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03.03 A Setback for Understanding Health Care Costs in the U.S.

Thursday, March 3rd, 2016 | David Schleifer, Ph.D. and Allison Rizzolo



A Supreme Court decision earlier this week was a setback for advocates of greater price transparency in health care. In a 6-2 decision in the case Gobeille v. Liberty Mutual, the Court ruled that state officials cannot require certain insurers to submit information showing how much they pay for health care services to a database.

This move greatly complicates efforts to understand health care price variation and trends in how much doctors and hospitals get paid. It also affects public access to robust information about health care prices and value.

Some advocates of price transparency argue that the public, if armed with information about health care price and quality, will shop for better quality care, driving down the cost of health care generally. While we are cautious about overstating the potential scale and impact of consumer shopping, the court’s decision leaves us disappointed.

Last year, we dug deep into public behaviors and attitudes related to health care prices with funding from the Robert Wood Johnson Foundation. Our findings suggest that the Supreme Court’s decision runs counter to the beliefs of the majority of Americans, 69 percent of whom say insurers should be required to make public how much they pay doctors.


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03.01 On Participatory Budgeting and Democracy, We Need Patience, Research and Clear Goals

Tuesday, March 1st, 2016 | Carolin Hagelskamp, Ph.D.



Back in 2009, one solitary community in Chicago was the first in the U.S. to pilot participatory budgeting, a process for engaging residents in local budget decisions. A large public housing authority in Toronto had been engaging its residents through participatory budgeting since 2001, but with few American or even Canadian cities noticing.

Over the past seven years, participatory budgeting (or PB) has expanded exponentially in the United States and Canada. Last year alone, 46 communities in 13 cities across the two countries used participatory budgeting to decide how to use nearly $50 million (US).

Participatory budgeting has even been endorsed by the White House, whose Open Government Plan highlights PB as a best practice for American democracy.

PB holds great promise for American democracy. It transforms local governance by getting residents directly involved in budgeting and giving them real decision-making power. PB thus has the potential to empower individuals, build stronger civic infrastructure, raise public concerns and needs that officials alone could not see, lead to more equitable distribution of resources, build trust in government and make government more efficient.

But how and when will we know whether PB indeed fulfills its potential in American and Canadian communities? How long are we willing to wait to see these results? And what resources are we willing to expend to see them?


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02.26 Engaging Ideas - 2/26

Friday, February 26th, 2016 | Public Agenda




A collection of recent stories and reports that sparked consideration on ways to make progress on divisive issues.


Democracy

Community Engagement Matters Now More Than Ever (Stanford Social Innovation Review)

Data-driven and evidence-based practices present new opportunities for public and social sector leaders to increase impact while reducing inefficiency. But in adopting such approaches, leaders must avoid the temptation to act in a top-down manner. Instead, they should design and implement programs in ways that engage community members directly in the work of social change.

These civic experiments are getting citizens more involved in governing themselves (The Washington Post)

John Gastil and Hollie Russon Gillman write: "Recently, a wave of democratic reforms that have tried to draw the public back into public life. These community-driven interventions connect to — but extend beyond — local and state government. Several of these innovations promise to engage traditionally marginalized people if they can be nurtured and scaled."

For Voters, Facts Should Be the Lifeblood of Democracy (Moyers & Company)

Rick Shenkman is an award-winning investigative reporter for The New York Times. In his new book, Political Animals: How Our Stone-Age Brain Gets in the Way of Smart Politics, he attempts to understand what shapes voters’ responses to politicians. Shenkman argues that in the voting booth, “contrary to what we tell ourselves, it’s our instincts rather than arguments appealing to reason that usually prevail.” In this excerpt, he wonders what it would be like if voters — on the left and the right — made up their minds on the issues based on actual facts instead of what they assume to be true.

5 Ways to Get Millennials to Choose Government (Governing)

Young people are as motivated by the idea of public service as they ever were. Governments aren't doing what they should to take advantage of that.


Restoring Opportunity

How America Is Putting Itself Back Together (The Atlantic)

Most people in the U.S. believe their country is going to hell. But they’re wrong. What a three-year journey by single-engine plane reveals about reinvention and renewal.


K-12 Education

Where Affordable Housing Is Scarce, So Are Teachers (Governing)

To get people to teach in expensive or rural areas, some school districts are offering to help pay their rent or mortgage.

The Secret to School Integration (The New York Times)

The budget request President Obama released this month includes $120 million to support integration efforts led by districts, more than double current funding. John King, the acting secretary of education, has deemed school integration a national priority, calling the opportunity to attend strong, socioeconomically diverse schools “one of the best things we can do for all children.”

