Sponsored by the United States–Japan Foundation, the Elgin Heinz Teacher Award recognizes exceptional teachers who further mutual understanding between Americans and Japanese. The award is presented annually to pre-college teachers in two categories, humanities and Japanese language. It is named in honor of Elgin Heinz for his commitment to educating students about Asia as well as for the inspiration he has provided to the field of pre-college education.

SPICE’s Reischauer Scholars Program Manager and Instructor Naomi Funahashi has won the 2017 Elgin Heinz Teacher Award for her teaching excellence with the Reischauer Scholars Program (RSP), an online course named in honor of former Ambassador to Japan Edwin O. Reischauer that introduces Japan and U.S.–Japan relations to high school students in the United States. Funahashi formally accepted the award at Stanford University on November 20, 2017.

In his opening comments, David Janes, Director of Foundation Grants and Assistant to the President, United States–Japan Foundation, who hosted the ceremony, praised Funahashi, explaining why she is so deserving of the distinction: “Like Ambassador Reischauer, Naomi knows how global education at the high school level can transform kids for life, making them better leaders for the future.”

Comments from the Honorable Jun Yamada, Consul General of Japan, were shared by Maiko Tamagawa, Advisor for Educational Affairs, Consulate General of Japan in San Francisco. Consul General Yamada noted, “Ms. Funahashi is indeed an extraordinary educator. Her dedication and commitment to inspiring and empowering young Americans to become experts on Japan is an invaluable contribution to the promotion of mutual understanding between our two countries.” Consul General Yamada, who serves on the advisory committee of the RSP, also graciously hosted a dinner at his residence in honor of Funahashi in July 2017, shortly after the announcement of the award.

SPICE Director Gary Mukai, who nominated Funahashi for the award, commented that “Naomi is extremely dedicated to her students, and I hear regular praise from her students, including those who have matriculated to Stanford. Elgin would have rave reviews of her interdisciplinary approach to teaching… Because of Naomi, the original RSP goal of creating a new generation of leaders in the U.S.–Japan relationship has become a reality.”

David Janes (United States–Japan Foundation) presents the 2017 Elgin Heinz Teacher Award to Naomi Funahashi (SPICE)

Former RSP student and recent Stanford graduate Aryo Sorayya spoke next and thanked Funahashi for extending herself to students far beyond the RSP’s course requirements themselves. Sorayya spoke not only about Funahashi’s careful attention to students’ work but also her sincere interest in their college plans and careers.

Also in attendance were former Ambassador to Japan Michael Armacost; many Stanford scholars—including Takeo Hoshi, Kenji Kushida, and Phillip Lipscy—who contribute lectures, lead online “virtual classrooms,” and/or serve as principal investigators of the RSP; former recipients the Elgin Heinz Teacher Award Norman Masuda and Saya Okimoto McKenna; and members of Funahashi’s family, including her mother Jan Funahashi, husband Rich Lee, and three-year-old son Akira, hopefully a future RSP student in 2030.

Funahashi was born in Tokyo and grew up moving between the United States and Japan. Naomi has resided in the San Francisco Bay Area since 2000, joining SPICE in 2005. She is a graduate of Brown University (BA), San Francisco State University (teaching credential), and the University of Illinois, Urbana-Champaign (M.Ed.). She has served as Manager and Instructor of the RSP since joining SPICE.

Find more information on the Elgin Heinz Teacher Awards online
http://us-jf.org/programs/elgin-heinz-teacher-awards/

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The Japan Program hosted the Abe Fellows Global Forum, “Confronting Climate Change: What Can the U.S. and Japan Contribute to Creating Sustainable Societies?” at Bechtel Conference Center at Stanford University on October 20, 2017. The event was co-organized with the Social Science Research Council, in collaboration with the Center for Global Partnership of the Japan Foundation, which funds the Abe Fellowship Program.

The conference opened with a remark by George P. Shultz, Thomas W. and Susan B. Ford Distinguished Fellow, Hoover Institution at Stanford University and former US Secretary of State and US Secretary of Treasury followed by a keynote by Michael Armacost, Shorenstein APARC Fellow at Stanford University and former ambassador to Japan and the Philippines, who addressed questions on strategies for reducing energy consumption and possibilities for future international cooperation between Japan and the United States on climate change.

