The Tampa Bay Times Politifact has awarded its coveted “lie of the year” rating to President Obama’s oft-repeated “If you like your health plan, you can keep it” promise. I’m happy to chalk this one up to naiveté and the heat of the political moment(s).
As President Obama has noted, the reason that existing health insurance policies have been cancelled willy-nilly is because the plans don’t measure up to ACA’s standard for coverage. Supermarkets can’t sell unpasteurized milk. Health insurers can’t sell these plans.
It is not immoral to sell or buy noncompliant plans. Many consumers chose noncompliant plans on purpose because they were cheaper. Let’s look at one provision of ACA that has received little coverage—the out-of-pocket maximum (OOPM). ACA initially required that a 2014 individual policy must cover all costs above $6,350 for singles or double this, $12,700, for families (of any size) within the year. That’s the OOPM (now delayed to 2015). Read more »
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 »
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.
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 »
Workers cast adrift by technology. Last week we learned that the economy added 236,000 jobs in February. Better than a sharp stick in the eye, to be sure. But it still isn’t enough. Average job growth over the past six months has been about 190,000. At this rate, it will take the economy 5 years to absorb the increase in the ranks of the unemployed since 2007, plus new workers entering the labor force. And don’t forget the 8 million working part time who would prefer full time employment, 3.6 million more than in 2007.
How do we square persistently tepid job growth with the other big economic news of the week, that the Dow Jones Industrial Average hit new highs? Why can corporate profits be strong while employment growth remains weak? This brief essay will address only one of the many reasons: This recovery has simply left many workers behind. Read more »
In 1975, Marva Collins founded Westside Preparatory School in Chicago’s Garfield Park neighborhood, a place of persistent and concentrated poverty. Renamed Marva Collins Prep, the school targeted disadvantaged students, many of whom had been classified by the public school as learning disabled. She was able to spur them to achieve at levels comparable to students in high income neighborhoods. Collins’ success was profiled by CBS’s 60 Minutes in 1979 and became the subject of a movie in 1981 starring Cicely Tyson and Morgan Freeman.
This example (and others like it) proved that concentrated poverty, while predictive of low academic achievement, does not assure it. The Holy Grail of education reform has been the “pursuit of Marva Collins.” For many years, it appeared that you couldn’t replicate Marva Collins’ success without Marva Collins—i.e. someone who combined unusual gifts of charisma, dedication and energy with exceptional teaching and leadership ability. Read more »