Project helps women in developing nations gain economically
By CATHERINE LUCEY
Thursday, February 7
WASHINGTON (AP) — Ivanka Trump is unveiling an effort aimed at helping 50 million women in the developing world get ahead economically over the next six years.
On Thursday, the White House will officially launch the Women’s Global Development and Prosperity Initiative, a government-wide project led by the senior adviser and daughter to President Donald Trump. The initiative will involve the State Department, the National Security Council and other agencies. It aims to coordinate current programs and develop new ones to assist women in areas such as job training, financial support, and legal or regulatory reforms.
The president previewed the launch during his State of the Union address Tuesday night, describing it as “part of our commitment to improving opportunity for women everywhere.” He will sign a national security memorandum to officially launch the initiative Thursday, framing it as a way to promote stability around the world.
Ivanka Trump, who will attend the Munich Security Conference next week to promote the project, stressed that she sees this as a national security priority. “We think women are arguably the most under-tapped resource in the developing world for accelerating economic growth and prosperity,” she told The Associated Press.
The effort will draw on public and private resources, with the U.S. Agency for International Development initially setting up a $50 million fund, using already-budgeted dollars. As part of the launch, USAID and Pepsi Co. will announce a partnership aimed at women in India, and USAID and UPS will sign an agreement designed to help female entrepreneurs export goods.
Trump has twice tried unsuccessfully to slash USAID’s budget by a third, and his “America first” foreign policy has sought to limit the United States’ role as an international leader. But his daughter said this effort was in keeping with administration goals, arguing it was a strategic investment that promoted security.
“We’re proud of our legacy of being a generous nation, looking to uplift others around the world. But we want to do so in a fiscally responsible way,” she said, promising “rigorous” efforts to track progress. Among those she has consulted for the project is former Secretary of State Henry Kissinger.
The White House launch Thursday will feature a round-table discussion and presidential signing ceremony. Attendees were to include Secretary of State Mike Pompeo, national security adviser John Bolton, officials from USAID and UNICEF, elected officials and business leaders, as well as women who are the beneficiaries of this type of aid.
The initiative builds on previous White House efforts to help women internationally. The Obama administration established an Office of Global Women’s Issues at the State Department and established an ambassador-at-large for global women’s Issues. That position has been vacant since Trump took office — drawing criticism from some advocates — but the White House said it now has a candidate lined up for the job.
Since she joined the administration in early 2017, Ivanka Trump has focused on women’s economic issues. She previously led an effort to launch a World Bank fund to help drive women’s entrepreneurship. And she recently advocated for the Women’s Entrepreneurship and Economic Empowerment Act, which bolsters efforts focused on women by USAID.
Ivanka Trump said her hope is that this effort has staying power beyond the current administration. Past global initiatives she has studied include the U.S. President’s Emergency Plan for AIDS Relief, started under President George W. Bush in 2003.
“This is not an initiative that we think should stop at the culmination of the administration,” she said. “We think it’s something that should sustain itself over time, and we’re going to work really hard to show that this is a great use of foreign development assistance.”
LEGAL MARIJUANA — TWO VIEWPOINTS
Opinion: Bipartisan Support For Legalizing Marijuana Upends Politics As Usual
By Paul Armentano
In today’s hyper-partisan environment, few issues enjoy majority support among those on both the right and the left of the political spectrum. But voters’ support for marijuana law reform is bucking this trend.
According to the latest national polling compiled by Gallup, 66 percent of U.S. adults — including majorities of Democrats, independents and Republicans — believe that the adult use of marijuana should be legal. The percentage of Americans who are supportive of the medicalization of marijuana is even higher. According to a 2018 Quinnipiac University poll, 93 percent of voters — including 86 percent of Republicans and 97 percent of Democrats — believe that patients ought to be able to access cannabis legally if they possess the authorization of their doctor.
Not surprisingly then, when given the opportunity to decide in favor of marijuana legalization, voters routinely elect to do so. To date, 33 states regulate the use and dispensing of medical cannabis. In more than half of these jurisdictions, these laws were enacted by the passage of a voter initiative — including most recently in the “red” states of Missouri, Oklahoma and Utah. Ten states have legalized the use of marijuana by all adults. Nine of these state laws were voter initiated, including most recently in Michigan.
