Health care is different from other goods and services.
- As a wealthy society, we aren’t willing to limit access to care based on ability to pay (at least entirely).
- Caveat emptor—let the buyer beware—fails in the face of complexity: The patient (the “buyer”) is often incapable of understanding what is appropriate or necessary and must rely on the provider (the “seller”) for essential advice.
- The pace of technological change outstrips our capacity to set limits on what constitutes adequate care.
- Public policy, operating through payment schema and regulation, is a blunt instrument, influencing the marketplace in both intended and unintended ways. Read more »
Our nation’s fiscal house is held together with duct tape and Crazy Glue. The porch roof is teetering—left unrepaired, it may collapse onto our economy at the end of the year. And our home’s foundation has a crack in it. While this structural gap between revenue and spending—largely caused by Baby Boom retirements—won’t be dramatically worse next year, the crack will get larger and larger until we make major repairs.
A wide array of tax cuts are due to expire at the end of 2012. As the Bush White House couldn’t muster the 60 votes required for a permanent tax change, the 2001 tax cuts were passed using the Senate’s arcane “reconciliation” procedure, which forced a 10 year “sunset” provision. (The vote was 50-50 with Vice President Dick Cheney casting the tie-breaker.) Unable to reach consensus on much of anything in 2010, the President & Congress kicked the can down the road another 2 years. In February, the 2 percentage point reduction in the payroll tax rate originally passed in 2010 was extended to the end of the year.
So, what happens if Congress & the President don’t do a deal? Read more »
Premature childbirth increases the risk of death or a lifetime of disability and nearly always drives up cost. Early care for expectant mothers can help increase the chances of a healthy, full-term pregnancy. Now that the Supreme Court had upheld national health reform and its mandate to carry health insurance, we might hope to see more expectant mothers receiving care early in their pregnancies. Studies suggest that access to health insurance isn’t the only factor, however.
The nation had set a goal for 2010: 90% of pregnant women getting care in the first trimester of pregnancy. In New York and in the Rochester area, we’re not close: in 2010, 79% of mothers in our region started prenatal care that early, higher than the state rate of 73% but largely unchanged over the past decade. Generally speaking, rates of early access to prenatal care haven’t changed much over the past decade, and neither have rates of problems that prenatal care helps prevent, such as low birth weight. Even more troubling, low-income and minority women tend to be less likely to start care early, another stubborn pattern. Read more »
During the Olympics we freely show unabashed pride in our native sons and daughters. The Rochester region cheers Jenn Suhr’s triumph over her longtime Russian rival in the pole vault and Abby Wambach’s soccer gold against Japan. Yes, some of the U.S. Olympians are transplants, immigrants to our nation. But most were born here.
While a burst of nativism is excusable during the Olympics, anti-immigration sentiment doesn’t serve our economy well. Asked by local businessman Dutch Summers to explore why Canada’s Golden Horseshoe—anchored by Toronto—has prospered and grown while Upstate New York has languished, we concluded that immigration policy is a powerful contributing factor. Read more »
Last school year, one of five Rochester schoolchildren tested proficient in reading and one of four in math, according to the just released NYS ELA (English Language Arts) and math assessments given in grades 3-8. Statewide, just over half tested proficient in ELA and two-thirds in math, though rates for African-Americans are much lower at 37% and 46% respectively. Who can argue that raising expectations and achievement beginning in kindergarten isn’t a dire need? Part of the solution could be the newly created and much ballyhooed Common Core State Standards. A working knowledge of these standards is a must for savvy taxpayers, armchair education policy wonks, practitioners and parents. Here’s a primer. Read more »
Humanity has long sought to influence the course of death. Only in the last half century have we been able to postpone death by restarting a stopped heart. As a practicing paramedic, I have developed an insider’s view of sudden death and what happens at the end-of-life.
Sudden cardiac arrest occurs an estimated 295,000 times each year in the United States. Until 1960, there was no effective treatment for cardiac arrest and life ended at the instant the heart stopped. However, with the advent of cardiopulmonary resuscitation (CPR), automated external defibrillators (AED), well designed emergency medical service systems, and advances in cardiac care in hospitals, there is now an 8.5% chance that a person who suffers a sudden cardiac arrest will survive to live a life similar to the one they had prior to collapse.
Are you surprised that the success rate is that low? Perhaps that’s because on television, 75% of patients in cardiac arrest survive. Happy endings make for better ratings, but they cloud the perception of the end of life and may encourage us to pursue resuscitation when we should let death take its course. Read more »
The predicted irrelevance of cities, offered by some as a consequence of the Internet and the falling cost of communication, has been proven to be false. Scholars like Bruce Katz of the Brookings Institute have long recognized and championed the economic significance of regions.
