That Which Cannot Go on Forever...

Herb Stein

Herb Stein, President Nixon's chief economist, once said, "That which cannot go on forever must come to an end."  There is a school of thought - to which our governor arguably belongs - that says that because tuition at colleges and universities has been rising faster than inflation, there is a bubble that will inevitably burst, maybe around now.  Bette Billet, president of the UCLA Faculty Women's Club for 2013-14, passed me an article that argues that both higher ed and medicine are in the same boat. So, one might assume, a university with a med school is really in trouble - or is soon to be in trouble.  Excerpt:

...(F)or cities hanging their hat on eds and meds growth, a ... fundamental problem now looms: these industries are at the end of their growth cycle. Spending on healthcare and college tuition costs has been skyrocketing at rates greater than inflation for years...

You can find the article at http://www.urbanophile.com/2013/07/07/replay-the-end-of-the-road-for-eds-and-meds/

Note that forecasting the timing of when things end is difficult.  Moreover, unlike financial bubbles - which tend to end suddenly with large ripple effects - other trends can reverse more gradually with less harm done. And note that the notion that putting courses online will fix the tuition problem is questionable even though that seems to be the remedy de jour. There is an item in Inside Higher Ed today that suggests that the MOOC bubble may be bursting: http://www.insidehighered.com/news/2013/07/09/higher-ed-leaders-urge-slow-down-mooc-train

UCLA Monkey Trial Soon

We have blogged about this case before - without really knowing what the full background is.  But apparently, it is coming to trial this Thursday: The dispute over a Wake Forest University Health Sciences primate colony in southern Forsyth County goes to its first hearing at 10 a.m. Thursday.  The hearing involves Wake Forest as plaintiffs and the board of regents for the University of California system as defendants. It will be held in the federal building in downtown Winston-Salem... The Wake Forest division filed a lawsuit in February to end a joint venture with the University of California at [sic] Los Angeles at the research center in the Friedberg community. Wake Forest officials are requesting a jury trial in Forsyth Superior Court. UCLA, in return, accuses Wake Forest of financially mismanaging the research center and using vervet monkeys there for unauthorized research, including a dengue fever study. The regents alleged in their countersuit that Wake Forest is making “false” and “misleading” statements about the regents' role with the state of California. Wake Forest said it is willing to shut down the vervet colony if UCLA doesn't agree to continue to pay its obligations for operating costs... UCLA said the contract allows the university to receive the title for the colony at no cost and to relocate the monkeys...

Full article at http://www.journalnow.com/business/business_news/local/article_ac4b8b34-e803-11e2-acb6-001a4bcf6878.html

There was a former ex officio Regent of UC who knew about such matters: 

(If you have more info on this case, please use the comment option to add it.)

Listen to the Regents: March 13, 2013 - morning session

Our efforts to archive Regents meetings (since the Regents' policy is currently to preserve them only for one year) continues.  Below is the agenda for the morning meeting of March 13, 2013.  Included was approval of a UCLA medical building about which cost concerns had been raised at an earlier meeting.  Eventually, the Regents seem to approve any construction project - even if concerns are raised - particularly when they are assured that it won't cost them anything.

Agenda for Wednesday, March 13, 2013 - morning
8:30 am Committee of the Whole (open session - includes public comment session)
9:30 am Committee on Grounds and Buildings (open session)
11:00 am Committee on Finance (open session)
11:15 am Committee on Educational Policy (open session)
12:00 Lunch

You can hear the audio of this meeting at the link below:
 

GlaxoSmithKline Problem Said to Be Fixed

Back in May, we blogged about a cautionary note from UCLA indicating that a grant competition from GlaxoSmithKline appeared to circumvent university procedures.

Now an email has gone out to faculty indicating that the problem has been fixed:

I am pleased to report we resolved the barriers to faculty participation in the GlaxoSmithKline (GSK) Discovery Fast Track Competition. We encourage faculty who are developing novel drug targets and drug screening assays to consider applying for this program.

When the competition initially launched, we found that the terms and conditions to be at odds with UC policies and faculty interests. We took a definitive stand and notified faculty – a position that was supported by many peer institutions.

With the support of the Office of the President, we have since resolved the key concerns with GSK. Faculty may submit proposals for developing and conducting screens of GSK’s internal compound collections and thereby advance the development of novel drug targets, pathways and assays. This may lead to further collaborations and/or sponsored research with GSK, thereby helping UCLA move discoveries forward to the clinic for the benefit of patients.

