Price Regulation, Global Budgets, and Spending Targets: A Road Map to Reduce Health Care Spending, and Improve Affordability

Report
  1. Congressional Budget Office, The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services (Washington, DC: Congressional Budget Office, October 2021),  https://www.cbo.gov/publication/57422

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  2. Matthew Rae, Rebecca Copeland, and Cynthia Cox, Tracking the rise in premium contributions and cost-sharing for families with large employer coverage (Washington, DC: KFF, August 14, 2019): https://www.healthsystemtracker.org/brief/tracking-the-rise-in-premium-contributions-and-cost-sharing-for-families-with-large-employer-coverage/

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  3. Health Care Cost Institute, 2019 Health Care Cost And Utilization Report (Washington, DC: Health Care Cost Institute, October 2021),  https://healthcostinstitute.org/images/pdfs/HCCI_2019_Health_Care_Cost_and_Utilization_Report.pdf

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  4. Suhas Gondi et al, “Early Hospital Compliance With Federal Requirements for Price Transparency,” JAMA Internal Medicine 181, no. 10 (June 14, 2021):1396-1397, doi:10.1001/jamainternmed.2021.2531.

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  5. Morgan A. Henderson and Morgane C. Mouslim, “Low Compliance From Big Hospitals On CMS’s Hospital Price Transparency Rule,” Health Affairs (March 16, 2021), https://www.healthaffairs.org/do/10.1377/hblog20210311.899634/full/

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  6. Bianca Mulaney, Shreya A. Shah, Christine Kim, and Laurence C. Baker, “Compliance with Price Transparency by California Hospitals,” Stanford Health Policy (July 10, 2021), https://healthpolicy.fsi.stanford.edu/publication/compliance-price-transparency-california-hospitals

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  7. Nisha Kurani et al, Early results from federal price transparency rule show difficulty in estimating the cost of care Estimates (Washington, DC:  Kaiser Family Foundation, April 2021), https://www.healthsystemtracker.org/brief/early-results-from-federal-price-transparency-rule-show-difficultly-in-estimating-the-cost-of-care/.

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  8. Sunita Desai et al, “Association Between Availability of a Price Transparency Tool and Outpatient Spending,” JAMA 315, no. 17 (May 3, 2016): 1874-1881, doi:10.1001/jama.2016.4288.

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  9. Anna D. Sinaiko, Karen E. Joynt, and Meredith B. Rosenthal, “Association Between Viewing Health Care Price Information and Choice of Health Care Facility,” JAMA Internal Medicine 178, no. 12 (December 2016), doi:10.1001/jamainternmed.2016.6622

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  10. Martin Gaynor, What to Do about Health-Care Markets? Policies to Make Health-Care Markets Work (Washington, DC: The Hamilton Project, March 10, 2021), https://www.hamiltonproject.org/papers/what_to_do_about_health_care_markets_policies_to_make_health_care_markets_work .

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  11. Benjamin Sommers, “Who Really Pays for Health Insurance?” International Journal of Health Care Finance and Economics 5 (March 2005): 89–118 https://doi.org/10.1007/s10754-005-6603-5.

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  12. Health Care Cost Institute, 2019 Health Care Cost And Utilization Report (Washington, DC: Health Care Cost Institute, October 2021),  https://healthcostinstitute.org/images/pdfs/HCCI_2019_Health_Care_Cost_and_Utilization_Report.pdf

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  13. Gerard F. Anderson, Peter Hussey, and Varduhi Petrosyan, “It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt,” Health Affairs 38, no. 1 (January 2019): 87-95, https://doi.org/10.1377/hlthaff.2018.05144

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  14. Irene Papanicolas, Liana R. Woskie, and Ashish K. Jha, “Health Care Spending in the United States and Other High-Income Countries,” JAMA 319, no. 10 (March 13, 2018):1024-1039, doi:10.1001/jama.2018.1150

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  15. Congressional Budget Office, The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services (Washington, DC: Congressional Budget Office, October 2021),  https://www.cbo.gov/publication/57422

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  16. Zack Cooper et al, “Hospital Prices Grew Substantially Faster Than Physician Prices For Hospital-Based Care In 2007–14,” Health Affairs 38, no. 2 (February 2019): 184-189, https://doi.org/10.1377/hlthaff.2018.05424

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  17. David M. Cutler and Fiona Scott Morton. “Hospitals, Market Share, and Consolidation.” JAMA 310, no. 18 (November 13, 2013); 1964-2970, doi:10.1001/jama.2013.281675

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  18. Brent D. Fulton, “Health Care Market Concentration Trends In The United States: Evidence And Policy Responses,” Health Affairs 36, no. 9 (September 1, 2017): 1530–1538,  https://doi.org/10.1377/hlthaff.2017.0556.