Groups Urge 'Whole-Child' Approach to Combat Poverty (EdWeek)

A pair of efforts has launched calling for the involvement of multiple local agencies to support the success of poor children in school. Expected to be unveiled this week, the first effort is a new project from Harvard University's Education Redesign Lab that is helping local city and school leaders link agencies responsible for children's services—such as mayor's offices, school systems, and social services agencies—to work together to address both in-school and out-of-school factors that affect student learning.

Feds seek more input on teacher prep (Politico Newsletter)

The Education Department wants to hear more from the public about distance education and how it relates to their long-delayed rule aimed at overhauling the way teachers are prepared for the classroom. The agency has sent a supplemental notice of proposed rulemaking to OMB that would allow them to collect more public comments, specifically on the distance education portion of the proposed teacher prep regulation, a department official told Morning Education. The supplemental NPRM will publish in the Federal Register following OMB review.


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02.24 When It Comes to Health Care Prices, the Truth Is Not Out There

Wednesday, February 24th, 2016 | Allison Rizzolo



Your doctor is concerned you may have Celiac disease and suggests blood work to test for it. You ask if it will be covered by insurance or if it will cost you out of pocket. She has no idea and advises that you call your insurance provider.

After experiencing stubborn back pain, you have an MRI. You researched the price and know your bill will be $500. Yet when the bill arrives, it's 3 times that amount. A hospital had bought the imaging center and raised the price.

Americans face realities like these every day. Try as we might to find out how much an X-ray, blood work, a colonoscopy or any other procedure may cost us, we're often unable to find that information or surprised with an unexpectedly high medical bill.

Despite the efforts of a host of policymakers, hospitals, insurers and others to provide patients with health care prices, that information remains startlingly opaque. A new report from the Pioneer Institute is the most recent to confirm this reality. In it, they note that, across 54 hospitals in 6 cities, patients find the task of determining the price of health care "difficult and frustrating."

This remains the case even though the Affordable Care Act has provisions requiring greater transparency in health care pricing, multiple states have passed legislation requiring the same, and multiple insurers, organizations and vendors have developed tools to aid in that task.

And it remains the case even as more and more people actively look for this information. We recently conducted a study into how Americans use prices in health care. In it, we found that 56 percent of Americans say they attempted to find information about the cost of health care before receiving said care.

One reason so many people look for this information is probably no surprise for you. More and more, our health insurance policies are moving toward a higher deductible. Some advocates of high-deductible health plans believe that, when patients have to pay more out of pocket for care, they'll be more prejudicial in using said care. This would then limit unnecessary tests and treatments, direct patients toward more affordable alternatives and ultimately bring down the cost of health care across the country.

Of course, some broad questions loom. Do high-deductible health insurance plans actually lead to lower health care costs? Do people think it's even fair to be required to shop around for health care? (In our study, 43 percent of Americans told us this expectation was unreasonable.) Can our country's health care system ever be considered a free market where people can shop for high quality, low cost health care in the same way they shop for televisions, cars and computers?


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02.22 Tax Credits for Business Working with Community Colleges: An Idea Worth Spreading

Monday, February 22nd, 2016 | Erin Knepler



In early February, the Obama Administration announced a new plan to cut taxes on businesses willing to work with community colleges. The Community College Partnership Tax Credit would connect community colleges and businesses in an effort to address the great need for more skilled workers with technical training and credentials. Through these partnerships, colleges and businesses would create or expand quality programs that prepare students for in-demand fields.

While President Obama's budget proposal will likely not pass, creating incentives to connect community colleges and businesses is a strong idea the federal government ought to consider.

Getting a good job remains one of the top reasons people decide to go to college, and community colleges are a good place to start on this path. They enroll over 10 million students annually, many of whom are pursuing a path for a good career. During the 2015–16 academic year, community colleges are expected to award 952,000 associate's degrees.

For students who came to college with a career in mind, it's important that colleges have a curriculum that provides a pathway to such a career. This pathway is often made more robust when there’s partnership between industry and academia. Creating these relationships and connections is one way we can restore America’s promise of education as the pathway for upward mobility and a good life.

The 1,108 community colleges in the United States offer students an affordable education and training opportunities in their local community. Because they are local and offer flexibility in scheduling, community colleges are viable options for some students who are raising children, working, in need of remedial classes, or can only take classes part-time. They are also uniquely positioned to partner with employers to create tailored training programs to meet the economic needs of their communities.

The Community College Partnership Tax Credit detailed in President Obama’s FY 2017 budget proposal, which builds on legislation introduced last fall by Senator Al Franken of Minnesota and Representative Tammy Duckworth of Illinois, includes four main points:


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02.19 Engaging Ideas - 2/19

Friday, February 19th, 2016 | Public Agenda





A collection of recent stories and reports that sparked consideration on ways to make progress on divisive issues.