The competition closes on Friday, July 19, 2013. The Office of Intellectual Property & Industry Sponsored Research will work closely with you to determine whether your submission may be appropriate for the program. Given the short and strict timeframe, we encourage you to contact us as soon as possible so that we can complete the necessary steps before your proposal can officially be considered.

For more on this program, please see the link below and we look forward to working with you on potential proposal submissions.

http://openinnovation.gsk.com/index.php

Sincerely,

Brendan J. Rauw
Associate Vice Chancellor for Research
Executive Director of Entrepreneurship

The Gay Marriage Decisions: What Do They Mean for UC?

As the preliminary reports and analysis of the U.S. Supreme Court's rulings on gay marriage appear, you may be wondering what effect it might have on U.C., particularly with regard to benefits.  Or maybe you are not wondering since you know that U.C. has provided dependent benefits for domestic partners.  There is actually an effect through the federal tax system.  The now-defunct Defense of Marriage Act (DOMA) meant that the IRS did not recognize gay marriages, even in states where such marriages were permitted.  Thus a spouse/dependent in such a relationship, even if eligible for, say, coverage under his or her spouse's health insurance (at UC or elsewhere) had to pay taxes on the value of that coverage.  With DOMA gone, presumably such benefits to dependent same sex spouses will now receive the same tax-favored treatment that was afforded under federal law to opposite sex spouses.

The Supreme Court avoided ruling on California's Prop 8 ban on gay marriage.  However, a lower court had voided the Prop 8 ban - which was the route by which the case reached the Supreme Court - so presumably gay marriage will now resume in California.  (There may be some local variation initially but it will be possible for gay couples to marry in the state and thus receive federal tax-favored treatment for benefits.)  It is unlikely, however, that domestic partnerships will be recognized as marriages by IRS, particularly since formal marriage will now be an option for gay couples.  Thus, gay couples under UC benefit plans that are currently in domestic partnerships and that choose not to get married won't receive federal tax-favored treatment.  At least, so says yours truly - a non-lawyer and non-tax expert.  (So be warned.)

UPDATE: The governor has told the counties to resume or begin issuing marriage licenses to gay couples. Story at http://blogs.sacbee.com/capitolalertlatest/2013/06/jerry-brown-tells-california-counties-to-issue-gay-marriage-licenses.html

Shying Away from Retiring

Inside Higher Ed today carries an article about surveys of faculty who say they don't plan to retire at the "normal" age or maybe ever.  The work-til-you-drop response is attributed to such motivations as wanting to be intellectually active but also importantly to concerns about having sufficient funds and health insurance to retire.  When UC was considering changing its retirement plan - it created a two-tier program - it retained the defined benefit approach rather than switch to a defined contribution approach.  Many faculty in the U.S. are under TIAA-CREF or some similar defined contribution program which means that they face the danger of outliving their savings.  Retiree health care is also not necessarily provided.

UC retained its basic defined benefit model in part to encourage faculty renewal.  Many years ago, before federal law changed, universities - including UC - had mandatory retirement ages.  Once that policy was made illegal, only the defined benefit system provides an incentive to retire.  Under defined benefit, the retiree can't outlive his or her savings.  And long service employees essentially end up working for nothing if they continue so the system incentivizes "on time" retirement.  Decisions in the future on retirement benefits need to be take account of the behavioral effects of the system.

The Inside Higher Ed article is at http://www.insidehighered.com/news/2013/06/17/data-suggest-baby-boomer-faculty-are-putting-retirement

Want a Riverside Med School? Legislature Says (Commands?) Do It Yourself

There has been ongoing agitation from UC-Riverside and UC for the state to put up money for a med school.  As bits and pieces about the state budget leak out, it appears that the legislature has not provided extra money but instead has told UC to take it out of its general allocation.  Apparently, the legislature doesn't view this matter as a suggestion; more of a command.

From the Riverside Press-Enterprise:
The Legislature’s budget conference committee late Monday altered the funding mix for a school of medicine at UC Riverside, eliminating a $15 million augmentation but directing the UC system to allocate money to the school from its budget. The compromise means the school will finally get the state money it has sought unsuccessfully since 2010. It effectively saves the state general fund $15 million. And most importantly, it has the support of the Brown administration, which did not include any money for the medical school in its January spending proposal or May revision...