As a result, most Americans now reside in a jurisdiction where some type of marijuana use is legally permitted and regulated. Contrary to the predictions of naysayers, the sky has not fallen. Teen use has remained flat and public safety has not been compromised. According to 2018 data compiled by the Colorado Department of Health, “Youth marijuana use remains relatively unchanged since legalization.” Data compiled by the Washington State Institute for Public Policy reaches a similar conclusion, finding: “(A)cross grades 6, 8, 10 and 12, cannabis use indicators have been stable or fallen slightly since I-502’s enactment. … We found no evidence that the amount of legal cannabis sales affected youth substance use or attitudes about cannabis or drug-related criminal convictions.”
With respect to traffic safety, data published in 2017 in The American Journal of Public Health reported “no significant association between recreational marijuana legalization in Washington and Colorado and subsequent changes in motor vehicle crash fatality rates in the first three years after recreational marijuana legalization.”
Rather than acting as a purported “gateway” to hard drug use, marijuana legalization is associated with reduced rates of opioid abuse and prescription drug spending. According to the findings of a RAND Corporation study, “States permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not.”
A separate analysis published in the journal Health Affairs concluded, “We found that the use of prescription drugs for which marijuana could serve as a clinical alternative fell significantly once a medical marijuana law was implemented.”
Legalization has also proven to be a financial windfall for states, generating increases in tax revenues, tourism and home values.
This is why more and more politicians are now jumping on board. For example, in this past election, nearly a dozen winning governors campaigned on platforms that included marijuana legalization. Lawmakers in numerous states — including Connecticut, Illinois, New Jersey, New York and Rhode Island — are now moving forward with legalization measures.
At the federal level, incoming House Rules Chairman Jim McGovern of Massachusetts immediately sought to distinguish himself from his Republican predecessor by pledging, “I’m not going to block (House floor) amendments for marijuana.”
House Speaker Nancy Pelosi is a former co-sponsor of legislation to legalize the medical use of cannabis, while the new chair of the House Judiciary Committee, Jerry Nadler of New York, previously co-sponsored legislation that sought to allow states to regulate cannabis like alcohol.
Of the 2020 presidential hopefuls thus far, almost all are on record in support of ending the federal prohibition of cannabis.
At a time when the majority of states regulate marijuana use, and when a growing number of leading politicians are calling for cannabis’ liberation, it makes no sense from a political, fiscal or cultural perspective to try to put this genie back in the bottle. It is time for members of the 116th Congress to look to the future rather than to the past, and take appropriate actions to comport federal law with majority public opinion and the plant’s rapidly changing legal and cultural status. That’s something virtually all voters can agree on.
ABOUT THE WRITER
Paul Armentano is the deputy director of the National Organization for the Reform of Marijuana Laws in Washington and is the co-author of the book “Marijuana Is Safer: So Why Are We Driving People to Drink?” He wrote this for InsideSources.com.
Opinion: Yes, Marijuana Legalization is Working
By Jeffrey Miron and Laura Nicolae
In recent decades, U.S. marijuana laws have liberalized substantially. Recreational marijuana use is now legal in 10 states and the District of Columbia, and many more states have legalized marijuana for medical use. In response, legalization opponents have claimed that marijuana use increases crime, violence and schizophrenia.
So is marijuana legalization good policy? Yes.
Recent research casts doubt on alarmist claims about the effects of recent state-level marijuana legalization. By looking at the pre- and post-legalization trends in outcomes such as marijuana use, other drug or alcohol use, marijuana prices, crime and traffic accidents, it becomes clear that state-level marijuana legalization has been associated with, at most, modest changes in these outcomes. The absence of significant adverse consequences is especially striking given the dire predictions made by some legalization opponents.
In addition, economic logic suggests that drug prohibition, whether for marijuana or any other drug, is misguided. Drug use entails risk for some users, and use sometimes harms innocent third parties. But the adverse effects of prohibition are far worse.
Little evidence suggests that prohibition reduces drug use. Instead, prohibition breeds black markets and pushes consumers into illicit drug use, which is far more dangerous than legal consumption. Drug quality control is poor in underground markets because reliable suppliers cannot legally advertise their goods and consumers cannot sue for damages due to faulty or mislabeled products. Drugs obtained from underground markets do not come with warning labels, and users cannot discuss safe use with their physicians, making them more likely to combine drugs with alcohol or other medications that suppress respiration.
Legalization opponents claim that drugs increase violent or criminal tendencies, but any association between drugs and violence arises mainly from prohibition’s impact on drug markets. Throughout the 20th century, major fluctuations in the U.S. homicide rate have been positively associated with fluctuations in the enforcement of drug and alcohol prohibition. Prohibition raises drug prices, which motivates some consumers to commit crimes to fund their drug use.
