Joint Select Committee Research Articles

The Potential Impact of Reduction in Federal GME Funding in the United States: A Study of the Estimates of Designated Institutional Officials

As a result of the decisions made in the Summer of 2011 to increase the federal debt limit of the United States,1 the Joint Select Committee on Deficit Reduction (the “Super Committee”) was formed to recommend to the Congress by 12 2011 reductions in federal spending to be accomplished over the next 10 years. Among the entitlement program elements being examined by the Super Committee, Medicare reimbursement for Graduate Medical Education (GME), the primary source of GME funding in the United States, has been identified as an opportunity for spending reductions. Specifically, the Medicare Payment Advisory Commission (MedPAC) has indicated that approximately 50% of the Indirect GME Reimbursement is not “empirically justified” on the basis of current costs of teaching hospitals intended to be covered by that reimbursement.2 This is seen by many as an opportunity for reduction. Furthermore, the Simpson Bowles Commission recommended a reduction in total GME funding in excess of 50% ($60 billion over 10 years) as a component of a comprehensive strategy to reduce federal deficit spending.3 This discussion occurs in the context of a predicted physician shortage, a mounting surge in the number of domestic graduates of schools of allopathic and osteopathic medicine designed to remedy that anticipated physician shortage,4 and slow growth in GME output over the past decade.5 However, this increase in medical school output must be accompanied by an increase in Graduate Medical Education, which is the required final pathway to entry into the unsupervised practice of medicine in the United States. As the body charged by the public and the profession with accreditation oversight of the vast majority of the GME programs in the United States, and to measure the quality of educational opportunities for physicians as they seek to prepare to meet the needs of the American public, the Accreditation Council for Graduate Medical Education (ACGME) attempted to estimate the impact of reductions in GME funding of the magnitude under discussion in our nation's capital on the educational pipeline for physicians.

COUNTDOWN TO BUDGET CONTROL

THIS WEEK the first step will be taken toward controlling the federal deficit, something that has garnered widespread attention, including that of the science community. By Wednesday, Nov. 23, the Joint Select Committee on Deficit Reduction—the so-called supercommittee—is to have completed its work on a plan to trim at least $1.2 trillion over the next decade from the federal budget. Once the supercommittee releases its plan, Congress will have until Dec. 23 to vote on the measure, and if it is approved, President Barack Obama will have until Jan. 15 to sign it into law. If a deficit-cutting measure fails to become law by the middle of January, automatic, across-the-government spending cuts will kick in with fiscal 2013 to achieve the statutory reductions. These cuts will affect both nondiscretionary funding—spending enacted by law, including entitlement programs—and discretionary funding—the money that supports federal agencies. This process was set in motion in August when Congress ...

Nobel Prize Honors Immunity Researchers

//tiny.cc/fyfxq) to the Joint Select Committee on Deficit Reduction in October. The letter emphasized that money spent on preventive health services yields a good return on investment. It cited a report by TFAH that estimated that a $3 billion per year investment in public health—approximately $10 per person—could save more than $15.6 billion annually within 5 years. Moreover, Hamburg noted, such an investment can “impact quality of life, reduce diseases [and] injuries, and may also have the result of saving money in the short and long term.” Pestronk noted that one of the difficulties facing public health departments’ efforts to secure adequate funding is that the work they do is often invisible in their communities. For example, such programs as immunization, preventive health services, or emergency preparedness may not be noticeable until they are no longer available. “Ultimately, over time people will discover they want those protections,” Pestronk said.