Full story at http://blog.pe.com/2013/06/10/medical-school-no-new-money-but-uc-told-to-allocate/

Of course, the Regents and UCOP could assert their constitutional autonomy but the legislature might object:

UCLA History: Santa Monica Hospital - now a part of UCLA - back in the day

Santa Monica Hospital in 1941:LA Public Library collection

Previous posts on this blog have dealt with the current strike at UC hospitals including UCLA.  News coverage tends to focus on Westwood. But UCLA also operates Santa Monica Hospital which it acquired a few years ago. The two-day strike is also occurring at the Santa Monica location.  (The photo above from 1941 shows a building - seen from 16th Street - that has since been replaced.)

Coverage on the strike can be found at http://www.latimes.com/news/local/la-me-uc-strike-20130522,0,3925126.story

Meanwhile, the conservative FlashReport news aggregation website was so interested in the UC strike story that someone forgot to use a spellcheck:

Update: Coverage continues http://www.latimes.com/news/local/la-me-uc-strike-update-20130523,0,1376304.story

UPDATE: If at first you don't succeed in using your spellcheck, try, try, again:

{And maybe again?)

UC (& UCLA) hospital 2-day strike to go ahead this morning with court-orded exceptions

A Sacramento judge Monday refused to stop a strike today by thousands of employees at...  UC hospitals – but ordered a limited number of critical care employees to stay on the job.  The union for nearly 13,000 workers, including nursing assistants, pharmacists, medical technicians, operating room scrubs and other health care workers, was to begin a two-day strike at 4 a.m. today (Tuesday, May 21). The American Federation of State, County and Municipal Employees announced the walkout of workers at the UC Davis Health System and University of California hospitals in Los Angeles, San Francisco, San Diego and Irvine. The union, which is resisting demands for increases in employee pension contributions, claims the strike is about hospital staffing that has been reduced to dangerous levels. UC officials say the walkout is over an intractable contract dispute over wages and benefits...

Full article at http://www.sacbee.com/2013/05/21/5435481/judge-allows-thousands-of-uc-medical.html

UPDATE: Below is a not-very-good cellphone photo of the strike today:

 

Something that didn't happen

Our prior post noted that the LA Times today carries a story about a deal that did occur - albeit not to the benefit of UCLA.  The Times also carries a story about a deal that did not happen, a possible purchase by UCLA of St. John's Hospital in Santa Monica:
http://www.latimes.com/business/money/la-fi-mo-st-johns-hospital-20130517,0,3436718.story

An earlier post on this blog about this deal that didn't happen (when it was still a possibility) is at:
http://uclafacultyassociation.blogspot.com/2013/03/hospital-takeover.html

UPDATE: See also:
http://bhcourier.com/open-letter-communities-santa-monica-west-los-angeles-2/2013/05/17

Possible Two-Day UC Hospital Strike Next Week

From the LA Times today:

Facing a possible two-day strike next week by patient care and technical workers, the five large University of California medical centers are starting to cancel elective surgeries that had been scheduled as soon as Monday, officials said. Emergency care will not be shut and patients already in the five hospitals across the state will continue to receive care. But many elective procedures will delayed until after the potential strike, set for Tuesday and Wednesday... At UCLA's hospitals in Westwood and Santa Monica, ...administrators are planning to hire 600 replacement workers through agencies and are preparing to train them and move them past picket lines...While UC is seeking an injunction to prevent the strike, both sides said they now consider the walkout likely, starting at 4 a.m...

Full story at http://www.latimes.com/health/la-me-0517-uc-medical-20130517,0,4947148.story

UPDATE: A court decision on UC's request (or is it PERB's request? - not clear) for an injunction is due on Monday, May 20:
http://www.latimes.com/local/lanow/la-me-ln-uc-strike-20130517,0,7957414.story

http://www.bizjournals.com/sacramento/news/2013/05/17/uc-goes-to-court-to-stop-hospital-strike.html

UPDATE: Apparently, food service for students will be affected by the strike:
http://dailybruin.com/2013/05/17/ucla-housing-will-alter-services-in-sympathy-with-striking-patient-care-technical-workers/