Following the keynote speech, experts from Japan and the United States engaged in a panel discussion and shared some of the lessons that have been learned from Asia’s experience.  Toshi Arimura, Professor, Faculty of Political Science and Economics, Waseda University, presented the experience of carbon pricing in the U.S. and Japan and the successful experience in both countries.  Janelle Knox-Hayes, Lister Brothers Associate Professor of Economic Geography and Planning, Massachusetts Institute of Technology, pointed out the importance of the socio-political context in various countries for creating well-functioning markets for carbon emission.  Philip Lipscy, Assistant Professor of Political Science and Thomas Rohlen Center Fellow at FSI, Stanford University, discussed how the political context has been influencing Japan’s energy policies.  Dana Buntrock, Chair, Center for Japanese Studies and Professor of Architecture, UC Berkeley, presented how specific contexts in Japan and the U.s. have shaped the energy policies in two countries.

The conference was followed by a reception in the Oksenberg Conference Room.

Phillip Lipscy examines Trump administration's decision to withdraw U.S. membership from the United Nations Educational, Scientific and Cultural Organization in an article in The Hill.

There is plenty of research on how the rapid warming of the planet is going to have growing adverse impacts on global economies, health, food supplies and natural disasters.

A new study now suggests that as temperatures continue to rise — particularly with more and more 90-plus-degree days — more fetuses and infants will experience economic loss by age 30.

“There is a growing body of evidence that finds that shocks to the fetus and young child — whether nutritional, environmental, economic or stress-related — have long-term consequences on health, education and economic outcomes throughout the life cycle,” said Maya Rossin-Slater, an assistant professor of health research and policy at Stanford Medicine and a faculty fellow at the Stanford Institute for Economic Policy Research.

Rossin-Slater published her study Dec. 4 in the Proceedings of the National Academy of Sciences, indicating early-life exposure to extreme temperatures is linked to potential losses in human capital. Her co-authors are Adam Isen, an economist with the U.S. Department of Treasury, and Reed Walker, an assistant professor at University of California, Berkeley.

The researchers used data from the U.S. Census Bureau’s Longitudinal Employer Household Dynamic Files, which contain information on adult labor market outcomes linked to county and exact date of birth. They looked at weather in counties in 24 states on any given day, and then measured how many days with average temperatures above 90 degrees a child born on that day in that county would have experienced during gestation and during the first year of life. They then compared the earnings of individuals who were exposed to different numbers of such hot days, but who were of the same race and gender, and born in the same county and on the same day of the year (but in different years).

Each day a fetus or infant experiences 90-plus-degree temperatures, Rossin-Slater and her co-authors found that he made $30 less a year on average, or $430 over the course of his lifetime. While that may not seem like a huge loss of income, the authors point out that their study is best understood from a population-level perspective rather than from an individual one.

“There is a lot of research already showing that extreme heat has immediate effects on labor market productivity and GDP,” she said. “What we are saying is that there is another wrinkle to this — that there can be consequences many years later, on cohorts who are still in the womb.”

Most Americans today only experience one day a year that is 90 degrees or hotter. But the Climate Impact Lab has indicated that if countries continue to take only moderate action on climate change, by the end of this century there will be about 43 such days a year.

So, if you multiple a $30 annual loss a day by 43 days, you come up with an average $1,290 a year — and compounded in large populations of pregnant women in hot climates.

“Prior research shows that exposure to extreme heat in utero leads to lower birth weight and increases infant mortality,” said Rossin-Slater, who is also a core faculty member at Stanford Health Policy. She said poor fetal and infant health could impact adult earnings in three ways: cognitive impairment, poor health that causes people to miss school or work, and less non-cognitive skill development such as self-control.

“With regard to exposure to heat specifically, fetuses and infants are especially sensitive because their thermoregulatory systems are not fully developed and they have less capacity to self-regulate when their bodies are exposed to extreme temperatures,” Rossin-Slater said.

Hot Zones and Air Conditioners

The obvious questions that arise from such research: What happens to the babies of women who already live in very high temperatures? And why not just ensure that all pregnant women have air conditioners, at least in the developed world where it would be more affordable?

Women in warm zones such as parts of Africa and South Asia, as well as U.S. cities like Phoenix and Washington, D.C., shouldn’t worry too much. The loss of income is relatively little and people living in hot climates may actually adapt over time to exposure to extreme heat.

“Our study is not saying that individual people should be doing something differently to avoid exposure to extreme heat,” Rossin-Slater said. “Instead, we think we are providing additional evidence for the possible population-level consequences of climate change and the projected increase in the number of days with extreme temperatures.”

