gambling.  In 2014, the New Jersey legislature repealed existing prohibitions on sports gambling at casinos and racetracks.  The NCAA and the four major professional sports leagues sued the State, arguing that the decision to allow sports gambling violated PASPA.

"Issue: Whether PASPA’s federal prohibition on state authorization of sports gambling violates the Tenth Amendment because it commandeers state legislatures.

"Court’s Holding: Yes.  PASPA unconstitutionally commandeers state legislatures by dictating the content of state law regarding sports gambling (i.e., preventing States from legalizing sports gambling).

“A more direct affront to state sovereignty is not easy to imagine.”

***********
Here's the Volokh conspiracy on possible broader implications of this decision

Broader Implications of the Supreme Court's Sports Gambling Decision
Commentators are right to suggest that Murphy v. NCAA will help sanctuary cities, but wrong to claim it is like to undermine federal laws restricting state taxes.

Still bleeding for Canada

Here's a paper on the ongoing debate in Canada about whether it should be legal to pay plasma donors.

Moral NIMBY-ism? Understanding Societal Support for Monetary Compensation to Plasma Donors in Canada
by
Nicola Lacetera, Mario Macis
NBER Working Paper No. 24572 May 2018

Abstract: "The growing demand for plasma, especially for the manufacture of therapeutic products, prompts discussions on the merits of different procurement systems. We conducted a randomized survey experiment with a representative sample of 826 Canadian residents to assess attitudes toward legalizing payments to plasma donors, a practice that is illegal in several Canadian provinces. We found no evidence of widespread societal opposition to payments to plasma donors. On the contrary, over 70% of respondents reported that they would support compensation. Our Canadian respondents were more in favor of paying plasma donors elsewhere than in Canada, but the differences were small, suggesting a weak role for moral “NIMBY-ism” or relativism. Moral concerns were the respondents’ main reason for opposing payments, together with concerns for the safety of plasma from compensated donors, although most of the plasma in Canada does come from paid U.S. donors. Among those in favor of legalizing payments to donors, the main rationale was to guarantee a higher domestic supply. Finally, roughly half of those who declared to be against payments reported that they would reconsider their position if domestic supply plus imports did not cover domestic demand. Most Canadians, therefore, seem to espouse a consequentialist view on issues related to the procurement of plasma.

Forbes Health Forum in Mexico City, May 23

I'm travelling to Mexico today, to speak about kidney exchange at a health forum sponsored by Forbes, and to meet with colleagues at Pro-Renal, the new kidney exchange program there.

Here's a brief news story:
Alvin E. Roth, el Nobel de Economía que ha salvado miles de vidas
No es médico, pero el doctor Roth ha ayudado a miles de personas a recibir un trasplante de riñón, lo que le valió un Nobel en 2012.

And here's the conference program:

FORO FORBES SALUD
May 23,
HACIENDA DE LOS MORALES, CDMX

Agenda (via Google translate)

08:30 HRS. WELCOME

MANAGING TEAM OF FORBES MEDIA LATAM

08:40 HRS. FORBES HEALTH FORUM RECOGNITION

ALFREDO QUIÑONES-HINOJOSA , "DOCTOR Q", MD, FAANS, FACS. WILLIAM J. AND CHARLES H. MAYO PROFESSOR | CHAIR, NEUROLOGIC SURGERY

Dr. Alfredo Quiñones is an example to follow. His history as a migrant in the United States is a reflection of tenacity, dedication, inspiration. He is currently one of the most recognized doctors in the United States for his contributions to neurosurgery. And it's Mexican.

09:00 HRS. INAUGURAL DISCOURSE

TBD

An economic-financial diagnosis of the sector and the challenges it faces such as increased investment in health services.

09:30 HRS. CONFERENCE.

"THE ECONOMY CURES THE HUMANS"

ALVIN E. ROTH , NOBEL PRIZE OF ECONOMY 2012

The work of Dr. Roth has allowed the realization of more than 4 thousand kidney transplants in the United States. This economist developed a "Algorithm of Compatibility" based on technology, big data and the economy applied to health that is solving two of the main public health problems in the world: chronic renal failure and incompatibility between couples of donors and recipients of transplants.

10:00 HRS. RECESS | EXPO | NETWORKING OPPORTUNITY 

10:30 HRS. PANEL. 1

"HEALTHY SOCIETY = HEALTHY ECONOMY"

Investing in health can mean big business, but above all the best practice to build a better future. The principle is basic: if we have healthy Mexicans, companies and the public sector would register a better performance and, consequently, economic activity would register better numbers. How to face costs, have the necessary infrastructure, treat chronic degenerative diseases and maintain a decent level of quality of life?

DR. DAVID KERSHENOBICH STALNIKOWITZ , DIRECTOR GENERAL OF THE NATIONAL INSTITUTE OF MEDICAL SCIENCES AND NUTRITION SALVADOR ZUBIRÁN

ÁNGELES DE GYVES , CEO OF THE CORPORATE HEALTH AND WELFARE COUNCIL

11:00 HRS. PANEL. 2

"THE DIGITAL WORLD IN HEALTH"

The patient has changed and that forces companies in the sector to adapt to the new circumstances. The digital revolution is largely responsible for this transformation. How to understand the new consumption habits? How to transmit the information to customers? This table will be aimed at understanding and applying the best techniques to know the voice of the e-patient.