Note: Much of the public comment session at the Regents on Wednesday was focused on the impending strike.  President Yudof began with a statement about it.  Most of the speakers thereafter were from the AFSCME local involved in the dispute and - after a demonstration began - the room was cleared.  You can hear it at the link below:

Possible strike at UC hospitals (including UCLA)

2008 strike at UCLA hospital

From the State Worker blog of the Sacramento Bee: The University of California said today that it will ask a judge to keep hospital workers from striking later this month. American Federation of State, County and Municipal Employees Local 3299 says its members will walk off the job at the university system's five hospitals May 21 and May 22. UC officials and the union have been in negotiations since last summer for a new contract covering some 13,000 patient care workers. The contract expired Oct. 1, and the contentious talks deadlocked earlier this year. AFSCME says it's fighting to fix unsafe hospital conditions and foolish spending by high-level university officials who enrich themselves while seeking cuts to employee compensation. The university counters that the union's real aim is to avoid new state laws that significantly reduce retirement benefits for new pension-system members...

Full story at http://blogs.sacbee.com/the_state_worker/2013/05/university-of-california-wants-court-to-stop-workers-strike.html

It might be noted that unlike many states, California does not have a general prohibition on strikes by public employees although such strikes may be enjoined in some cases.  Labor relations matters in private hospitals are subject to federal regulation by the National Labor Relations Board NLRB).  Because UC is a state entity, however, labor relations issues at UC hospitals are regulated by state law and the California Public Employment Relations Board (PERB).  The particular state law covering UC (and CSU) is the Higher Education Employment Relations Act (HEERA) which can be found at http://www.perb.ca.gov/laws/HEERA.aspx. A strike at UC hospitals last occurred in 2008.  An earlier post on this blog concerning the current situation is at http://uclafacultyassociation.blogspot.com/2013/04/strike-vote-to-be-taken-at-uc-med.html.

Read more here: http://blogs.sacbee.com/the_state_worker/2013/05/university-of-california-wants-court-to-stop-workers-strike.html#storylink=cpy

Not Clear on the Concept

You may have seen the LA Times article today which reports that UCLA's Reagan hospital received a D grade for patient safety, albeit up from F in the prior survey of the Leapfrog Group.  We reported on the F last November: http://uclafacultyassociation.blogspot.com/2012/11/whatever-happened-to-grade-inflation.html

The new report says UCLA's Santa Monica Hospital, in contrast, received a top grade.  I get nervous about composite rating systems so I went on the Leapfrog website [http://www.leapfroggroup.org/cp] which allows comparisons of hospitals and compared Reagan with Santa Monica.  The two look pretty much the same as the image above shows. [Click on the image to enlarge.]  Indeed, Reagan shows a somewhat better rating in one category than Santa Monica. 

The LA Times article is at: http://www.latimes.com/news/local/la-me-hospital-ratings-20130509,0,7228604.story

Maybe you can figure it out.  It's true that Reagan himself didn't always promote healthy habits.

But on the other hand:

Hearing CalPERS Rate Hike for Long-Term Care Insurance

San Francisco's Poor House

As prior blog posts have noted, although UC is not under CalPERS, UC employees - because they were state employees - were invited to enroll in CalPERS' long-term care insurance plan.  Such plans ostensibly protect enrollees against potential catastrophic expenses that can be entailed in major health crises.  Those who did enroll now find themselves facing large rate hikes or accepting an alternative less generous plan.  Many who enrolled did so assuming that CalPERS would protect them from such hikes.  Yours truly has encountered a number of folks who now find themselves in this predicament.  CalPERS blames the matter on stock market reverses, low current interest rates, and early underestimates of what the program would actually cost.

Yours truly offers this observation.  An insurance carrier can cut the cost of offering such plans by removing from coverage the truly catastrophic expenses.  But that is what insurance is all about.  If you go to the audio link below, you will hear from CalPERS that most people don't have catastrophes and therefore taking an alternative plan that effectively removes them from full coverage won't affect most enrollees. The problem is that it is catastrophes that insurance is all about.  Most people who have fire insurance on their houses won't have their house burn down.  But it is precisely that unlikely event that causes people to buy fire insurance. If CalPERS ever does reopen with some version of long-term care insurance - see below - caveat emptor.

