April 2015

[Commentary] Earlier in April, Australian Federal Treasurer Joe Hockey announced that he will introduce legislation subjecting overseas sellers of downloaded movies, music, books and other media to the obligation to collect and pay Goods and Services Tax (GST) to the Australian government for downloads destined for Australia. Treasurer Hockey claimed the move would level the playing field, be easy to administer and raise billions in additional revenue. The move appears to have been prompted by the recent arrival of Netflix down-under, which is conveniently incorporated and selling its services from a non-Australian jurisdiction. As such, Netflix is not (at the moment at least) subject to the 10 percent GST on its subscriptions in the same manner as locally-incorporated streaming services are. Colloquially, this has now been dubbed the “Netflix Tax.” Solving historical tax jurisdiction issues and technical questions about attribution all at once sounds pretty amazing, doesn’t it? Unfortunately, neither seems to be true, as neither of these dilemmas appears to be solved by Treasurer Hockey’s legislative proposals.

[Bronwyn Howell is general manager for the New Zealand Institute for the Study of Competition and Regulation]

[Commentary] The collapse of Comcast’s plan to buy Time Warner Cable is a big victory for anyone who watches TV or uses the Internet. But it won’t be the last time the interests of consumers clash with the desires of big corporations in the media and technology space. Here are five lessons from this fight I think we should keep in mind going forward.

1. We should believe in the power of grassroots activism: we won because ordinary Americans can wield extraordinary power when they raise their voices.
2. We should empower regulators to do their jobs: This decision illustrates an important reason why we have the FCC (and federal regulatory agencies in general): to protect the American people from being taken advantage of by big corporations.
3. We should still be worried about lack of competition: Even without this deal, there is far too little competition in the cable and broadband markets.
4. We should remember when corporations break their promises: Comcast had a hard time convincing me, and regulators, that this deal wouldn’t hurt consumers. Part of the reason why is that we had heard similar promises from Comcast before -- and they’d been broken time and time again.
5. We should always put consumers first in media and technology policy: I happened to know a lot about consolidation in media because I used to work in media. But to a lot of people, vertical integration and antitrust law sound like obscure, and almost comically boring, topics. And that’s a shame. Because this is really about consumers, and the services they rely on as part of their daily lives, and how much they have to pay for those services every month.

When WGN America dropped local sports from its programming this season, it ended nearly four decades of beaming Cubs baseball to far-flung places across the country. Distant viewers can still watch the Cubs through paid service online or on cable or satellite TV. But for displaced fans within the team's designated "home" turf -- an expansive region that includes Illinois, Iowa and Indiana -- it's hit or miss because of MLB broadcast rules dating to the rabbit-ears era.

While streaming and cable or satellite packages can deliver every Cubs game, almost anywhere, they are considered out of market platforms prohibited within the team's home television territory. "That's a blackout issue," said Bob Bowman, president of business and media for Major League Baseball. "There's no alternative, you can't really watch the game." Local Cubs broadcast partners WLS-Ch.7, WGN-Ch.9 and Comcast SportsNet Chicago are enjoying robust ratings this season. But watching the Cubs has been a regional and national pastime since WGN first uploaded the games to satellite in the late 1970s. For fans outside the home territory, there are several options to watch the Cubs from DirecTV, Xfinity and MLB.TV, all with costs of $100 to $200. But the league's definition of a home television territory -- where only the team's local broadcast partners can deliver games -- is extremely broad, leading to widespread blackouts, taking those out-of-market off the table for many. The Cubs are looking to launch their own regional sports network after the current local TV and cable broadcast rights deals expire in 2019. Bowman said any changes in the home television territory will have to protect the existing ecosystem of regional sports networks and local TV stations. But he believes technology will eventually make following the home team a whole new ballgame. "The goal should be that if a fan wants to watch the game, he or she should be able to, in one shape or form," Bowman said. "We won't have it overnight, but I think we have to start making progress on this issue."

[Commentary] The nation has seen widespread adoption of health IT as a result of the Medicare and Medicaid EHR Incentive Programs. With that increase in adoption, there should be more and better evidence on the actual impact of health IT on safety. Health IT should raise the floor on patient safety, and the evidence shows that it has. To help answer questions about the role health IT plays in patient safety, we recently posted an Issue Brief titled “Recent Evidence that Health IT Improves Patient Safety.”

On balance, the report found health IT has clearly made care safer. These studies mean that health IT has almost certainly led to far fewer people being harmed than would have been without widespread health IT adoption. The Issue Brief reviews four systematic literature reviews that used a consistent methodology and finds consistent and significant net benefits on patient safety from the adoption of health IT. Health IT is not and never will be a “silver bullet” that reduces unsafe conditions, errors, and adverse events. To improve safety and quality, health IT is an important part of delivery system reform and redesigned systems of care. Health IT, when well designed and implemented, is a tool that can help health information flow in ways that allow for improvements in patient health and safety. Whatever the drawbacks to health IT systems, the evidence suggests that health IT has raised the floor on safety. The widespread adoption of health IT has been a clear benefit to patient safety. We need to continue to work on making health IT even better in a redesigned health system with patient safety and quality its first priority.

[Andrew Gettinger, MD is Chief Medical Information Officer and Acting Director of the Office of Clinical Quality and Safety. Kathy Kenyon, JUD is a Senior Policy Analyst]