Like most aging runners, my wife’s knees aren’t what they used to be. Fortunately, there is a solution to this problem—knee replacement has become nearly routine surgery. The Agency for Healthcare Research and Quality reports 718,000 hospital stays in 2011 were due to “knee arthroplasty” or total knee replacement. The rate per 10,000 population nearly doubled from 1997. Yes, the aging of the population has something to do with the increase—yet even among 65-84 year olds the rate increased by 59% (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb165.jsp). And yes, the rising rate of obesity explains part, but not all, of the trend.
We needn’t look to sophisticated studies for the reason as joint replacement surgery can significantly improve quality of life. A 2011 “meta analysis” of over 100 studies concluded that nearly 90% of artificial knees were still doing the job 10 years after surgery. As these studies necessarily involved surgeries that took place before 2000, results have almost surely improved. For most patients, an artificial knee (or hip) can be expected to last 15-20 years. Recovery time is getting shorter, too. Many patients are back to driving in a month. If you can’t walk without pain, an implant would seem to be an easy choice. Provided you can convince your insurer to foot the bill.
Which brings us to the cost of artificial joints. Did you wonder why the medical device industry gets its very own tax under the Affordable Care Act? American health care’s dysfunction has enabled the medical device industry to earn very robust profits, thus making it a target for special treatment. Does this tax make sense? Read more »
There is nothing more debilitating than unemployment—both for the individual and society. The jobless are deprived of the dignity of work and the community is deprived of the benefit of their labor. We look to workforce development programs and higher education to match jobs and job seekers and, often, to help the unemployed gain the skills that are needed in the workplace.
Recent attention has focused on “middle skills,” those positions requiring some postsecondary technical education and training but not a four year college degree. A recent Harvard Business Review article[*] found that nearly half of new job openings from 2010 through 2020 will be middle-skills positions in fields such as computer technology, nursing, and high-skill manufacturing. Community colleges (such as Monroe Community College) are particularly well suited to addressing the middle skills gap and are exploring how they can best fill that need.
This leads to a reasonably neat policy prescription: If we have willing workers whose skills simply fall short, then the public’s role is to provide a bridge to employment through training. Easy, right? As one of the Rochester area’s most strategic training providers, Monroe Community College is continuously seeking better information on the needs of its market. Read more »
Remember the Fast Ferry connecting Rochester and Toronto? Although the idea failed in execution, connecting with the vibrant “Golden Horseshoe” economy made sense then—and still does today. When we compare Rochester to, say, Charlotte or Atlanta or Austin, we can always blame the snow. But that doesn’t work when we look across the lake. What’s their “secret sauce?”
We may be separated only by a bit of water and a line on a map, but it is clear that Canada’s Golden Horseshoe Region, powered by Toronto, has prospered while Upstate New York (defined here as Rochester, Buffalo and Syracuse) has just held its own. Although these neighboring regions share much—that climate, access to markets, and transportation infrastructure—since 1996 the Golden Horseshoe added more than a third to its employment base and a quarter to its population. Read more »
New York isn’t alone in struggling with the financial viability of its public nursing homes. Across the country, public nursing home operators are weighing their options in an era of diminishing state and federal reimbursement. Many counties, especially those in the Northeast, are choosing to sell, or contract out management of the homes, in order to stem financial losses.
In New York, 92% of homes had operating deficits in 2010, as CGR detailed in our in-depth report, The Future of County Nursing Homes in New York State. Financial pressures have led 8 of the 33 remaining counties with homes to decide to sell them, and another 5 to actively consider it. If all those potential sales actually occurred, New York would be left with 20 counties with nursing homes, down from 40 just 15 years ago.
From 2005 to 2009, half of states had declines in the number of public nursing homes, compared to 28% that had increases (more recent data aren’t yet available).