The California State Assembly Committee on Aging and Long-Term Care held a hearing today largely devoted to the CalPERS issue.  A link to an audio of the first part of that hearing - which runs about two and a quarter hours - can be found below.  There is a general presentation on long-term care followed by witnesses including one from CalPERS.  After the official witnesses, there are lengthy public comments by CalPERS enrollees and others, generally expressing anger at the hikes, the fact that CalPERS is an autonomous public entity not subject to the kind of regulation that applies to private companies, etc.  At present, it appears that CalPERS is not offering long-term care policies to new enrollees.  However, it was said that there might be such new enrollment allowed - albeit to a limited policy - later this year.

The audio link is at:


Below is the agenda:

"Paying the Price for a Long Life: What's Next for Long-Term Care Insurance?"
 
Hearing of California Assembly Committee on Aging and Long-Term Care held largely in response to large premium increases announced by CalPERS for its long-term care program, May 7, 2013
 
Hearing chaired by Assembly Member Mariko Yamada
 
Presentation on trends of older Americans and Older Californians preparing for retirement and Long-Term Care, Victoria R. Ballesteros, Director of Communications, The SCAN Foundation
 
PANEL 1 Government/Industry Officials

1. Ann Boynton, Deputy Executive Officer of CalPERS
2. Nettie Hoge, Chief Deputy Commissioner, Department of Insurance
3. Ted Angelo, Association of California Life & Health Insurance Companies
4. Rebecca Blanton, Executive Director, Commission on the Status of Women and Girls
Public Comments
 
Note: Recorded from a live stream. In some cases, there were breaks in the transmission. Gaps have been edited out of the recording.

Cap Removed

Earlier posts on this blog have noted the controversy surrounding the lifetime cap on UC student health insurance.  Most students are healthy and never hit the cap.  But if a major illness occurs, the insurance, which students must have unless they have some other coverage, could run out.

The new federal healthcare law generally forbids such caps but UC was able to continue it as a self-insured plan.  It appears, however, that after complaints about the limit, the cap will be removed. (We also noted in a recent post that UC-Berkeley was planning to pull out of the UC-wide plan and provide its own insurance program.)

An article on the removal can be found in the Sacramento Business Journal at:
www.bizjournals.com/sacramento/news/2013/05/03/uc-eliminating-lifetime-coverage-limit.html

I'm Outta Here

An earlier post on this blog noted that there were concerns about caps on total payouts under the health insurance plan for students at UC.*  Now, apparently, there are also big premium jumps coming. UC-Berkeley has announced it will pull out of the UC-wide plan and run its own.  From the San Francisco Business Times: Following intense pressure from students, UC Berkeley is pulling the plug on participation in a controversial, deficit-plagued student health plan run by the University of California system, Chancellor Robert Birgeneau said Thursday. Birgeneau said the system's flagship Berkeley campus will jump ship effective Aug. 15, when it will leave the UC Student Health Insurance Plan and return to a campus-specific plan. As of that date, health coverage for UC Berkeley students will revert to the former Berkeley campus-run program...

Full story at http://www.bizjournals.com/sanfrancisco/blog/2013/05/uc-berkeley-jumps-ship-will-leave.html

*Our earlier post is at http://uclafacultyassociation.blogspot.com/2013/01/issue-of-uc-health-cap-for-students.html

Hiking

Earlier blog posts have noted that CalPERS' premiums for long-term care are going nowhere but up.  Another rate hike is being announced with an option instead to move to a lesser-value plan.

UC employees and faculty are normally not covered by CalPERS' pension and health care plans.  However, as state workers, they were offered the chance to enroll in CalPERS' long-term care program when CalPERS got into that business.  Unfortunately, there was no guarantee concerning what the premiums would be over time.  From the Sacramento Bee's State Worker blog:

The California Public Employees' Retirement System today is mailing some 150,000 official notices to long-term care insurance policyholders that a rate hike is coming. The letter explains that CalPERS is raising premiums 5 percent this year on the plan's costliest policies, which offer lifetime coverage and daily benefit payouts that keep up with inflation.Policyholders can avoid the premium increases by moving into plans that offer up to 10 years of benefits without automatically inflation-adjusted coverage. The deadline to opt into another plan varies by policyholder. CalPERS' letter also flags a 5 percent increase planned for 2014 and another 85 percent jump in 2015 spread over two years. All the rate hikes apply to policies offering inflation-protected, lifetime coverage for things like nursing home services and in-home care...

