July 2015

CBO Responds to Questions About Telemedicine

Question: Would expanding Medicare coverage for telemedicine increase or decrease federal spending? Whether expanding Medicare coverage for telemedicine services would increase or decrease federal spending is difficult to predict, but doing so depends on two main considerations:

  • The payment rates that would be established for those services
  • Whether those services would substitute for (or reduce use of) other Medicare-covered services or would be used in addition to currently covered services.

Given the substantial interest in proposals related to telemedicine, CBO has prepared a discussion which further describes the issues that arise in defining a telemedicine benefit and how CBO estimates the budgetary effects of those proposals. How CBO Estimates Effects on Spending: CBO seeks to incorporate information from a variety of sources when estimating how proposals to expand telehealth or telemedicine services that Medicare covers might affect the budget. Those sources include available data about the costs of covering similar services and the results of academic studies investigating how telemedicine affects health care spending. In particular, CBO considers the evidence about spending on telemedicine services in Medicare itself, in the Department of Veterans Affairs, and in the Medicaid program. CBO also considers evidence about the use and effects of telemedicine in Medicare Advantage plans (private plans delivering Medicare’s benefits) and other private health plans. In doing so, the agency accounts for the potential differences in benefit management between private and public plans noted above. CBO also consults experts who help the agency understand how telemedicine may affect health care spending.

Here’s today’s depressing chart about the state of journalism

[Commentary] Here are the raw numbers: In 2014, the workforce at daily newspapers in the United States was 36,700. In 2015, it's 32,900. That's a 10 percent drop --in one year! Ten years ago, there were 54,100 people working at daily newspapers; that's a 39 percent drop over the last decade. Now, yes, it is true that the ASNE numbers document only people working for daily newspapers. So, the Washington Post is included but Buzzfeed, for example, is not. There are more than 32,000 people working in newsrooms and as journalists in the country. Even so, the decline documented above is staggering; there's simply no way that the growth in online-only publications has made up for the massive erosion in daily newspapers.

No matter what you think of the media -- and, judging from polling, most of you don't think much of it -- this data is very bad news for accountability in our political system (and elsewhere). The less people watching, the lower the likelihood that attempts to skirt rules and laws get flagged. The less people watching, the more willing people are to try things they might never do if they knew someone was tasked with keeping an eye on them. The rapid decline in the number of journalists employed by daily newspapers isn't just bad news for members of the media. It's a very bad thing for society too.

Net Neutrality -- An Update

[Commentary] The Federal Communications Commission’s Network Neutrality rules became effective on June 12. Since then, contrary to the warnings of some opponents, the digital world has not stopped turning. On the other hand, while Net Neutrality supporters were jubilant, there has been little visible change for the good, either. That should not be surprising, since the most important impact of the new rules is in shaping future conduct. Even so, for those interested in preserving an open Internet, there are a number of developments worth noting.

37 million Americans don’t use the Web. Here’s why you should care.

In 2000, nearly half of Americans didn't use the Web. Now that the figure stands at 15 percent, it's clear we've come a long way. But these remaining holdouts are likely to be the hardest to reach, because you can't just throw money at them. Of non-Internet users surveyed in 2013, just 19 percent cited the cost of Internet or owning a computer as an obstacle to adoption. Many more, 34 percent, said they didn't find the Internet relevant to them. Thirty-two percent said the Web was too difficult to use. Federal studies have shown that although 10 million disconnected Americans might be willing to get online at the right price, that still leaves some 27 million people for whom price is practically irrelevant to their decision to stay offline.

As the rest of us use the Internet to do homework, find jobs, make friends, get the news, earn a living, learn new skills, buy groceries, organize politically and do a seemingly endless range of other activities, encouraging the disconnected to hop online has become a national priority. New programs are being launched all the time in Washington to expand Internet access, sometimes by federal agencies that would appear to have nothing to do with the Internet.

"If you build it, they will come," goes the adage. But for these folks, simply building out the Internet isn't enough; convincing them that the Web could help them grow is crucial to getting them online. And it's not merely a matter of waiting for old fuddy-duddies who don't "get it" to die off: As the data show, older people have been among the quickest to adopt the Internet among the disconnected population. By contrast, there are real structural challenges (poverty and inequality) that are keeping younger, less socially mobile populations from becoming America's next great inventors or scientists or civil servants. And those people matter, too.

Imagine life without Internet

[Commentary] The divide between Americans who have access and those left behind is too great. But this divide can be bridged with the Federal Communications Commission's recent proposal to expand the Lifeline program to include broadband. The Lifeline program was established in 1985 under President Ronald Reagan to help low-income Americans have access to affordable communications. Under President George W. Bush, the program was updated to include both wireline and wireless technology. It's time to bring it up to date again. The FCC is on the right track as it explores new ways to modernize the program.

Research shows that broadband adoption in the home improves household income, leads to more employment opportunities and increases independence. And strong, thriving households lead to strong, thriving communities. Access to broadband also has implications for democracy. It lets people join conversations that directly impact their own communities. Increasingly, communities of color rely on broadband services to mobilize powerful movements and public voices on important issues such as immigration and the rights of low-wage workers. Groups such as Color of Change and Voto Latino come immediately to mind. Expanding the Lifeline program to include broadband would further elevate underrepresented voices and spur civic engagement. This is exactly what our country needs to help close the digital divide and ensure that everyone -- no matter who they are or where they live -- has a chance to improve their life and provide for their loved ones. The FCC gets this. We understood this under President Reagan's administration and President George W. Bush's administration. Now it's up to our current policymakers to back this up, too.