Under prohibition, drug-related disputes between users and suppliers, such as those over faulty or mislabeled products, are more likely to be settled with violence since they cannot be tried in court. Prohibition also decreases the marginal cost of committing a crime; a marijuana supplier who already evades the law has little incentive to obey the law in other instances. The Mexican drug war has also been linked to increases in homicide as captures of kingpins motivate rival gangs to exploit weakened organizations.
In addition, prohibition is expensive; the War on Drugs costs taxpayers around $50 billion annually, in addition to leaving a similar amount of tax revenue in the underground market. Prohibition reallocates law enforcement away from responding to violent offenses and increases civil liberties violations as police pursue perpetrators of victimless crimes.
The War on Drugs contributes to racial profiling and other racial disparities in law enforcement. Although black and white Americans use marijuana at roughly equal rates, blacks are nearly four times as likely to be arrested for marijuana possession. Prosecutors pursue mandatory minimum sentences for black defendants at twice the rate as for white defendants charged with the same offense. Criminalizing nonviolent and largely victimless behavior grants law enforcement substantial discretion in the interpretation and application of the law.
Prohibition has cost American taxpayers more than $1 trillion and has been largely ineffective in decreasing marijuana use. Worse, prohibition has created new risks to health and safety and has increased the incentive to engage in violence or crime. We should look forward to continued legalization of marijuana at the state and federal level.
ABOUT THE WRITERS
Jeffrey Miron is director of economic studies at the Cato Institute and the director of graduate and undergraduate studies in the Department of Economics at Harvard University, where Laura Nicolae is a student. They wrote this for InsideSources.com.
Why the US has higher drug prices than other countries
February 7, 2019
Author: Simon F. Haeder, Assistant Professor of Political Science, West Virginia University
Disclosure statement: Simon F. Haeder is a Fellow in the Interdisciplinary Research Leaders Program, a national leadership development program supported by the Robert Wood Johnson Foundation to equip teams of researchers and community partners in applying research to solve real community problems.
Partners: West Virginia University provides funding as a member of The Conversation US.
Spending on pharmaceuticals is on the rise worldwide. And it well should be. Today, we are able to cure some diseases like hepatitis C that were virtual death sentences just a few years ago. This progress required significant investments by governments and private companies alike. Unquestionably, the world is better off for it.
Unfortunately, as President Trump pointed out in the State of the Union address, the United States has borne a significant amount of the negative effects associated with this development. For one, its regulatory apparatus has focused largely on drug safety, yet regulators have failed to emphasize cost-effectiveness when it comes to both new and existing drugs.
At the same time, the United States also pays significantly higher prices than the rest of the developed world when it comes to prescription drugs, due primarily to limited competition among drug companies.
These two problems are well-known to policymakers, consumers and scholars alike. The Trump administration’s recent proposal seeks to lower costs by restructuring drug discounts that occur between pharmaceutical companies, health insurers and entities called pharmacy benefit managers.
But in my view as a health policy scholar, the plan does little to address the underlying problems of prescription drugs in the U.S. I believe the U.S. can refocus its regulatory approach to pharmaceuticals, adapted from the one used in Europe, to better connect the value prescription drugs provide and their price.
The US and other countries
Until the mid-1990s, the U.S. was really not an outlier when it came to drug spending. Countries like Germany and France exceeded the U.S. in per capita drug spending. However, since then, spending growth in the U.S. has dramatically outpaced other advanced nations. While per capita spending in the U.S. today exceeds US$1,000 a year, the Germans and French pay about half that.
And it is not like Americans are overly reliant on prescriptions drugs as compared to their European counterparts. Americans use fewer prescription drugs, and when they use them, they are more likely to use cheaper generic versions. Instead the discrepancy can be traced back to the issue plaguing the entirety of the U.S. health care system: prices.
The reasons for the divergence starting in the 1990s are relatively straightforward. For one, dozens of so-called blockbuster drugs like Lipitor and Advair entered the market. The number of drugs grossing more than $1 billion in sales increased from six in 1997 to 52 in 2006. The recent introduction of extremely pricey drugs treating hepatitis C are only the latest of these.
Lacking even rudimentary price controls, U.S. consumers bore the full brunt of the expensive development work that goes into new drugs. These costs were further augmented by marketing expenditures and profit seeking by all entities within the pharmaceutical supply chain. Consumers in Europe, where there are government-controlled checks on prices, were not as exposed to those high costs.
The Food and Drug Administration has also consistently moved to relax direct-to-consumer advertising regulations, a practice that is either banned or severely limited in most other advanced nations. While there are limited information benefits to consumers, this practice has certainly increased consumption of high-priced drugs.
Additionally, the overall complexity of the U.S. health care system and the lack of transparency in the drug supply chain system create conditions favorable to limited competition and price maximization.
