Friday, May 1, 2015
Bipartisan Bill Proposes National Complete Streets Policy
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Sick Juror Keeps Dzhokhar Tsarnaev Relatives In Boston Under Tight Security
The surprise announcement by District Judge George O'Toole on Thursday morning delayed the departure of five of Tsarnaev's relatives who flew in from Russia and are being kept under tight security at an undisclosed location.
The family members were expected to testify for the defense on Thursday and board a flight home on Friday.
A security detail of 16 FBI employees is monitoring them around the clock. Because of the considerable expense to taxpayers, the prosecution had insisted that they testify by the end of the week, according to the transcript of a private meeting in the judge's chambers, The Boston Globe reported.
“It’s an enormous expense and distraction for the agency, and that’s just part of the expense that the government has endured,” Assistant U.S. Attorney William Weinreb said in the Monday meeting with O'Toole and the defense, according to the transcript.
William Fick, one of Tsarnaev's lawyers, said he couldn't guarantee that the defense would be ready for them on Thursday, according to the transcript.
The jury convicted Tsarnaev, 21, on April 8 of charges related to the 2013 bombing. The same seven women and five men will sentence him to spend life without parole in isolation at a federal prison or to be executed.
Some of the relatives have been seen in the courthouse in South Boston this week wearing devices on their ankles.
The relatives checked into a Hampton Inn in Revere, Massachusetts, on April 23, but were then whisked away to another location because members of the news media kept poking around the hotel. A Revere police official said at the time that six relatives had been moved, though the transcript of the meeting notes that five are expected to testify.
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Obama chooses Chicago to host his presidential library
U.S. President Barack Obama speaks at a Civil Rights Summit to commemorate the 50th anniversary of the signing of the Civil Rights Act at the LBJ Presidential Library in Austin, Texas on April 10, 2014. Photo by Kevin Lamarque/Reuters
WASHINGTON — President Barack Obama has chosen his hometown of Chicago to host his future presidential library, two individuals with knowledge of the decision said, placing the permanent monument to his legacy in the city that launched his improbable ascent to the White House.
Obama’s library will be built on Chicago’s South Side, where the University of Chicago has proposed two potential sites not far from the Obama family’s home. It was unclear which of the two sites had been selected, but an official announcement was expected within weeks.
For Chicago, the decision solidifies the city’s claim to Obama and the legacy of the nation’s first black president. Yet it marks a harsh letdown for New York and Honolulu, two other cities that played pivotal roles in Obama’s journey and competed fiercely to host the library.
While the library won’t be built until after Obama leaves office, fundraising has already started for the expansive project, which is expected to cost hundreds of millions of dollars to build while serving as an economic engine for the surrounding area. The Barack Obama Foundation, formed by longtime Obama associates, screened proposals and recommended the winner to the president and first lady Michelle Obama, who only recently made the final decision.
Although Chicago’s victory had long been anticipated, the decision brings to a close a hard-fought competition that began in the earliest days of Obama’s second term. What started as quiet discussions among Obama loyalists in and out of the White House kicked into high gear in 2014 when the foundation began soliciting proposals and interested parties began lobbying the president in public and in private.
An initial list of about a dozen pitches was culled to four universities that the foundation invited to submit comprehensive proposals, replete with architectural designs, programming ideas and zoning assessments.
Each school had a compelling case to make.
The University of Hawaii, not far from Obama’s childhood home in Honolulu, cast its proposal as an opportunity for Obama to continue his focus on the Asia-Pacific region after leaving office. New York’s Columbia University, where Obama went to college, offered prime real estate on its new campus expansion in West Harlem. And the University of Illinois at Chicago presented its proposal as a chance for the president to invigorate a blighted neighborhood while reinforcing his commitment to public education.
Little is known about the contents of the University of Chicago’s winning proposal, which the school has declined to make public. Still, the president has suggested that the library may be only one component of the post-White House project.
Presidential libraries often have accompanying policy institutes, presidential centers or museums. Obama has signaled an interest in spending time in New York and Hawaii after leaving the White House, and individuals familiar with the decision said Obama was likely to base other types of programming at the universities that lost out on the library itself.
Obama’s decision to place the library in Chicago was conveyed to The Associated Press Thursday by two individuals with direct knowledge of the decision. Both spoke on condition of anonymity because the decision hasn’t been publicly announced.
Obama’s foundation, the White House, the University of Chicago and Chicago Mayor Rahm Emanuel’s office all declined to comment.
But the individuals said the foundation’s chairman, Obama pal and businessman Marty Nesbitt, spoke with the president earlier in the week about the announcement. A news conference that had been scheduled for Wednesday to announce the decision was postponed at the last minute, and is now expected to be rescheduled for mid-May.
That the University of Chicago had the inside track grew increasingly evident as the competition progressed. After all, Obama taught law there before becoming president, Mrs. Obama once worked for the school’s medical center, and her former chief of staff was put in charge of running the university’s campaign to win the library. Half of the Obama foundation’s board lives in Chicago.
Yet while the Obamas had intended to announce the winning site by the end of March, a messy confluence of Chicago politics and Obama’s busy schedule led to multiple delays.
The university’s struggles to put forward a solid proposal burst into public view late last year when Obama’s foundation let it be known publicly that it had serious concerns. The school, in its proposal, had failed to prove it could secure the Chicago Park District land on which it was proposing to build.
That set off a scramble by university officials and Emanuel, Obama’s former chief of staff. Despite vocal opposition from a park preservation group, the City of Chicago moved to acquire access to the property while state lawmakers fast-tracked legislation ensuring that Chicago could use public park land for the project, all but ensuring the library would go to the South Side.
But when Emanuel failed to win enough votes in his March re-election to avoid a runoff, the foundation opted to hold off on a final decision until the runoff vote in April, the AP reported. The library had become a potent issue in the race, and the foundation wanted to avoid injecting the library decision into the political fray.