Groups Want Liability Reform Included in Budget Debates

Back to table of contents Previous article Next article Government NewsFull AccessGroups Want Liability Reform Included in Budget DebatesMark MoranMark MoranSearch for more papers by this authorPublished Online:4 Nov 2011https://doi.org/10.1176/pn.46.21.psychnews_46_21_6_1AbstractAPA joined the AMA and more than 50 medical specialty groups as well as state medical societies in urging the special congressional committee charged with devising a deficit reduction plan to include medical liability reform in its proposals. In separate October 3 letters, APA and the other medical groups told the cochairs of the Joint Select Committee on Deficit Reduction (often called the "supercommittee") that medical liability claims and the high cost of liability insurance for physicians contribute significantly to increasing costs in publicly funded health programs. "The inefficiencies of our current medical liability system, escalating and unpredictable awards, and the high cost of defending against lawsuits, including those without merit, contribute to the increase in medical liability insurance premiums and add billions of dollars to the cost of health care each year—which means higher government spending on Medicare, Medicaid, and other federal health benefits programs and higher health insurance premiums for patients," they said.The supercommittee cochairs are Sen. Patty Murray (D-Wash.) and Rep. Jeb Hensarling (R-Texas). It was established in the budget deal to which Congress agreed in August following a showdown over raising the debt ceiling. The 12-member committee—consisting of six members (three Democrats and three Republicans) from both the House and the Senate—was charged, as part of the budget deal, with determining how various federal programs will be cut and how the deficit will be reduced. "Regular" standing committees of Congress were required to recommend total savings and/or possible revenues of $1.5 trillion by October 15, and the Joint Select Committee must in turn vote on a package of savings/revenues by November 23 and report out a bill to the House and Senate by December 2. If the Joint Select Committee fails to act, or if Congress or the president fails to approve what the committee recommends, then "automatic sequestration"—mandatory cuts—will go into effect that must achieve $1.2 trillion in savings from defense and nondefense funding over 10 years (Psychiatric News, August 19). In their letters to the cochairs, APA and the other medical groups said that reforming the liability system will "save American taxpayers billions of dollars while protecting patient access to care." They noted that the Congressional Budget Office has estimated that implementing comprehensive medical liability reforms, including limits on noneconomic damages, would reduce the federal budget deficit by $62.4 billion over 10 years. Additionally, the groups noted, the National Commission on Fiscal Responsibility and Reform (appointed by President Obama) recommended in December 2010 that medical liability reform be part of a solution to reduce the federal budget deficit. APA and the other groups urged a list of specific reforms (see Liability Reforms Recommended by APA and Other Medical Groups) saying they would "save taxpayers money while simultaneously improving our health care and legal systems."The letters are posted at <www.psych.org/MainMenu/AdvocacyGovernmentRelations/GovernmentRelations/MLR-Murray-Letter.aspx> and <www.psych.org/MainMenu/AdvocacyGovernmentRelations/GovernmentRelations/Hensarling-MLR-.aspx>. ISSUES NewArchived

The Supercommittee Stirs LTC-Policy Pot

The Supercommittee Stirs LTC-Policy Pot

Congressional Action Expected on Therapy Caps

You have accessThe ASHA LeaderPolicy Analysis1 Nov 2011Congressional Action Expected on Therapy Caps Ingrida Lusis Ingrida Lusis Google Scholar More articles by this author https://doi.org/10.1044/leader.PA4.16142011.11 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In http://www.asha.org/Publications/leader/2011/111122/Congressional-Action-Expected-on-Therapy-Caps.htm Capitol Hill staffers indicate that Congress will most likely address the Medicare therapy caps issue by the end of the year, but aren’t predicting how. Since 1997, Medicare has capped the amount of Part B therapy services each beneficiary may receive each year. The caps—one for combined speech-language pathology and physical therapy and one for occupational therapy—were designed to control costs, but do not consider a patient’s need for treatment or the provider’s clinical judgment. Every year, Congress has either extended a moratorium on the caps or instituted an exceptions process that allows medically necessary services beyond the cap. Provider and consumer groups, however, are looking for a permanent solution rather than an annual congressional “fix.” Observers indicate two viable options: As the Joint Select Committee on Deficit Reduction formulates its recommendations on debt reduction under the Budget Control Act, larger Medicare legislation, including a new formula for establishing reimbursement rates, could be part of its recommendations. If the “Super Committee” addresses the formula, ASHA, the American Physical Therapy Association (APTA), and the American Occupational Therapy Association (AOTA) will urge committee members to address therapy caps at the same time. If the Super Committee does not address Medicare payment issues, observers anticipate Congress will pass a more modest approach—including a possible one-year extension of the current exceptions process. Caps were never intended as a long-term payment policy. When they were instituted, Congress also called on the Centers for Medicare and Medicaid Services (CMS) to develop a payment system for outpatient therapy services. To date, CMS has provided no recommendations on payment alternatives. ASHA, APTA, and AOTA have formulated a proposal that would create new billing codes for physical and occupational therapy (moving away from time-based codes to per-session codes), refine the therapy cap exceptions process, and repeal the therapy caps in 2015. The three organizations hope the proposal will be adopted as part of larger Medicare reforms, and are working with members of Congress to move it forward. The yearly moratorium to the caps and the exceptions process indicate lawmakers’ recognition that arbitrary limits on outpatient speech-language, physical therapy, and occupational therapy services are not in the patient’s best interests. However, the cost of repealing the caps and the lack of a viable alternative have forced Congress to maintain the status quo. ASHA and other stakeholders have worked with CMS for many years to develop an alternative payment system for outpatient therapy. ASHA also worked with CMS and its contractor to develop speech-language pathology-specific questions for a patient assessment tool for the Developing Outpatient Therapy Payment Alternatives project. The tool is in the data collection phase. Given that a new policy is unlikely in the near future, ASHA, APTA, and AOTA will continue to advocate for new payment methodology. ASHA also met separately with CMS in September to discuss health care reform legislation and potential long-term therapy cap alternatives. Author Notes director of federal and political advocacy, can be reached at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 16Issue 14November 2011 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2011 Metrics Downloaded 41 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2011 American Speech-Language-Hearing AssociationLoading ...