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  19. Brent D. Fulton, “Health Care Market Concentration Trends In The United States: Evidence And Policy Responses,” Health Affairs 36, 1530–1538, https://doi.org/10.1377/hlthaff.2017.0556.

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  20. Maximilian J. Pany, Michael E. Chernew, and Leemore S. Dafny, “Regulating Hospital Prices Based On Market Concentration Is Likely To Leave High-Price Hospitals Unaffected,” Health Affairs 40, no. 9 (September 2021): 1386-1394, https://doi.org/10.1377/hlthaff.2021.00001

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  21. Michael E. Chernew, Leemore S. Dafny, and Maximilian J. Pany, A Proposal to Cap Provider Prices and Price Growth in the Commercial Health-Care Market (Washington, DC: The Hamilton Project, March 2020),  https://www.hamiltonproject.org/papers/a_proposal_to_cap_provider_prices_and_price_growth_in_the_commercial_health_care_market

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  22. Robert Murray, Robert Berenson, Hospital Rate Setting Revisited: Dumb Price Fixing or a Smart Solution to Provider Pricing Power and Delivery (Washington, DC: Urban Institute, November 2015), https://www.urban.org/sites/default/files/publication/73841/2000516-Hospital-Rate-Setting-Revisited.pdf

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  23. Robert Murray, Robert Berenson, Hospital Rate Setting Revisited: Dumb Price Fixing or a Smart Solution to Provider Pricing Power and Delivery (Washington, DC: Urban Institute, November 2015), https://www.urban.org/sites/default/files/publication/73841/2000516-Hospital-Rate-Setting-Revisited.pdf

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  24. David C. Chan Jr and Michael J. Dickstein, Industry Input in Policymaking: Evidence from Medicare (Cambridge, MA: National Bureau of Economic Research, February 2018), https://www.nber.org/system/files/working_papers/w24354/w24354.pdf

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  25. Hospital Competition Act of 2019, H.R. 506, 116th Cong. § 2 (2019).

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  26. Fair Care Act of 2019, H.R. 1332, 116th Cong. § 401 (2019).

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  27. Michael E. Chernew, Andrew L. Hicks, and Shivani A. Shah, “Wide State-Level Variation In Commercial Health Care Prices Suggests Uneven Impact Of Price Regulation,” Health Affairs 39, no. 5 (May 2020): 791-799, https://doi.org/10.1377/hlthaff.2019.01377

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  28. Joseph P. Newhouse and Daniel J. Byrne, “Did Medicare’s Prospective Payment System cause length of stay to fall?” Journal of Health Economics 7, no. 4 (December 1988): 413-416, https://doi.org/10.1016/0167-6296(88)90023-9

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  29. Mireille Jacobson, Craig C. Earle, Mary Price, and Joseph P. Newhouse, “How Medicare’s Payment Cuts For Cancer Chemotherapy Drugs Changed Patterns Of Treatment, “ Health Affairs 29, no. 7 (July 2010):1391-1399, https://doi.org/10.1377/hlthaff.2009.0563

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  30. Zack Cooper, Stuart V Craig, Martin Gaynor, and John Van Reenen, “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured,” The Quarterly Journal of Economics, 134, no. 1 (September 4, 2019): 51-107, https://doi.org/10.1093/qje/qjy020

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  31. Chapin White and Christopher M. Whaley, Prices Paid to Hospitals by Private Health Plans Are High Relative to Medicare and Vary Widely: Findings from an Employer-Led Transparency Initiative (Santa Monica, CA: RAND Corporation, 2019), https://www.rand.org/pubs/research_reports/RR3033.html

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  32. Michael E. Chernew, Andrew L. Hicks, and Shivani A. Shah, “Wide State-Level Variation In Commercial Health Care Prices Suggests Uneven Impact Of Price Regulation,” Health Affairs 39, no. 5 (May 2020): 791-799, https://doi.org/10.1377/hlthaff.2019.01377

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  33. Congressional Budget Office, The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services (Washington, DC: Congressional Budget Office, October 2021),  https://www.cbo.gov/publication/57422

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  34. Congressional Budget Office, The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services (Washington, DC: Congressional Budget Office, October 2021),  https://www.cbo.gov/publication/57422

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  35. Martin Gaynor M, Kate Ho, Robert J. Town, “The Industrial Organization of Health-Care Markets†,” Journal of Economic Literature 53, no. 2 (June 2015): 235-284, https://www.jstor.org/stable/24433982

