This is way back when when i was a graduate student at the university of california berkeley where secretary napolitano runs these days, we learned about wedge issues. Wedge issues were those things that really divided the electorate, got everyone excited, everyone had an opinion about. Well, immigration has become a wedge issue. Wedge issues kind of come and go, and depending upon the year, and clearly since 2015 when President Trump started to run for office, immigration has been at the forefront in terms of one of the wedge issues. It divides not just democrats and republicans, it divides republicans. In fact, there is an nbc wall street journal poll out today that has fascinating divides within the Republican Party between Trump Supporters and people who were call themselves more or less traditional republicans. So, this is a big issue. This is an issue that everyone has an opinion about as opposed to many of the other issues we talk about here at brookings, telecommunications and
ALJAZAM Your World This Morning January 20, 2016
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So to give you a sense of why that really diminishes the incentives, if you think about an aco increasing spending during a Contract Period, medicare shared savings program, aco for example that isnt facing any Downside Risk, they are penalized for doing that. And it increases their benchmark for the following Contract Period and then they can receive a shared savings bonus for doing nothing. Under the pioneer program, they are penalized for doing more, but again theres that offsetting effect by the benchmark going up and the subsequent Contract Period, so for pioneer acos the incentives are more akin to fee for service with a lag. Then, thinking about the fixed costs of investing in systems to actually control spending, the rebasing is that much more of a problem because it may be hard for acos to recoup their investments of investing in the right systems. So that is one challenge. And i know sean and his team is working hard on a revamped proposed rule for the shared savings program.
Microphone, please give us your name and where you go to school. If anyone would like to come up. Here is our first inquire. He is adjusting it. Until someone gets the courage up, you mentioned nate silver. He offers the fascinating thesis that it is that talking heads on all the cable channels are the ones who are constantly predicting things that, believe it or not, have the worst prognostication records. He said that the amount of minutes you are on television are inversely proportionate to the accuracy of your predictions. I listen to your show every sunday afternoon. I want to know, i saw on your web site that you went through an independent bookseller. I am wondering about the role of amazon in the book industry and how it is hurting it. Actually, norton bought the book. They wanted it. I was delighted that they did. We were proceeding along very well. It is owned by time warner, and they came in and said by the way, we own all rights to it. We can do what we want with it without