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 »
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 »
Several proposals to dissolve village boundaries were on the ballot last week. Voters in the villages of Malone (Franklin County) and Chaumont (Jefferson County), both rejected the idea. The Village of Lyons (Wayne County) embraced it, although by a very narrow margin (and absentee ballots, when counted, could change the vote).
Most village dissolution votes fail to gain the support of voters, putting Malone and Chaumont with the majority. Should these voters have chosen to dissolve these villages? Not being a resident of either community, we at CGR don’t have a voice in the decision. In fact, having studied the issue in both, we can make a case on either side. Our role is to lay out the facts to the best of our ability—informing the voters and empowering them to make their own decisions.
At issue in these votes is a possible loss of identity, and some loss of local control—the power to enact laws and to provide village residents with the services they alone vote to support. Village residents remain voters and taxpayers in the surrounding town and will look to their town for a continuation of needed public services. In exchange for giving up some autonomy, residents expect a smaller tax bill. Read more »
It stands to reason, say some, that eliminating some of the overlapping layers of local government—villages, in particular—will save lots of money. The facts are more complicated.
In CGR’s experience after studying more than three dozen communities in the last five years or so, the operational savings from a simple merger are typically modest. Yet this misses one of the important reasons for communities to review their local government structures—the capital budgets of local governments. Decisions about capital investments are often made through the lens of a single local government—the individual town, village or school district. Even though these individual governments may be running their governments efficiently, many studies show that taxpayers are paying for more buildings, more equipment, and more people to manage them than would be needed if local government services were managed by thinking regionally. Four examples illustrate this point. Read more »
We policy wonks like to believe that good ideas win in the end. That right makes might. That if we only got a chance to convince-oh, Barack Obama or John Boehner or Tom Richards or Maggie Brooks-then the right idea would win the day.
Think again. Truth to tell, ideas are powerful only when wielded effectively. It’s effective political action that shapes government, thus society. Read more »
I sent my Nissan Quest to the crusher for a lousy $4,500. Yes, I could see into the engine compartment without opening the hood—but it ran like a top! Now the feds will have their way with my car. Some minion will replace its engine oil with sodium silicate and fire up the unsuspecting engine—until it seizes up, never to run again. It’s the automotive equivalent of “hung from the neck until dead.” What have I done?
As cars fly out of the showroom and the dealerships are clogged with eager buyers, many of us are questioning this bit of Washington wisdom.
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I’ve been in a funk since the 2009-10 state budget passed. The state’s elected leaders entered the budget negotiations confronting a potential $20 billion deficit, up from the $14 billion estimated when the Governor released his original budget proposal. That is, the state would have run a $20 billion deficit in 2009-10 if spending and revenue continued without changing anything structural (like tax rates or spending formulae). The faltering economy could no longer satisfy the state’s addiction to ever-greater spending.
Given such a dire forecast, we all wondered how the state would manage to find the money to avoid a major reduction in spending. Imagine our surprise when the Legislature and Governor pulled a rabbit out of the budgetary hat and increased budgeted spending by $12 billion, nearly 9% more than in 2008-09.
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Originally published in Rochester Business Journal
1/9/2009, 1/16/2009, 1/23/2009
Early signals from our health insurer led us to expect another double-digit increase in our insurance premiums—perhaps a 15% hit. Frankly, I thought that we were just being softened up for something lower—If I were led to expect 15%, then a mere 11% bump should make me (relatively) happy. I was stunned when the final price of the most popular of our plans would go up 21% in 2009.
The big increase in price led us to explore cheaper plans, particularly a policy that includes a “Health Savings Account” (HSA). The discussion below refers to the specific plans we were offered by Excellus BlueCross BlueShield.
CAUTION: The remainder of this column discusses insurance premiums, deductibles, out-of-pocket maxima and other arcane health insurance jargon. Readers looking for lighter fare might prefer IRS Publication 17 or, perhaps, a William Faulkner novel.
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Albany parishes should find other uses for buildings after churches close
Restructuring. Consolidation. Mergers. And now, layoffs. Those words have been used to describe the current state of affairs in the area’s Roman Catholic churches. Last week Bishop Howard Hubbard previewed the pain to come. He said that about 20 percent of the 190 worship sites will close or be reorganized across the 14 counties that make up the Diocese of Albany. Some of the lay staff who work at the parishes involved might lose their jobs. The decision on which churches will close is expected this weekend, but it is likely that urban parishes will suffer the most.
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CGR recently recruited a staff member from out of town. After he and his wife had found a house they liked (comparable to the home they were selling), they were confronted with what is a familiar problem—the property tax bill. The house they were about to buy was going to cost them nearly 50% more in property taxes each year. Familiar story, right? Darn those folks in North Carolina and Florida and Utah for their low property taxes! How can we compete?
But my colleague was moving from Orchard Park, a Buffalo suburb, not from Raleigh or Tampa or Salt Lake City! That’s right—Erie County property taxes are lower than Monroe County’s.
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