With Love and Rage: Notes on the Connections and Tensions Between Academia and Activism in Jamaica

This paper is a conference paper that was presented at 34th Annual Caribbean Studies Association Conference, June 2009 in Kingston, Jamaica on a panel organised by Freidrich Ebert Stiftung Foundation on the Nexus between Academia and Activism. The paper provides a discussion and an interpretation of academia and activism, connections and tensions therein, in Jamaica during legal reform process of sexual offences legislation, 2006-2007 involving civil servants, social justice advocates and activists representing rights of women, LGBT persons, children and persons with disability. The paper draws on two years of engagement with Government of Jamaica's Parliamentary Joint Select Committee on Sexual Offences formed in 2006-2007 to review and revise two pieces of legislation governing sexual offences – Offences Against Persons Act and Incest Punishment Act; into a new Bill – Sexual Offences Bill (passed in 2009); and examines key issues and challenges that arose over period.

Theatre Censorship: From Walpole to Wilson (review)

Reviewed by: Theatre Censorship: From Walpole to Wilson Alec Patton Theatre Censorship: From Walpole to Wilson. By David Thomas, David Carlton, and Anne Etienne. Oxford: Oxford University Press, 2008; pp. xvi + 280. $99.00 cloth. Theatre Censorship: From Walpole to Wilson is the first comprehensive history of British theatre censorship legislation. Authors Thomas, Carlton, and Etienne draw on previously unpublished archival material, including papers relating to the 1968 abolition of censorship, which were only made public in 1999. This work complements Steve Nicholson’s exhaustive research into the Lord Chamberlain’s readers’ reports, further illuminating the work of the court official who shaped the history of British theatre. Theatre Censorship is a rich scholarly resource, although the authors’ analysis of events is not always as rigorous as their research. The book begins with Henry VIII’s appointment of the first Master of the Revels, and ends with contemporary protests over plays such as Gurpreet Kaur Bhatti’s Behzti. This broad scope allows themes to resonate across centuries; for example, Queen Elizabeth’s decree that plays addressing religion or government are only to be performed for “graue and discreete persons” (8) anticipates the Lord Chamberlain’s twentieth-century tolerance of theatre clubs as “a sort of safety valve,” where a small, elite audience could see plays that had been refused a license (119). However, the book focuses primarily on five parliamentary fights over censorship: Prime Minister Robert Walpole’s establishment of the Lord Chamberlain as theatre censor in 1737; unsuccessful attempts to repeal or reform Walpole’s act in 1843, 1909, and 1949; and the end of official state censorship in 1968. Each of these was a year of great legislative upheaval. The authors do not fully explain why the waves of social change propelled legislation in 1737 and 1968, but drowned it in the other three years. But now that the authors have provided a lucid and thorough account of the events, the field is open to further research. At the outset, the authors explain that they intend to “disentangle issues of censorship exercised under the Royal Prerogative from censorship exercised under statute law” (2). Royal Prerogative cannot be questioned in Parliament without triggering a constitutional crisis, while statute law is passed by Parliament and therefore subject to legal challenge. Walpole’s act gave statutory powers to the Lord Chamberlain, who derives his power from the Royal Prerogative. Throughout the ensuing centuries, cabinet ministers would claim (either mistakenly or duplicitously) that theatre censorship operated under the Prerogative rather than statute law and was therefore outside the jurisdiction of Parliament. Whatever their understanding of the law, most MPs did not want to end censorship, and were even less eager for censorship to come under