The post Obama chooses Chicago to host his presidential library appeared first on PBS NewsHour.
Medicare reveals how much it spends on prescription drugs for Americans
Illustration by Getty Images
The data show that 14 drugs cost the federal government and Medicare beneficiaries more than $1 billion each, accounting for nearly a quarter of Medicare prescription drug spending in 2013. Most of those drugs are used to treat chronic conditions that plague the elderly, including diabetes, depression, high cholesterol and blood pressure, dementia and asthma.
The brand drug Nexium, used to treat heartburn, acid reflux and related stomach ailments, cost the most: $2.5 billion for 1.5 million Medicare patients, who filled 8 million prescriptions and refills. The total cost included what was paid by Medicare, beneficiaries and third party groups such as supplemental health plans. The cost covered not just the drug ingredients but also sales tax and dispensing fees. It did not, however, include sometimes substantial manufacturer rebates, and the drug makers’ trade group warned that omission distorted the actual cost.
The most frequently prescribed drug was Lisinopril, a generic used to treat high blood pressure and help patients survive after heart attacks. The drug was prescribed or refilled nearly 37 million times by more than 7 million Medicare beneficiaries at a cost of $307 million.
Niall Brennan, the chief data officer for the Centers for Medicare & Medicaid Services, said agency analysts have been examining the data for several years but that “the data is larger and diverse enough that other outside folks may develop insights that we have missed.”
Dan Mendelson, the CEO of Avalere, a Washington, D.C., consulting firm, said the data could provide patients with new questions about their prescription history when they visit their physician. “It’s really important to stimulate conversations that get patients more actively engaged in their care,” he said.
However, he noted that some doctors may not take kindly to a more inquisitive patient and longer conversations. “In the shorter term, I think it will irk some physicians,” he said.
The database tracked 3,450 different drugs prescribed by a million doctors, nurse practitioners, medical students, dentists and other providers.
The most expensive drug per prescription was Carbaglu, a man-made enzyme used to treat people with high ammonia levels in the blood caused by a rare disorder, according to a Kaiser Health News analysis of the data. The drug was dispensed only 24 times, but at nearly $60,000 per claim it cost the government $1.4 million.
Among drugs dispensed to at least 10,000 beneficiaries, the most expensive was Revlimid, KHN found. It is used for some cancer patients. Dispensed for 24,637 patients, Revlimid cost $8,778 per claim. That totaled more than $1.3 billion.
Drug prescribing varied considerably among states, KHN found. Rhode Island and Nebraska had the most claims per Medicare beneficiary, averaging 4.6 per patient. Delaware had the lowest number, with the average number of claims per beneficiary at 3.3.
The CMS data is likely to be used in conjunction with other datasets the government has previously released, including what procedures individual doctors billed to Medicare and how much those cost. Analysts are also sure to look for relationships between drugs commonly prescribed by doctors and another Medicare database showing payments physicians received from drug companies for research, gifts, speaking fees, meals or travel.
Pro Publica, a nonprofit news site, obtained similar data for earlier years through the Freedom of Information Act and has already published analyses.
The Pharmaceutical Research and Manufacturers of America called the data misleading. “Significant price negotiation exists in Part D and results in rebates of as high as 20 to 30 percent for branded medicines,” the association’s president, John Castellani, said in a written statement. “These savings are not reflected in the data. Rebates have been a significant factor in keeping Part D program costs hundreds of billions of dollars below original estimates, while still offering beneficiaries steady premiums and a robust choice of plans.”
The American Medical Association also cautioned that the data could be misinterpreted.
“The data does not account for varying strengths or dosage levels of the medications or varying patient needs,” the association said in a written statement. “For example, a physician could prescribe a low dose of a medication and at a later time need to prescribe another, stronger dosage for the same patient if the low dose isn’t meeting their need or if the patient has an adverse react.”
The government noted that the top 10 most commonly prescribed drugs were generic and the 10 most expensive drugs were all brand name. The finding is not surprising since some brand name drugs are protected from competition by their patents.
An analysis Medicare released with the data found that in some parts of the country brand drugs were dispensed much more frequently than generics. Doctors in the western part of the country, including Washington, Oregon, Idaho and Nevada, and parts of in the Midwest leaned heavily toward generics, which tended to be dispensed between 78 percent and 81 percent of times. Brand drugs were favored in much of Texas and Alaska, where generics were dispensed in between 65 percent and 75 percent of cases.
Federal officials also calculated how prescription patterns varied among medical specialties. Family practice doctors prescribed the most drugs, followed by internal medicine doctors. Among the biggest medical specialties, psychiatrists prescribed the most expensive drugs, averaging $104 for a prescription or refill. While hematologists and oncologists were not among the top prescribers, their drugs averaged $550 per claim. The average cost of all prescriptions or refills was $75.
The data does not present a complete picture of physician prescribing. Most notably, it includes only those drugs for 36 million beneficiaries that were billed to Medicare’s Part D program, which make up 68 percent of all the people on Medicare. It does not reflect the prescriptions doctors wrote for privately insured patients or those on other government programs such as Medicaid. It also reveals nothing about the quality of these treatments or what kind of patients each doctor saw. The data also omit drugs administered in doctors’ offices and billed to Medicare’s Part B program.
To ensure that people could not identify beneficiaries, Medicare omitted prescriptions that were based on 10 or fewer claims per drug. That excluded 13 percent of claims.
Kaiser Health News (KHN) is a nonprofit national health policy news service.
The post Medicare reveals how much it spends on prescription drugs for Americans appeared first on PBS NewsHour.
Anger As Hurricane Sandy Victims Have To Pay Back Emergency Aid With Interest
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