Full story at http://blogs.sacbee.com/the_state_worker/2013/04/calpers-letters-detail-long-term-care-rate-hikes-options.html

Read more here: http://blogs.sacbee.com/the_state_worker/2013/04/calpers-letters-detail-long-term-care-rate-hikes-options.html#storylink=cpy

Seems like they are asking too much for too little and doing it too late:

Update: Legislative hearings on CalPERS long-term care are now scheduled:
http://www.sacbee.com/2013/05/02/5388222/the-state-worker-committee-calls.html

Strike Vote to Be Taken at UC Med Centers

Strike at UCLA hospital in 2008

With contract negotiations stalled, union workers at University of California hospitals... say they will vote next week on whether to strike. The strike talk started Friday with a statement from the American Federation of State, County and Municipal Employees Local 3299, which represents about 13,000 employees at university medical facilities across the state...

The university attributes the current strike talk to a refusal by the union “to agree to UC’s pension reforms,” which require employees to pay a larger percentage of their incomes toward pensions starting July 1... But the union says just the opposite. “UC Medical Centers have offered their front line care workers cuts in total compensation,” the union said in its statement.The union is also focusing on the pay and benefits paid to top executives... The union has not specified a specific strike date or duration...

Full story at http://www.utsandiego.com/news/2013/apr/21/afscme-threatens-strike-uc-hospitals/ 

UPDATE: AFSCME announced the strike authorization was passed on May 6.  As noted, a strike vote authorization does not necessarily mean that a strike will occur:
http://blogs.sacbee.com/the_state_worker/2013/05/university-of-california-employees-vote-to-authorize-strike.html

Dog Days at the UCLA Medical Center

Several four-legged volunteers with the People-Animal Connection (PAC) program at Ronald Reagan UCLA Medical Center and their human counterparts will star in an upcoming episode of the PBS television show, “Shelter Me: Let’s Go Home,” premiering in April...

The show followed a handful of human/dog teams with UCLA’s animal-assisted therapy PAC program as they volunteered at the hospital. All of the dogs featured were adopted from shelters and now help people by bringing comfort to patients and their families, as well as joy to the doctors and nurses. “Our animal-assisted therapy dogs truly provide a sense of healing and comfort that no medicine can offer,” said Erin Rice, the recently appointed director of UCLA’s PAC program. “The show will help raise awareness about the real impact dogs can have on our hospitalized patients and we hope viewers will be moved by the program.”...

Full story at http://www.newswise.com/articles/ucla-s-hospital-therapy-dogs-showcased-in-new-pbs-documentary

and centurycity.patch.com/articles/pbs-is-going-to-the-dogs?

The program can be seen on KOCE, April 3 at 12:30 p.m. and April 9 at 7 p.m. Below is an excerpt from the program from a longer YouTube promo: 

Hospital Takeover?

The original St. John's Hospital in the early 1940s

A report in the LA Times today suggests UCLA is considering a bid to take over St. John's Hospital in Santa Monica.  St. John's is only a few blocks from Santa Monica Hospital which UCLA previously acquired.

UCLA and the nation's largest Catholic healthcare system are teaming up on a potential acquisition of St. John's Health Center, a storied Santa Monica hospital up for sale after a recent management shake-up. The partnership between UCLA Health System and Ascension Health Alliance in St. Louis is one proposal under consideration by St. John's and its nonprofit Catholic owner, the Sisters of Charity Leavenworth Health System in Denver, according to people familiar with the matter...

A purchase of St. John's by UCLA would further strengthen its local market power, and that could draw extra scrutiny from government officials concerned about some healthcare deals reducing competition and boosting medical prices. The California attorney general's office is already examining the effects of healthcare consolidation statewide. A spokeswoman for UCLA said it "does not have a bid in alone or in partnership with any other party to purchase St. John's." Ascension, UCLA's potential partner, has been expanding in California. In December, it agreed to an affiliation with St. Vincent Medical Center in Los Angeles and five other California hospitals owned by another Catholic system. Ascension runs more than 70 hospitals in 21 states and it had revenue of $16.6 billion in the year that ended June 30...

Full story at http://www.latimes.com/business/la-fi-saint-johns-deal-20130323,0,420817.story