This is a great piece on how a nonprofit hospital system, Parkview, amassed 69% market share in Fort Wayne, IN through acquisitions and now abuses that power at the expense of the community. It details many of the worst practices of the industry and is worthy of a thread. 1/12 Since 2000, ParkView Hospital has acquired 6 hospitals & 100s of provider locations in/around Fort Wayne. When it couldn't acquire a community hospital voluntarily, it bought local doc practices and siphoned referrals away, crippling its finances until it relented and sold. 2/12

Had the opportunity to do a ride-along with police in LA this week. A few observations about LAPD, and policing in general.
THREAD 1/9 The majority of calls for service had mental illness and/or substance use as a direct cause. The vicious cycle of addiction -> mental illness -> low level crime -> homelessness -> addiction is an incredible driver of social ills without an easy fix. The suffering caused by fentanyl was very clear, and is unlike any other drug epidemic in history. 2/9

The addiction treatment industry has the perfect conditions for fraud:
- fast growing demand
- new reimbursement programs
- desperate clientele
- difficulty to differentiate quality
And sure enough the scammers came for people at their most vulnerable moment. 1/4 It's why we @Arnold_Ventures seed funded the Shatterproof Treatment Atlas, a tool that measures treatment centers against clinical best practices. It helps consumers and payors find quality centers that maximize the chance of success and steer clear of the vultures. 2/4

Americans have been wasting billions a year on cold medicines like Sudafed & Benadryl with the active ingredient phenylephrine, despite conclusive evidence they don't work. But a report published yesterday may finally lead to the removal of these drugs from pharmacy shelves. 1/6 It's a great example of the waste in the healthcare system that leads to high costs/poor outcomes. A vote next week will be a big test whether the FDA follows the science or caves to industry pressure. 2/6

Kudos to Austin for recently approving a >50% reduction in the minimum single-family lot size to address rising housing costs. IMO, this is the most impactful change most cities can enact to maintain economic vibrancy and improve residents' standard of living. THREAD 1/n Austin’s reforms are similar to, though not as aggressive, those enacted in Houston 25 years ago. In 1998, Houston reduced minimum lot size from 5000 sq ft to 1400, allowing 3 townhouses or 2 detached houses to be built on land that had previously held one house. 2/n

A long-time criticism of charter schools is that their results don't beat district schools. But the average performance conflates 3 very different models. Deeper analysis of the new CREDO study shows that urban charters create very significant learning gains.
1/6 The charter sector comprises 3 types of charters: urban (54%), exurban (40%), and virtual (6%). Urban charter schools averaged a very significant 29 additional days of learning per year compared to district schools. However, exurban charters, on average, did not outperform.
2/6

The desire to be independent of FERC jurisdiction has kept ERCOT as a separate grid, but why are the Eastern and Western Interconnects separate and not linked? Turns out to be a remnant of history and geography. 1/6 Electrical systems were developed where people lived. In the first half of the 20th century, most people lived in the eastern half of the US or the West Coast (stll largely true). Very few people lived in the Plains because of tough climate, soil and transportation networks. 2/6

There's a widespread, but incorrect, belief that wind and solar costs are falling and will inevitably keep doing so. The widely underreported reality is that prices are up 30-60% from pre-pandemic lows. The first step to reversing this trend is to acknowledge it. 1/6 This cost increases are well known by industry but absent from public discourse. Two recent studies document it. Here is Lazard's LCOE study, showing the large price declines leading up to 2021 but an increase from $36 to $60 for solar & $38 to $50 for wind over past 2 years. 2/6

It's now clear that in order to meet our goals for affordable, reliable, clean and secure energy, the US must have more interregional transmission lines. Yet, because of past frustrations, there are way too few resources dedicated to modernizing the grid. 1/4 In 2021, I committed to try and build this needed infrastructure, pairing with industry vet Michael Skelly to start Grid United with a stakeholder-first model and funding level that had never before been tried. 2/4

Amgen’s new Humira biosimilar is launching at 2 different list prices: a 5% discount & a 55% discount off Humira’s ≈$80k list price. Exact same drug, very different prices. Yet they'll likely sell much more of the higher $ drug. Welcome to dysfunctional world of drug pricing. 1/ PBMs, the drug buying orgs that insurers either own or contract with, will prefer the higher priced version, as they can negotiate bigger discounts off the list price. Rebate more $ to PBMs and they will steer more patients to the biosimilar. Don't, and they won't. 2/