JENNIFER BARBA , FOUNDER AND CEO OF FRAME CONSULTING

ALEJANDRO PAOLINI , MANAGING DIRECTOR OF SIEMENS HEALTHINEERS MESOAMÉRICA AND MEXICO

HÉCTOR VALLE MESTO , EXECUTIVE PRESIDENT OF THE MEXICAN FOUNDATION FOR HEALTH, AC

JORGE RUIZ ESCAMILLA

11:30 HRS. PANEL. 3

"HACKING HEALTH"

New forms emerge as a muscle for efficient use and maximization of resources, patient management and electronic records. Along with this, home care, mobile applications and regulatory challenges begin to be promoted. Also, the best practices of IT companies. This space will serve to know the best strategies that allow the Health Sector to capitalize on the new trends.

MARTHA GONZÁLEZ , DIRECTOR OF IBM WATSON & amp; CLOUD PLATFORM

JAVIER CORDERO , PRESIDENT OF ORACLE MEXICO

FERNANDO OLIVEROS , CEO OF MEDTRONIC

GABRIEL LOOR MD., FACC , SURGICAL DIRECTOR, LUNG TRANSPLANT PROGRAM BAYLOR AT ST. LUKE'S MEDICAL CENTER

MODERATOR : ARMANDO SANDERS , CO-FOUNDER OF GENO +

12:00 HRS. PANEL. 4

"HEALTH AS A BUSINESS AND INVESTMENT"

Health is a good investment. The Mexican Pharmaceutical Industry as a contributor to the productive capacity of the country. Multinational and Mexican companies will share their success stories and strategies to adapt to market conditions.

RODRIGO PUGA , CEO OF PFIZER MEXICO

ANA LONGORIA , CEO OF NOVARTIS MEXICO

RAFAEL GUAL , DIRECTOR GENERAL OF CANIFARMA

VLADIMIRO DE LA MORA , PRESIDENT OF GE MEXICO

MODERATOR : JUANA RAMÍREZ , FOUNDER AND PRESIDENT OF SOHIN

12:30 HRS. CONFERENCE.

"EXPONENTIAL HEALTH", ACCORDING TO SINGULARITY UNIVERSITY

RAYMOND MCCAULEY , CHAIR OF THE BIOTECH TRACK OF SINGULARITY UNIVERSITY

13:00 HRS. TIME FOR FOOD

14:30 HRS. PANEL. 5

"THE NEW FINANCING"

Pharmaeconomics, changing the health dialogue. Going from asking for "budget" and "demonstrating that health brings productivity". This space has a clear objective: to understand public finances and the impact it has on the country's fiscal balance. What are the new financing models? Topics such as investment in infrastructure, private equity and health financing models will be put on the table.

PATRICK DEVLYN , PRESIDENT OF THE CCE HEALTH COMMISSION

PABLO ESCANDÓN , PRESIDENT AND DIRECTOR GENERAL OF GRUPO NADRO

FRÈDÈRIC GARCÍA , PRESIDENT OF THE EXECUTIVE BOARD OF GLOBAL COMPANIES (CEEG)

FÁTIMA MASSE , CONSULTANT IN URBAN URBAN DEVELOPMENT

ANTONIO CHEMOR RUIZ , NATIONAL COMMISSIONER OF SOCIAL PROTECTION IN HEALTH / PEOPLE'S INSURANCE

MODERATOR : GUSTAVO CANTÚ , CEO OF SEGUROS MONTERREY NEW YORK LIFE

15:00 HRS. PANEL. 6

"THE END OF THE TRADITIONAL DISTRIBUTION"

New disruptive models of distribution and access to primary health care. The customer service in the last chain of the process in the distribution of the drug is being transformed.

MAX LEONARDO , ATTORNEY GENERAL OF PHARMACIES OF SAVINGS

RICARDO MARTÍ , DIRECTOR OF WALMART FARMACIAS

15:30 HRS. CONFERENCE.

"BENEFITS OF AEROSPACE MEDICINE ON EARTH"

EMMANUEL URQUIETA, MD, MS , SENIOR RESEARCH PORTFOLIO MANAGER OF THE TRANSLATIONAL RESEARCH INSTITUTE FOR SPACE HEALTH

16:00 HRS. HEALTH VIEWED BY THE NEXT SEXENIUM

The political times are already here and, under this environment, this table will convene the links of the candidates to the Presidency of the Republic to share with the audience the great tasks that would be carried out in the next six years.

JORGE ALCOCER VARELA , REPRESENTATIVE OF ANDRÉS MANUEL LÓPEZ OBRADOR, PRESIDENTIAL CANDIDATE FOR THE COALITION TOGETHER WE WILL HISTORY

16:30 HRS. CLOSING

***********

And here's an article in the Mexican edition of Forbes describing some of the health problems faced in Mexico:

La biotecnología puede ser una cura para muchos males en México
México está enfermo: Cada año unas 100 mil personas mueren a causa de diabetes, 80 mil por infartos y 80 mil por tumores, sin embargo, la tecnología podría estar cerca de cambiar las reglas del juego. Este tema y otros se tocarán en el Foro Forbes de Salud.

Google translate:
"Biotechnology can be a cure for many ills in Mexico
Mexico is sick: Every year about 100 thousand people die from diabetes, 80 thousand from heart attacks and 80 thousand from tumors, however, technology could be close to changing the rules of the game. This theme and others will be played at the Forbes Health Forum."