parliamentary jurisdiction. Thus a law that Walpole passed (by means of bribery and deception) in order to prevent playwrights such as Henry Fielding from writing satires accusing him and George II of corruption became, according to the authors, his most durable legislative legacy. The government’s position on theatre censorship is epitomized by a note sent by the secretary of state in 1909: “Personally I don’t think the present arrangement is at all satisfactory in principle, though it has worked tolerably well in practice. . . . But it is one of those questions which should be allowed to sleep as long as possible” (86). The government therefore maintained a policy of inertia, taken to its furthest extreme after the prime minister established a joint select committee to review theatre censorship in 1909 (probably in order to take censorship off the main parliamentary agenda). Unexpectedly, despite covert attempts by both the Home Office and the Lord Chamberlain to select sympathetic and malleable witnesses, the committee concluded unanimously that submission of plays for licensing should be optional, and that there should be no penalty for performing unlicensed plays. The government ignored the findings completely. “This,” the authors write, “was a superb demonstration of the hidden levers in English politics moving quietly and unobtrusively to thwart the clearly expressed recommendations of a Select Committee of both Houses of Parliament” (106). They also point out that this was not simply the “establishment” closing ranks: the Liberal government was at that time mounting...

Editorial: Bring back the veil!

Editorial: Bring back the veil!

The Royal North Shore Hospital inquiry: an analysis of the recommendations and the implications for quality and safety in Australian public hospitals

In October 2007, the New South Wales Parliament appointed a Joint Select Committee to inquire into the quality of patient care at Royal North Shore Hospital (RNSH). The inquiry was initiated in response to the publicity and complaints surrounding a patient who had a miscarriage in the toilets of the RNSH emergency department waiting area. The Committee held four public hearings and received 103 submissions. It handed down 45 recommendations in its report on 20 December 2007. There has been criticism from clinicians and others that the recommendations are too general and will not effect significant change for the severe systemic problems affecting the hospital. This article represents the view of some of the clinicians who work at RNSH, and who gave evidence at the inquiry, on the recommendations and some possible solutions for the health system in general.

Legislative Gender Quotas and Indian Exceptionalism: The Travails of the Women's Reservation Bill

In 1996 the Indian government introduced the Constitution (8 1st Amendment) Bill. This bill proposed that 33 percent of seats in the Lok Sabha (national parliament) and in state-level assemblies be reserved for women. In those constituencies, all contesting political parties would only run women candidates. After inconclusive debate, it was referred to a joint select committee, one-third of whose members were women MPs. The committee reported at the end of the year.' Faced with obvious manifestations of opposition, the government decided not to proceed to a vote. Reintroduced by the next government, led by the Bharatiya Janata Party (BJP) as the 84th Amendment Bill in July 1998, it provoked a stormy session in the house, featuring unprecedented scenes of snatching of papers from the Speaker and the law minister and the virtual coming to blows of members....2 Discussion of the bill stalled without ever going to an initial vote. Presented next (as the 85th Amendment Bill) in December 2000, in a virtual replay of earlier scenes particular party leaders trooped into the well of the chamber. When introduced one further time in May 2003:

Injecting Law into Politics and Politics into Law: Legislative and Judicial Perspectives on Constitutional Human Rights