New York State’s Governor Cuomo agrees—since taking office, he’s been working hard to shift the initiative for economic development away from central decision-makers in Albany and NYC to the regions. It is no accident that Bruce Katz has served as an informal Cuomo advisor, the two having worked together when Cuomo was HUD Secretary under Bill Clinton.
Here in the Finger Lakes, the Regional Economic Development Council (FLREDC) is charged with developing and implementing an economic development plan for the region. A coalition of business, non-profit and government representatives, the FLREDC has been empowered to chart out the region’s strengths and how best to support its growth into the future. At the state level, many grant programs have been brought together in support of the strategies identified locally and set out in the plan. The Governor has also focused the work of state agencies. Attending Monday’s FLREDC meeting were regional representatives from a number of NYS departments and agencies (e.g. State, Labor, Agriculture & Markets, and NYS Energy Research & Development Authority), all part of the State Agency Resource Team (SART). Additionally, the state has identified action that it can take to support implementation, including expediting regulatory review of priority projects. In essence, the state has asked the region to “tell us what you need” so that it can support local efforts for job creation and economic growth. While NYS retains significant discretion over uses of state funds, the Cuomo Administration is making a concerted effort to engage regional players in the decision process. Read more »
The Supreme Court—through the actions of tie breaker Chief Judge John Roberts—has resolved the constitutionality of the Patient Protection and Affordable Care Act (ACA). In the best tradition of the court, his Solomonic ruling declares that the law is within the powers of Congress. Good law? Bad law? “Not my problem. It’s constitutional.” He also applied the “duck” test to the Administration’s “penalty”—if it looks like a tax and quacks like a tax, it’s a tax.
The constitutional sideshow behind us, let’s get back to the Main Event: Health care remains an unaffordable, inequitable mess. ACA addresses some of the coverage problems built into the American health insurance model, but it will inevitably create some inequities of its own.
Cost is still an enormous problem. In fact, the law will increase the share of GDP spent on health care. ACA’s supporters are eager to report the Congressional Budget Office (CBO) finding that the law will not increase the deficit. First, remember that this is a forecast built on complex models, loaded with assumptions. The CBO finding is an estimate, not a measurement. Read more »
I love summer and I love sports. 2012 has already produced many sports highlights with I’ll Have Another winning 2/3 of horse racing’s Triple Crown, Tiger Woods’ renewed success on the golf tour, Roger Federer’s and Serena Williams’ record breaking tennis wins at Wimbledon, the mid-summer classic, baseball’s All-Star game and King James winning his first NBA title. And now it’s the Tour de France and, soon, the summer Olympic Games.
Big Sports Event = Big Economic Impact?
Sports spectaculars are often lauded for their economic impact. Does the reality match the claims? Victor Matheson, an economics professor at College of the Holy Cross in Massachusetts has analyzed the economic impact of “mega sporting events” like the Super Bowl, the Olympics, the All Star Game, and World Series. He finds many examples of major sporting events not living up to their pre-event hype. For instance, Major League Baseball claims economic impact on cities that host the All-Star game in the neighborhood of $75 million in direct benefits. Matheson’s ex post research suggests that for the cities that hosted All-Star games between 1973–1997, average employment actually declined by a half percent. Organizers of the 1996 summer Olympics in Atlanta suggested upwards of 77,000 new jobs would be generated. Matheson estimates that as few as 3,500 were actually created. Read more »
New York State has been working to make a high school diploma meaningful for most of the past two decades, and the work continues. Since a push toward higher standards began in the mid-1990s, the state tightened graduation requirements twice: first requiring all students to pass 5 Regents exams, then increasing the minimum score to pass from 55 to 65.
Many feared graduation rates would plummet, but recently released data showed they’ve mostly held steady or increased. In the last five years, as the 65 minimum score was applied to more and more tests, the statewide graduation rate increased from 69% to 74%. New York City gained 8 points, rising from 53% to 61%, and the combined rate for students of the 4 next largest cities (Buffalo, Rochester, Syracuse and Yonkers) also increased from 47% to 53%. Rochester’s performance remained the lowest of the five, with a graduation rate of 46% in 2011.
At the same time, the federal government has gotten tougher about how states are to calculate graduation rates. Starting with the class of 2010, schools had to include every student in their building for even one day in their graduation cohort – the previous threshold had been 5 months. That means schools are held accountable for those students – those who moved or transferred don’t count against them, but missing students are considered dropouts. Read more »