All entities in the pharmaceutical supply chain, including manufacturers and wholesale distributors, have become extremely skilled at finding regulatory loopholes that allow them to maximize profits. This includes, for example, creatively expanding the life of patents, or having them recategorized as “orphan drugs” for rare disease to preserve monopolies. So-called pharmacy benefit managers, the middlemen that administer prescription drug programs, add further complexity and often may be driven by profit maximization.
Finally, the U.S. has undergone a series of coverage expansions, including the prominent creation of the Children’s Health Insurance Program, Medicare Part D, and the Affordable Care Act. For many of the newly covered, this meant access to prescription drugs for the first time and pent-up demand was released. However, it also encouraged pharmaceutical companies to take advantage of the newfound payers for their drugs.
Trump’s proposed fixes
The consequences of pricey pharmaceuticals are significant in terms of costs and diminished health. Close to 20 percent of adults report skipping medications because they are concerned about costs. Nonetheless, the U.S. may be spending close to $500 billion annually.
The plan proposed by the Trump administration basically replaces an opaque discount arrangement between drug makers, insurers and middlemen called pharmacy benefit managers with a discount program directly aimed at consumers. Particularly benefiting from the change would be those individuals requiring costly non-generic drugs. Unquestionably, their lives would improve due to increased access and lower costs.
At the same time, costs would be shifted to healthier consumers who do not rely on expensive drugs, as well as those relying on generic versions. Both will be faced with higher overall insurance premiums while not seeing any reductions in the prescription drug bills. That’s because insurers would no longer be able to use drug discounts to hold down premiums.
Trump greets Health and Human Services Secretary Alex Azar, who is spearheading the administration’s plan to restructure how drug discounts work. Reuters/Jonathan Ernst
The Trump administration’s discounting approach, however, is not uncommon. The Veterans Health Administration’s has done so quite successfully, obtaining discounts in the range of 40 percent. Likewise, Medicaid programs are also using their purchasing power to obtain discounts. And calls for Medicare to negotiate discounts with pharmaceutical companies are common.
The way I see it, there are three major issues inherent in negotiating discounts for drugs.
For one, true negotiations would only take place if Medicare or any other entity was willing to walk away from certain drugs if no discounts could be obtained. In a country that heavily values choice, and where such activities would become a political football, this is highly unlikely.
Moreover, it would only work for drugs where viable alternatives are available. After all, most Americans would likely be hesitant to exclude a drug, even at high costs, when no alternative cure exists.
Yet even if some version of a discount program were to be implemented more widely, such a program does not change the underlying pricing or market dynamics. Crucially, relying on discounts does nothing to reduce list prices set by manufacturers. Pharmaceutical companies and all other entities in the supply chain remain free to set prices, bring products to the market, and take advantage of loopholes to maximize corporate profits.
Ultimately, pharmaceutical companies and all other entities involved in the pharmaceutical supply chain are unlikely to be willing to simply give up profits. Quite likely, steeper discounts for Medicaid and Medicare may lead to higher costs for employer-sponsored plans.
Focusing on effectiveness and consumer information
The question then emerges: What could be done to truly improve the twin issues of high costs and limited cost-effectiveness when comes to pharmaceuticals in the U.S. health care system?
While Americans are often hesitant to learn from other countries, looking to Europe when it comes to pharmaceuticals holds much promise. Countries like Britain and Germany have taken extensive steps to introduce assessments of cost-effectiveness into their health care systems, refusing to pay higher prices for new drugs that do not improve effectiveness of treatment over existing options.
Since reforming its system in the early 2010s, Germany has allowed manufacturers to freely set prices for a limited period when bringing new drugs to the market. It then uses the data available from that period for a nongovernmental and nonprofit research body to evaluate the benefit provided by the new drug, as compared to existing alternatives. This added benefit, or lack thereof, then serves as the foundation for price negotiations between drug manufacturers and health plans.
While the legal restrictions and the fragmented nature of the U.S. health care system severely limit the ability of the U.S. to fully translate such a model, in my opinion, the underlying approach bears great value.
Lacking the corporatist nature of the Germany economy, the U.S. should resort to a bottom-up approach focused on investing in assessing and subsequent publicizing of cost-effectiveness data as well as cost-benefit analyses for all drugs. In order to minimize politicization, these analyses would be best handled by one or multiple independent research institutes.
Ultimately, knowing what drugs provide what value would equally benefit consumers, providers, and payers, and serve as a meaningful first step towards connecting the prices we pay for prescriptions to the value we derive from them.