Law, unlike political theory, is capable of providing minimum standards for objective assessments of the rightness and wrongness of political actions. Constitutional rights can affect the rule-making process in Parliament by influencing legislators and the executive, as well as judges, with specific ideas of right and wrong. The Parliamentary Joint Select Committee on Human Rights (JCHR) has provided a means of injecting such ideas into the legislative process, allowing Parliament to address human rights issues and forcing the executive to do so. The article analyses the ways in which human rights law has been allowed to affect law-making. It then considers whether the need for judges to enforce human rights has led judges to undertake activities that are more political than previously. To this end the article examines the techniques of self-discipline developed to ensure that the judiciary stays within its constitutional authority, illustrates how the proper relationship between judges, Parliament and the executive depends on context, and explores the effect of these developments on possible criteria for judicial legitimacy, including accountability and representativeness. It concludes that the interplay of human rights law and political judgment has had a positive impact, helping to open up and structure legislation and policy-making.

Inevitability, masculinity, and the American military tradition: the committee on the conduct of the war investigates the American Civil War

This essay examines the work of the Joint Committee on the Conduct of the War, a joint select committee of investigation formed by Congress during the American Civil War. During its tenure in the 37th and 38th sessions of Congress, the Committee investigated almost every aspect of Union military operations; however, its principal concern was the examination of Union military defeats. Members of the Committee on the Conduct of the War were influenced by the notion of inevitable Union victory. As self‐made men who had achieved a degree of success in the emerging market economy of nineteenth‐century America, Committee members exemplified the period's predominate concept of masculinity. Also skeptical of military science and distrustful of the United States military academy at West Point, the Committee showed a marked preference for volunteer soldiers and officers throughout the war. Believing that West Point generals who endorsed strategic maneuver were cowardly and disloyal, Committee members were frequently critical of regular army officers in their investigations. Confusing the rhetoric of ‘hard war’ with military competence, the Committee's disdain for military education caused it to endorse incompetent military leadership and advocate mediocre generals for high command.

Election Reform Efforts in Pennsylvania

509 EVENTS SURROUNDING the November 2000 presidential election focused the nation’s attention on a process that few Americans consider more than twice yearly. As events in Florida gripped the nation, Americans became keenly aware of the pivotal role that the process of voting plays in the success of democracy. The subsequent scrutiny devoted to the electoral process revealed that elections are not perfect. However, at a time when many citizens are concerned about the significance of their votes, we must make every effort to ensure that, when a vote is cast, it is counted. The U.S. Supreme Court’s ruling in Bush v. Gore1 made it clear that states should strive to promote the equal protection of their electors. The ballot of a voter in one part of Pennsylvania should not be counted by a different standard than that of a voter elsewhere in the Commonwealth. These concerns have inspired many states to initiate reviews of their election systems and outline plans for reform that would institute more uniformity into the electoral processes. Pennsylvania’s former Governor Tom Ridge had begun exploring ways to improve the Commonwealth’s electoral system well before the 2000 election. Under his guidance, the Pennsylvania Department of State had been studying methods of establishing a centralized voter registration system for the Commonwealth and had promoted other election reforms. Even though Pennsylvania did not experience the magnitude of problems encountered elsewhere in the 2000 election, its leaders understood that they should take steps to bolster the confidence of Pennsylvania’s citizens in our electoral process. As the year 2001 began, election reform in Pennsylvania took three tracks. First, Governor Ridge requested $8.5 million in his 2001–2002 budget for the development of a statewide integrated voter registration system. The system envisioned would combine 67 diverse county voter registration systems into one single statewide system, while electronically linking state agency voter registration data to the system. Second, the Pennsylvania General Assembly convened a Joint Select Committee to Examine Election Issues. This Committee was charged with examining a broad array of election issues. Over the course of 2001, the Joint Select Committee held hearings across the state on, among other issues, voting systems, voter registration, and Election Day procedures. The third track of Pennsylvania’s election reform effort focused on county voting methods. In March 2001, Governor Ridge signed Executive Order 2001-3 establishing the Voting Modernization Task Force to examine the method by which Pennsylvania’s voters cast their ballots and make recommendations for modernizing these systems.2 Pennsylvania is a textbook example of a decentralized election system. Its Election Code places the responsibility for the conduct of elections with the 67 county boards of election across the Commonwealth. Although the Secretary of the Commonwealth holds the title of Pennsylvania’s chief election official, until a recent act of the General Assembly (Act 3 of