The story of healthcare over 2010s was horizontal consolidation, with each sector being dominated by a handful of firms. The story of 2020s is vertical consolidation, with winners of each sector pairing up to create an oligopoly of giants controlling most of the value chain. 1/6 Insurers, physician practices, hospitals, PBMs, pharmacies, data analysis & home health providers are all part of the consolidation. Every company involved in insurance, delivery & analytics is ending up in the blob. (Drugs and devices are consolidating outside the blob). 2/

There's a vicious cycle of addiction, mental illness, homelessness, poverty, and criminal behavior that has been incredibly difficult to break. Everyone agrees that jail doesn't break the cycle, but it’s become the default answer because of a lack of other options. 1/5 New research on a program funded by @Arnold_Ventures shows promise. Denver focused on people who had 8+ arrests over 3 years, randomly placing some of them in supportive housing. The results were significant: 40% reduction in arrests, 27% reduction in jail stays, 2/5

The political divide between police and IRS agents is that the collateral consequences of enforcement from the former affect lower-income communities while that from the latter affect higher-income communities. If you're against more IRS agents because of worries of collateral consequences of enforcement and the costs of enforcement borne by the law-abiding, you should also use that same framework to think about policing in general, and vice versa.

Carried interest taxation is back in the news, so here’s a little background on the issue and why I think the compromise that created both the current law and the proposed change are bad policy by creating misalignment between managers and investors. 1/ Prior to 2017, if a fund manager received an incentive fee on the investment fund (often 20% of profits), the income was taxed the same way as the investment was taxed for the investors (i.e. long term cap gains if held for >1 year). 2/

Kudos to @EdDebtJustice for winning $6 bln of student loan forgiveness for 200k students defrauded by predatory colleges. It's a high point of our work at @Arnold_Ventures to fix the student loan program that enables bad actors & harms students. Thread..1/
nytimes.com/2022/06/23/bus… Laura and I are privleged to run @Arnold_Ventures, which has the $ and human capital to work to improve systems that harm the people they’re supposed to help. The higher-ed financing system is one of those programs. Too often, enrolling in college makes students worse off. 2/

Government has invoked the Defense Production Act at least 6 times since 2020 when a shortage has occurred for a strategic product. Natural gas today fits this description. Rather than responding with helpful policies, gov’t helped create the shortage & is making things worse. 1/ NG prices are up 3x in past year, reaching record highs in the shale gas era. Previously, the market has responded with a flood of new supplies. But the regulatory state has effectively capped growth in the largest and most prolific gas region in the US. 2/

graph via @sheetalrbn

Even Energy Sec Granholm is calling for higher oil production. However, besides shale, it can easily take 2-4 years from final investment decision & start of production. Term pricing, not spot, drives investment. But, term crude prices settled lower yesterday than a month ago. 1/ Green line is prices at close yesterday; blue line 1 month ago. The market is saying that energy crisis today will have structural supply and demand impacts, resulting in lower prices starting in 2025. This is not the signal producers are looking for to increase investment. 2/

Infuriating expose on how decades of concessions to NYC correction officers' union has led to complete dysfunction at Rikers. Despite having most expensive & best-staffed system in nation, detainees essentially run the jail.
Many thoughts below... 1/
nytimes.com/2021/12/31/nyr… The core issue, and one local Dem politicians need to grapple with, is there exists a conflict between labor and system outcomes. Whether in schools, prisons, police, fire, etc, when politicians completely acquiesce to unions, social service outcomes suffer. 2/

Thread about rebirth of CTE:

The 'college for all' movement was valuable in ensuring a path existed for all students who desired & had skills for higher-ed to have the opportunity. But to the extent it tried to force all kids down the college path, the movement harmed many. 1/9 One unintended effect was relegating college and technical ed to a couple classrooms in the back of the school. But for some students, working with their hands in fast-growing, middle-class+ fields is how to keep them engaged in school. And CTE doesn't preclude higher-ed. 2/9

Absolutely heartbreaking stories shared by America's veterans who fell prey to deceptive, low-quality "colleges". They waste students' time & scarce GI Bill $ while leaving vets with debt & worthless degrees. Govt is complicit in allowing these schools access to federal funds. 1/ “I never expected that going to college would be such a negative force in my life. But so far, I have no college degree, very few transferable college credits, and unrelenting student loan debt.” - Air Force veteran Joshua Queen 2/7

The energy crisis in Europe is a wake-up call that US must ensure a smooth transition to decarbonization (i.e. reasonably priced energy). Efforts by some to kill oil/gas industry will result in price spikes to levels that risk losing voter support for the energy transition. 1/ A perfect storm of factors has caused UK gas prices to jump 4x this year, from $6 to $24/mmbtu. For reference, US gas is $5 after doubling since the spring. UK electricity providers are going bankrupt, industrial plants are shutting down, and this spike may cause a recession. 2/