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  36. Michael E. Chernew, Leemore S. Dafny, and Maximilian J. Pany, A Proposal to Cap Provider Prices and Price Growth in the Commercial Health-Care Market (Washington, DC: The Hamilton Project, March 2020),  https://www.hamiltonproject.org/papers/a_proposal_to_cap_provider_prices_and_price_growth_in_the_commercial_health_care_market

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  37. Michael E. Chernew, David A. Cutler, and Shivani A. Shah, Reducing Health Care Spending: What Tools Can States Leverage? (Washington, DC: Commonwealth Fund, August 2021),  https://www.commonwealthfund.org/publications/fund-reports/2021/aug/reducing-health-care-spending-what-tools-can-states-leverage

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  38. Michael E. Chernew, Leemore S. Dafny, and Maximilian J. Pany, A Proposal to Cap Provider Prices and Price Growth in the Commercial Health-Care Market (Washington, DC: The Hamilton Project, March 2020),  https://www.hamiltonproject.org/papers/a_proposal_to_cap_provider_prices_and_price_growth_in_the_commercial_health_care_market

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  39. Maximilian J. Pany, Michael E. Chernew, and Leemore S. Dafny, “Regulating Hospital Prices Based On Market Concentration Is Likely To Leave High-Price Hospitals Unaffected,” Health Affairs 40, no. 9 (September 2021): 1386-1394, https://doi.org/10.1377/hlthaff.2021.00001

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  40. Zack, Cooper, Joseph J. Doyle Jr, John A. Graves, and Jonathan Gruber, Do Higher-Priced Hospitals Deliver Higher-Quality Care? (Cambridge, MA: National Bureau of Economic Research, February 2022), http://www.nber.org/papers/w29809

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  41. Michael E. Chernew, Leemore S. Dafny, and Maximilian J. Pany, A Proposal to Cap Provider Prices and Price Growth in the Commercial Health-Care Market (Washington, DC: The Hamilton Project, March 2020),  https://www.hamiltonproject.org/papers/a_proposal_to_cap_provider_prices_and_price_growth_in_the_commercial_health_care_market

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  42. Michael E. Chernew and Maximilian J. Pany, “Regulation of Health Care Prices: The Case for Backstop Price Caps in Commercial Health Care Markets,” JAMA 325, no. 9 (March 2, 2021):817, doi:10.1001/jama.2020.26821

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  43. Robert A. Berenson and Robert B. Murray, “How Price Regulation Is Needed To Advance Market Competition,” Health Affairs 41, no. 1 (January 2022): 26-34, https://doi.org/10.1377/hlthaff.2021.01235

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  44. Aditi P. Sen et al, “Participation, Pricing, and Enrollment in a Health Insurance “Public Option”: Evidence From Washington State’s Cascade Care Program,” The Milbank Quarterly 100 (March 2022), https://www.milbank.org/quarterly/articles/participation-pricing-and-enrollment-in-a-health-insurance-public-option-evidence-from-washington-states-cascade-care-program/

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  45. Catalyst for Payment Reform, Reference-Based Pricing: Risks and Rewards of Playing Health Care Hardball (Catalyst for Payment Reform, April 2021), https://www.catalyze.org/wp-content/uploads/2021/04/RBP-Whitepaper_April-2021_Published.pdf

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  46. Steve Schramm and Zachary Aters, Estimating the Impact of Reference-Based Hospital Pricing in the Montana State Employee Plan, (Scottsdale, AZ: Optumas, April 6, 2021), https://www.nashp.org/wp-content/uploads/2021/04/MT-Eval-Analysis-Final-4-2-2021.pdf

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  47. Aditi P. Sen et al, “Participation, Pricing, and Enrollment in a Health Insurance “Public Option”: Evidence From Washington State’s Cascade Care Program,” The Milbank Quarterly 100 (March 2022), https://www.milbank.org/quarterly/articles/participation-pricing-and-enrollment-in-a-health-insurance-public-option-evidence-from-washington-states-cascade-care-program/

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  48. Michael E. Chernew, Leemore S. Dafny, and Maximilian J. Pany, A Proposal to Cap Provider Prices and Price Growth in the Commercial Health-Care Market (Washington, DC: The Hamilton Project, March 2020),  https://www.hamiltonproject.org/papers/a_proposal_to_cap_provider_prices_and_price_growth_in_the_commercial_health_care_market

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  49. Michael E. Chernew, Leemore S. Dafny, and Maximilian J. Pany, A Proposal to Cap Provider Prices and Price Growth in the Commercial Health-Care Market (Washington, DC: The Hamilton Project, March 2020),  https://www.hamiltonproject.org/papers/a_proposal_to_cap_provider_prices_and_price_growth_in_the_commercial_health_care_market