Competition in the food marketing chain

Competition in the Australian food marketing chain is of continuing concern, but little evidence is available to guide policy debate. In a search for broad guidelines, the theoretical and empirical evidence is reviewed and the recent report of the Joint Select Committee on the Retailing Sector is examined. Then publicly available data on several food groups are used to test for evidence of persistent market power. The purchasing behaviour of the grains and oilseeds processing sector is found to warrant more detailed attention. A possible research agenda and a call for greater attention to data requirements complete the article.

Community without Flesh

Community without Flesh

History of the book in Australia: impacts of public policy in the second half of the twentieth century

To the memory of Dietrich Hans Borchardt, bibliographer and friend, 1916–1997This article, based on a paper delivered at the 1997 HOBA (History of the Book in Australia) conference, discusses the implications of the term ‘history of the book in Australia’. Consideration focuses on official publications in Australia and the impact of the 1964 Report of the Erwin Joint Select Committee on Government and Parliamentary Publications. The place of official publications in the collections of major libraries and their value as items for international gift and exchange between libraries are discussed. Next, the role of public institutions is considered, especially that of the National Library of Australia's attempts to develop the ‘national collection’. The idea of the Distributed National Collection is reviewed, and the need for clarity on what is understood by a ‘national collection’ is stressed. A case is stated for a non-parliamentary committee of inquiry into problems of acquisitions and resources now confronting Australian libraries generally and the National Library in particular. The article concludes by examining the future of the important nineteenth-century collections of the Australian parliamentary libraries. A note of caution is sounded against taking ‘use’ as the guiding criterion for deciding whether to sell off or discard books from these libraries.

The Child Support Scheme: Failures of the first decade

This article focuses upon the first ten years of implementation of the Australian Child Support Scheme. It investigates the philosophy and social ideology which underpin the Scheme and questions whether the objectives of the Scheme are being achieved. The central thesis is that the ideology of the Scheme needs to be fundamentally altered in order to properly cater for financial support of children of separated families.The article suggests that the amendments put forward by the recent Joint Select Committee investigation into the Child Support Scheme will not ameliorate the deficiencies in the Scheme as they do not go to the pivotal core of what a child support scheme is created to do. The article describes how the ideologies inherent in the Scheme might be altered in order to create a system of child support which would cater for all system users.

RANDOMISATION AND THE 1975 SENATE BALLOT DRAW

Summary “So the last shall be first, and the first last; for many be called, but few chosen.” Matthew 20:16 The “random” draw for positions on the Senate ballot papers in the 1975 election resulted in an apparently non-random ordering, to the possible advantage of one particular party. This paper assesses the statistical significance of the 1975 draw and looks at possible causes of the evident non-randomness. A simplified yet realistic mathematical model is used to describe conditions under which the so-called donkey vote can have an effect on the final outcome of the election, thereby confirming the widely-held belief that the order of parties on the Senate ballot paper is relevant. We examine other Senate elections between 1949 and 1983 for the existence of relevant non-randomness similar to the 1975 result. Finally, we report briefly on our submission to the 1983 Joint Select Committee on Electoral Reform, which led to an improvement in the randomisation procedure.

Has the AGPS a future? Some comments on current problems

The failure of the Australian Government Publishing Service (AGPS) to achieve the goals envisaged for it in the Erwin Joint Select Committee report (1964) is reviewed. The effect of the recommendations of the federal Joint Committee on Publications' Sixth Special Report (1978) is discussed in relationship to the role of AGPS. The work of the AGPS-AACOBS Liaison Committee which links the library community with the official publisher is reviewed and defects are noted. The need for a more effective organisation of official publishing at the federal level is seen as still unresolved, especially at a time when concern for freedom of information and a more active desire for participatory democracy are becoming evident in Australia.