And what about those air conditioners? The cohorts in the study are actually born in the 1970s, during a period of rapid expansion in air conditioning across American households. The researchers found the earning losses went away in areas where most people got air conditioners installed.

“If we think that there is something biological going on as a result of the fetus being overheated, then it makes sense that AC, which prevents the overheating, can mitigate this negative effect,” Rossin-Slater said.

But it’s important to recognize, she said, that air conditioners come with costs, both financial from the perspective of individuals and households who can and can’t afford such systems, and environmental from the perspective of the country or planet as a whole.

“So this is not a `free’ solution and any cost-benefit calculations related to climate change should take into account this adaption response,” Rossin-Slater said. “But we ought to think about what these results imply at the global level — in many countries that are much hotter than the United States and still don’t have AC. So if we are trying to understand global inequality and the impacts of climate change on developing countries, our results suggest that climate change could play a role in perpetuating global inequality across generations.”

"The problems with our democracy—ever-deepening polarization, incivility, gridlock, dysfunction, conflicts of interest, and disregard for democratic norms—are not just problems of political culture and behavior. Politicians are driven by incentives, especially the desire to get re-elected. Institutions heavily shape these incentives, and our institutions are in need of reform. Unless we reform our democracy, we will be increasingly hard-pressed to improve the health of democracy globally." Listen to Larry Diamond, Senior Fellow at the Freeman Spogli Institute for International Studies, explains in this podcast what are the options from here, by Hoover Institution. 

CVS Health announced it would buy Aetna, the country’s third-largest health insurance company for $69 billion, a deal that could revamp the nation’s health-care industry and impact millions of consumers who are always on the lookout for better delivery and costs.

The merger, which must still undergo an antitrust review by the government, could impact the cost of drugs and the way patients visit health-care providers.

“This combination brings together the expertise of two great companies to remake the consumer health-care experience,” CVS Health President and CEO Larry J. Merlo said in a statement on Dec. 3. “With the analytics of Aetna and CVS Health’s human touch, we will create a health-care platform built around individuals.” 

Merlo said that by using CVS’s 10,000 pharmacy locations around the country, they would make health care more affordable and accessible.

We asked Stanford Health Policy’s Laurence Baker, chair of Stanford Medicine’s Department of Health Research and Policy and an expert on health-care delivery and costs, several questions about the potential merger.

Q. Could this lead to lower drug prices for the consumer?

Baker: One of the hoped-for effects is that a combined Aetna-CVS would be better able to negotiate favorable prices for prescription drugs. It is possible I suppose, since together they would have a considerable amount of information and strengthened incentives to control costs. In a model where a pharmacy benefit manager, like CVS, did most of the negotiating with the pharmaceutical companies, and insurers like Aetna separately paid the costs, there might be less ability and incentive to negotiate for favorable prices than if the two do merge. 

At the same time, there is no guarantee that there will be savings and if there are it is not clear that they would be very large. CVS and others have been negotiating for drug prices already, and the advantages conveyed by the merger need not be that big.  I can only imagine that if there were lots of low-hanging fruit Aetna and CVS, and others, would already have had some good opportunities to pursue changes. 

One place where a combined Aetna-CVS could make a difference would be in working with doctors and patients, doing more to promote the use of better or higher-value drugs. A merged entity might be more effective at getting patients to use appropriate generics rather than expensive branded drugs, for example.  This effect could be even stronger if a merged company were to be successful in their announced plan to do more to integrate physicians and other health-care providers with CVS pharmacies.

Q: If there were savings, would consumers see them?

Baker: If a combined Aetna-CVS were to negotiate better drug prices, whether or not those are passed on to consumers or just retained by the company depends on things like the degree of competition in the insurance marketplace. If the company could benefit from lowering prices for, say, Aetna insurance policies because of the lower drug prices, at least some of the savings could be passed on to consumers. But we often worry that many insurance markets are not competitive enough, so it would remain to be seen whether consumers would see the benefits or not.

The effects of stronger efforts to move patients toward higher-value or lower-cost drugs also might or might not flow through directly to patients. Overall savings may or may not be passed on, but it is possible that some patients would see changes in their copayments that could be beneficial.

Q: Could the potential merger lead to new and improved methods of delivering care?

Baker: Leaders of CVS and Aetna talked about the potential for building new and improved methods for health care delivery, including having more care delivered through clinics associated with CVS stores. These are intriguing ideas, consistent with many discussions going on about the next generation of health-care delivery. It isn’t entirely clear why a merger is needed to develop this, nor is it clear that it would lead to widespread improvements in health care, but innovation in this area doesn’t seem likely to do harm either and would probably benefit some people.