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  50. Michael E. Chernew, Leemore S. Dafny, and Maximilian J. Pany, A Proposal to Cap Provider Prices and Price Growth in the Commercial Health-Care Market (Washington, DC: The Hamilton Project, March 2020),  https://www.hamiltonproject.org/papers/a_proposal_to_cap_provider_prices_and_price_growth_in_the_commercial_health_care_market

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  51. Robert A. Berenson and Robert B. Murray, “How Price Regulation Is Needed To Advance Market Competition,” Health Affairs 41, no. 1 (January 2022): 26-34, https://doi.org/10.1377/hlthaff.2021.01235

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  52. Congressional Budget Office, The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services (Washington, DC: Congressional Budget Office, October 2021),  https://www.cbo.gov/publication/57422

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  53. Martin Gaynor M, Kate Ho, Robert J. Town, “The Industrial Organization of Health-Care Markets†,” Journal of Economic Literature 53, no. 2 (June 2015): 235-284, https://www.jstor.org/stable/24433982

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  54. Jared Lane Maeda and Lyle Nelson, “How Do the Hospital Prices Paid by Medicare Advantage Plans and Commercial Plans Compare With Medicare Fee-for-Service Prices?” INQUIRY 55 (Jan-Dec 2018), doi: 10.1177/0046958018779654

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  55. Julius L. Chen, Andrew L. Hicks, Michael E. Chernew, “Prices for Physician Services in Medicare Advantage Versus Traditional Medicare,” American Journal of Managed Care 24 no. 7 (July 20, 2018):341-344, https://www.ajmc.com/view/prices-for-physician-services-in-medicare-advantage-versus-traditional-medicare

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  56. Michael E. Chernew, Leemore S. Dafny, and Maximilian J. Pany, A Proposal to Cap Provider Prices and Price Growth in the Commercial Health-Care Market (Washington, DC: The Hamilton Project, March 2020),  https://www.hamiltonproject.org/papers/a_proposal_to_cap_provider_prices_and_price_growth_in_the_commercial_health_care_market

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  57. Michael E. Chernew and Maximilian J. Pany, “Regulation of Health Care Prices: The Case for Backstop Price Caps in Commercial Health Care Markets,” JAMA 325, no. 9 (March 2, 2021):817, doi:10.1001/jama.2020.26821

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  58. Michael S. Sparer, “Redefining the “Public Option”: Lessons from Washington State and New Mexico,” Milbank Quarterly 98 (June 2020), https://www.milbank.org/quarterly/articles/redefining-the-public-option-lessons-from-washington-state-and-new-mexico/

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  59. Aaron Baum et al, “Health Care Spending Slowed After Rhode Island Applied Affordability Standards To Commercial Insurers,” Health Affairs 38, no. 2 (February 2019):237-245, https://doi.org/10.1377/hlthaff.2018.05164

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  61. Michael E. Chernew, Leemore S. Dafny, and Maximilian J. Pany, A Proposal to Cap Provider Prices and Price Growth in the Commercial Health-Care Market (Washington, DC: The Hamilton Project, March 2020),  https://www.hamiltonproject.org/papers/a_proposal_to_cap_provider_prices_and_price_growth_in_the_commercial_health_care_market

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  62. Michael E. Chernew and Maximilian J. Pany, “Regulation of Health Care Prices: The Case for Backstop Price Caps in Commercial Health Care Markets,” JAMA 325, no. 9 (March 2, 2021):817, doi:10.1001/jama.2020.26821

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  63. Michael E. Chernew, Leemore S. Dafny, and Maximilian J. Pany, A Proposal to Cap Provider Prices and Price Growth in the Commercial Health-Care Market (Washington, DC: The Hamilton Project, March 2020),  https://www.hamiltonproject.org/papers/a_proposal_to_cap_provider_prices_and_price_growth_in_the_commercial_health_care_market

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  71. J. Michael McWilliams et al., “Early Performance of Accountable Care Organizations in Medicare,” The New England Journal of Medicine 374 (June 16, 2016): 2357-2366, DOI: 10.1056/NEJMsa1600142

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  77. Zirui Song Z, Yunan Ji, Dana G. Safran, and Michael E. Chernew, “Health Care Spending, Utilization, and Quality 8 Years into Global Payment,” New England Journal of Medicine 381, no. 3 (July 18, 2019): 252-263, doi:10.1056/NEJMsa1813621

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  94. Gobeille v. Liberty Mutual Insurance Company, 577 U.S. ___ (2016)

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  96. New York State Conference of Blue Cross & Blue Shield Plans v. Travelers Ins. Co.,514 US 645 (1995)

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The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California.