Georgia sues legal rebel for posting state’s copyrighted law online

While they aren't even suing over a music recording or motion picture, the Georgia's copyright complaint can be seen as equally nitpicky. Georgia claims that a legal rebel, Public.Resource.org, is publishing and making it easy for others to copy the physical text and accompanying annotations of Georgia's state law -- the Official Code of Georgia Annotated.

"We had a similar showdown with Oregon but no court case," said Carl Malamud, a Californian and the man behind the site. "They did the civilized thing and held hearings and then decided that the law belongs to the people." The state's Code Revision Commission maintains that PublicResource.org is not entitled to reproduce the annotated version of Georgia’s code. Georgia is essentially saying it is not OK to copy and distribute the texts of the state's laws if those texts are accompanied with the state-owned summaries of what the law actually means. Keep in mind, it remains totally kosher to distribute and copy the actual text of the state's laws. Again, it depends on where you line up on the debate.

Tata finds 26 companies set to spend $1 billion on the Internet of things in 2015

Twenty-six companies (including 14 in the US) plan to spend $1 billion or more each on Internet of things initiatives in 2015 according to research out from Tata Consultancy Services. That billion-dollar group comes from seven industries: six from banking and financial services; five from automotive; four from travel, hospitality, and transportation; four from high tech; three from insurance; two telecommunications firms; one retailer; and one from healthcare and life sciences.

Those companies are outliers, but a broad swath of businesses intend to invest $86 million in 2015 -- or 0.4 percent of their revenue -- on Internet of things projects according to Tata Consultancy. And while surveys about the purported value of the Internet of things are a dime a dozen, this one also offers excellent points about the cultural changes that would need to accompany the technical implementations if businesses really wanted to take advantage of the promise of the Internet of things.

Will digital Service Funding Survive Congressional Penny Pinching?

The White House’s US Digital Service team, which is approaching its first birthday and has staffed up over the past year with top techies from Silicon Valley, is getting tight-fisted treatment from lawmakers in the spending bills being hashed out on Capitol Hill. The Obama Administration’s plan to embed similar digital tech teams at agencies across government has also run into congressional penny pinching, even as lawmakers say they support the teams’ role in turning around troubled government IT projects.

The Senate appropriations committee approved an annual spending measure that would grant USDS just one-third of the new funding President Barack Obama requested to scale up the “stealth startup” team. The Senate Financial Services and General Government Appropriations bill OK’d a $5 million increase for the Office of Management and Budget’s IT fund, which is currently operating with a $20 million budget. The Administration had sought an additional $15.2 million for 2016 to support the growth of the White House tech team and other governmentwide IT initiatives. The House appropriations committee, meanwhile, has recommended nixing new digital service funding. The Senate committee didn’t specify why lawmakers decided not to fully fund the Administration’s request, although annual caps on agency spending -- the result of a 2011 bipartisan budget deal, which the White House wants to renegotiate -- limit the amount of new spending.

The Future-Forward Cybersecurity Fix

[Commentary] Recent breaches to US federal computer networks -- such as the Office of Personnel Management hack -- have catapulted the need for improved identity management and authenticated access to the top of the national agenda. The White House-mandated a 30-day call for action for all federal agencies: tighter control of privileged user access and multifactor authentication. After closing out the “30-day sprint” July 11, the government committed to a July 20 results announcement date only to delay the release until an undetermined date. The delay may serve as an indication the government has a long way to go in its efforts to increase network security, yet meeting the call for improved identity authentication is largely achievable within the existing infrastructure of any government computer network. Today, all federal employees have already been issued Personal Identity Verification credentials, which can be leveraged by a derived credentials system to instantly enhance secure network access from mobile devices.

The US government is playing catch-up on security primarily because it has not been able to keep up with the advances in technology over the last decade. With the imminent availability of derived PIV credentials, the US government can effectively address the critical need to improve the current state of cybersecurity. The growing demand for a more mobile work environment for federal employees and the introduction of new connected devices will create new potential entry points for unauthorized access within a government network.

[Chris Edwards is chief technology officer at Intercede]

Sheryl Sandberg says Facebook will publicly share its internal diversity training

Despite the fact that its own diversity numbers haven't moved much in the past year, Facebook has decided to publicly share its internal program for training employees on unconscious bias. Sheryl Sandberg, the company's chief operating officer and a leading advocate for women's careers, wrote that the social network is releasing its course to outsiders. The company launched a Web site that includes video modules of its training course, slides used in the presentation and a downloadable worksheet with a bulleted list of "what you can do." "Many people have asked if we'd be willing to share our training outside of Facebook," Sandberg wrote, noting that the company has worked with "leading researchers" to develop the course. "Managing bias is an essential part of building diverse and high-performing organizations. We know we still have a long way to go, but by helping people recognize and correct for bias, we can take a step towards equality."