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Q:  Would this result in reduced consumer choice of health care provider?

Baker: It does stand to reason that a merged Aetna-CVS might prefer that people with Aetna insurance use CVS rather than other competitors. They might develop restrictions or incentives that would steer their customers in this direction, and that could certainly be a concern for some people. This gets at a larger question facing the health-care system these days. It may be that the formation of more integrated care networks, with less provider choice overall, but with providers that are carefully chosen and better at working together, offers opportunities to improve care and lower costs.  This could have advantages, but would also come with tradeoffs for choice.

Q: Would a merger lead to a company that is “too big” with too much power?

Baker: One thing analysts have worried about lately is the amount of consolidation in the health-care marketplace. This would be another example of that, combining two already large players. Sometimes people argue that bigger can be better if it helps align the activities of different players in ways that could push us toward lower costs or improve quality. Often enough, however, we have seen consolidation lead to higher prices without seeing improved quality. This particular type of merger — combining a health insurer with a health care provider — is a bit less common than the consolidation we’ve most commonly seen such as hospitals merging and has some different features, so the overall effects will be something analysts will want to keep an eye on.

There is no denying the Affordable Care Act has significantly increased the number of Americans with health insurance. Yet many policymakers and consumers question the value of Marketplace plan coverage under the ACA because cost-sharing can get pretty high.

A survey by the Kaiser Family Foundation and The New York Times last year found that 22 percent of people who purchased health insurance through an ACA Marketplace plan had trouble paying their medical bills due to copayments, high deductibles, and co-insurance payments.

Out-of-pocket costs under a typical silver plan, for example, can be twice as high as they are in the average plan provided by employers.

So Stanford health policy researchers conducted a study, published online in Health Affairs, in which they simulated out-of-pocket spending for bronze, silver and gold Marketplace plans — those having actuarial values of 60 percent, 70 percent and 80 percent, respectively.

They found that while Marketplace plans significantly reduce exposure to the financial risk of a catastrophic illness, the use of actuarial values can be misleading. For the vast majority of consumers, the proportion of covered spending is likely to be far less than their actuarial values.

“Many Americans may find themselves not using their health insurance plan in a given year because they didn't get sick,” said Maria Polyakova, an assistant professor of health research and policy at Stanford Medicine and lead author of the paper.

In fact, only when annual health-care spending exceeds $16,500 for bronze plans, $19,500 for silver plans, and $21,500 for gold plans do plans in these metal tiers cover the proportion of costs matching their actuarial values. These metal levels are intended to provide standardized information on coverage generosity to help consumers choose among plans.

Marketplace plans provide relatively comprehensive coverage for the small proportion of people who experience extremely high health-care spending, the authors wrote. But the vast majority of enrollees experience relatively little direct benefit from their coverage in any given year because most of their services out of pocket because their expenses fall below the deductible limits.

But Polyakova, who is also a faculty research fellow at the National Bureau of Economic Research, said it’s important not to conclude that purchasing health insurance is a waste of money for the young and healthy.

“Indeed, most working-age adults do not use much health care,” she said. “The idea of health insurance, however, is to protect household finances in those cases when someone does get sick and needs expensive care. In this paper, we find that for many consumers, Marketplace plans are likely to provide valuable risk protection.”

The mismatch between expected and experienced coverage for the majority of people who have low health-care expenditures is one factor that may have inhibited enrollment in Marketplace plans among relatively healthy people, the authors wrote, a phenomenon that could have contributed to Marketplace instability.

“More generally, a weakness of using actuarial value is that doing so distracts consumers from the key purpose of insurance, which is financial risk protection,” said Polyakova and co-author Kate Bundorf, an associate professor of health research and policy and chief of the Division of Health Services Research at the Stanford School of Medicine.

“Policymakers should consider alternative ways of communicating plan generosity that more accurately convey to consumers their likely out-of-pocket spending in a plan and how much risk protection plans provide,” they wrote. “Moreover, it may be important and valuable to emphasize the risk protection value of plans in the public debate.”

One fairly easy fix, Polyakova said, would be for healthcare.gov to show consumers their expected spending under different “sick” and “healthy” scenarios. Currently, the health site asks consumers whether they expect to be sick or healthy and then shows which out-of-pocket costs would result. But it doesn't show people who expect to be healthy what would happen to their spending if they did get sick.