This week, we discuss Australia's wildfires; how artificial intelligence could supercharge disinformation; why the fentanyl crisis requires innovative solutions; Medicare's overpayments to surgeons; Iran's regional influence; and systemic risks to the economy.
Massive bushfires have destroyed millions of acres in Australia over the past few months. RAND's Melissa Finucane, a community resilience expert who grew up in a remote region of New South Wales, has watched in anguish.
Experiences from previous disasters have highlighted concrete steps that can help communities start to recover right away, she says. She also notes that rural Australians have “a special kind of resilience,” with perspectives and wisdom from years of hard experience. But still, measuring the effects that fires and other disasters have on people's mental health, social, and economic needs remains a unique challenge.
Bad actors could use artificial intelligence to exploit human flaws at an unprecedented scale, speed, and level of effectiveness, warn RAND experts. Social bots like the ones already sending ads for cars or skin care could eventually be used to change people's attitudes toward other groups. They could also influence people's views on foreign or domestic policy. The first country to employ such tactics could prey on the public for years, the researchers say. But there's still time to defend against AI-driven social manipulation.
U.S. deaths involving fentanyl and other synthetic opioids have surged from around 3,000 in 2013 to more than 30,000 in 2018. The crisis is unlike any drug problem in modern history. That's why traditional interventions—such as disrupting the supply and getting people into treatment—won't be enough to turn the tide. Innovative, and controversial, responses, such as supervised drug-consumption sites, should also be part of the policy discussion.
Late last year, there were significant protests against the Iranian regime—not only in Iran, but also in Iraq and Lebanon. This left Iran facing the greatest challenge to its regional position in years, says RAND's Jordan Reimer. But due to the regime's machinations and the fallout over the U.S. killing of Iranian Major General Qassem Soleimani, Tehran appears to have regained its footing, despite this month's smaller-scale protests over the downing of a Ukrainian passenger plane. It's unclear whether this will last, says Reimer.
For most surgical procedures, Medicare provides a bundled payment for the operation as well as postoperative care. RAND's Andrew Mulcahy and colleagues highlighted problems with this approach in the New England Journal of Medicine this week. Evidence suggests that surgeons provide only a small share of the postoperative care they're paid for. And because Medicare caps spending each year, overpayments to surgeons can lead to lower payments for other services, such as office visits. The researchers recommend moving to a system that better reflects the postoperative care that surgeons actually provide.
The 2008 auto industry bailout is a reminder that the risks of being “too big to fail” extend beyond financial firms and into other sectors. A new RAND report explores this idea, citing top technology, telecommunications, and health care companies as particularly important to the economy. For example, consider that U.S. businesses and households are becoming more reliant on the services of companies like Amazon, Comcast, and Apple. A shock to any one of those firms could ripple across the entire economy.
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