Read more »
The health insurance mandate, probably the most visible outcome of the Patient Protection & Affordable Care Act (ACA or Obamacare), goes into effect in January. Enrollment in the health insurance exchanges opens October 1, so much attention has been focused on the premiums: Supporters of the law hope for lower rates; opponents have been widely predicting that rates would soar.
In July, premiums for New York State’s Health Insurance Marketplace were released and revealed two notable facts: First, premiums in the individual market are far below current rates. Second, Rochester has the lowest rates in the state. Read more »
“There but for the grace of God go I.” Big city mayors from across the country consider the plight of Detroit’s Mayor Dave Bing and wonder if they’ll be next. What killed Detroit? There must be someone or something we can blame for the staggering decline of a great city.
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Summer’s finally here, but just weeks ago students in schools across New York completed state tests that carry bigger stakes than ever before. This is the first year that test scores will feed into teacher evaluations, and with the tests now aligned with the new Common Core curriculum, many observers believe passing rates will decline.
The push-back against testing and increased accountability has grown, and it’s easy to see why. Students, families and schools have seen passing rates decline, felt more pressure to increase performance and wondered whether testing now gets too big a space in education. It’s worth revisiting why and how these changes came about, and examining the long-term trend in performance.
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Police service is often the most cherished and visible municipal service—and inevitably one of the costliest. When it comes to balancing local government costs and quality of life, law enforcement increasingly is part of the public conversation. Too often, the immediate reflex is to equate cost savings in law enforcement with compromising public safety. That need not be the case.
A dichotomy drives the challenge
First, there’s emotion involved. We like the sense of security that comes with knowing an officer is patrolling our street. Whether responding to emergencies and criminal activity or getting to know residents on a first-name basis, police form bonds and fill roles that many residents consider vital for their community. Recently I learned some youths in my own neighborhood had accosted one of my neighbors. When I found out how intimately the police officers know the community and possible perpetrators, I could turn my attention away from being fearful for my family and instead focus on community advocacy and intervention.
Second, there are dollars and cents involved. Local governments across the country are more constrained than ever by limited resources and rising costs. In New York and New Jersey, for example, pension and other negotiated benefits are driving mandated annual increases that result in many governments bumping up against their state’s 2% cap on the growth in the tax levy. Plus in New York existing police union contracts are further insulated from certain cost pressures by law (i.e., Taylor Law, Triborough Amendment) and unions can exercise a binding arbitration process that has historically produced favorable outcomes for their members.
Read more »
After my last column on hydrofracking, I was asked to participate in a forum at the University of Rochester sponsored by Phi Beta Kappa. In my intro, I quipped that I was the guy invited to defend the despoiling of the earth and destruction of the climate. Nobody laughed.
This issue has stirred a level of religious fervor that is reminiscent of both sides of the abortion debate. Yet common to most consequential policy questions, the hydrofracking issue (like Oscar Wilde’s truth) is neither pure nor simple. I understand the appeal of clarity and simplicity—we would prefer that fracking be either boon or bane. Complexity makes our heads hurt.
Let me make the case for complexity. Read more »
Higher education is a major contributor to our region’s prosperity. Home to 18 colleges and universities, total employment in the sector rose steadily during the recession and totaled nearly 35,000 last year, up 16% since 2007.
Yet Rochester higher ed stands out for more than just job and payroll totals. The community is home to a number of distinctive institutions that set the region apart. One of these, the National Technical Institute for the Deaf (NTID) at the Rochester Institute for Technology, may be better recognized outside Rochester than inside. NTID is the world’s first and largest technological college for students who are deaf or hard of hearing. Established by Congress in 1965, the first students entered in 1968.
A recent CGR study of NTID concluded that the Institute is responsible for more than 1,000 jobs, both direct and spillover, and over $50 million in labor income. Moreover, due to its national scope and reputation, it captured $84 million in outside funding (75% federal) over the 2006-11 period. NTID has done its part to strengthen higher ed in Rochester, boosting enrollment by 24% from 2007. Read more »