Democracy

Turned Around: Why do leftists move to the right? (The New Yorker)
George Packer writes: “The most common explanation is the one variously attributed to Churchill, Clemenceau, and Lloyd George: “Any man who is not a socialist at age twenty has no heart. Any man who is still a socialist at age forty has no head.” The move rightward is thus a sign of the hard wisdom that comes with age and experience—or, perhaps, the callousness and curdled dreams that accompany stability and success. Irving Kristol, the ex-Trotskyist who became the godfather of neoconservatism, quipped that a neoconservative was “a liberal who has been mugged by reality.” Most people are hardly aware of the shift until it’s exposed by a crisis, like a major political realignment that forces us to cross party lines. Even then, they want to believe that it’s the politics, not themselves, that changed.”

How 'Philanthrocapitalism' Could Transform Government (Governing)
Mark Zuckerberg and his peers have ushered in a new playbook and a new agenda for philanthropy. Let’s hope positive change through meaningful partnerships with state and local governments is a core part of that agenda.



Research and Media

Why People Are Confused About What Experts Really Think (The New York Times)
Critics argue that journalists too often generate “false balance,” creating an impression of disagreement when there is, in fact, a high level of consensus. One solution, adopted by news organizations such as the BBC, is “weight of evidence” reporting, in which the presentation of conflicting views is supplemented by an indication of where the bulk of expert opinion lies. Whether this is effective is a psychological question on which there has been little research. Derek J. Koehler conducted two experiments to find out; they are described in a forthcoming article in the Journal of Experimental Psychology: Applied. Both studies suggest that “weight of evidence” reporting is an imperfect remedy. It turns out that hearing from experts on both sides of an issue distorts our perception of consensus — even when we have all the information we need to correct that misperception.



Restoring Opportunity

The Color of Money: A Top Bank and Nonprofit Take Aim at the Racial Wealth Divide (Inside Philanthropy)
Corporation for Enterprise Development's Racial Wealth Divide Initiative, headed by Dedrick Asante-Muhammad, is “excited to partner with JPMorgan Chase and organizations of color across the country in strengthening capabilities to address racial economic inequality.” CFED is thinking bigger here, with an eye on systemic change and the larger conversation about economic inequality. It has a multi-pronged and ambitious agenda in this new initiative, including helping leaders of color become stronger voices advocating for public policy change. The nonprofit will partner with Georgetown University’s Center for Public and Nonprofit Leadership to cultivate the skills and strategies of “nonprofit leaders of color in five cities” and will provide coaching and training to build leadership “at multiple levels: individual, organizational and community.”



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02.17 Our 2015 Year in Review

Wednesday, February 17th, 2016 | Public Agenda



A snapshot of what we got up to in 2015.

Want to contribute to our work in 2016? Click here!



Comment

02.12 Engaging Ideas - 2/12

Friday, February 12th, 2016 | Public Agenda




A collection of recent stories and reports that sparked consideration on ways to make progress on divisive issues.


Democracy

Policymakers Need to Start Taking Social Media Seriously (Governing Magazine)

In gathering public input, governments remain stuck in a world of public hearings and postal mail.


Polling and the Election

Could Pop-up Social Spaces at Polls Increase Voter Turnout? (Smithsonian Magazine)

Placemaking the Vote, one of the finalists in the Knight Cities Challenge, wants people to hang out at their polling places.


Restoring Opportunity

This Is Why You Can’t Afford a House (The Daily Beast)

There’s little argument that inequality, and the depressed prospects for the middle class, will be a dominant issue this year’s election. Yet the most powerful force shaping this reality—the rising cost of housing—has barely emerged as political issue. The connection between growing inequality and rising property prices is fairly direct. Thomas Piketty, the French economist, recently described the extent to which inequality in 20 nations has ramped up in recent decades, erasing the hard earned progress of previous years in the earlier part of the 20th century. After examining Piketty’s groundbreaking research, Matthew Rognlie of MIT concluded (PDF) that much of the observed inequality is from redistribution of housing wealth away from the middle-class.

Women in Company Leadership Tied to Stronger Profits, Study Says (The New York Times)

A review of nearly 22,000 companies found an association between gender diversity in executive positions and increased profitability.


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02.10 Working Together to Sustain Stakeholder Engagement in K-12 Education

Wednesday, February 10th, 2016 | Nicole Hewitt




Flickr: Lars Plougmann

Engaging with your child’s school is often the easiest and most direct way for ordinary citizens to become involved in decisions that affect their communities. Optimally, that engagement is deeper and more sustained. From the local PTA to the municipal board of education, parents, teachers, school administrators and education advocates can and should work together to grapple with difficult and often emotional issues.

School districts often contend with controversial decisions like budgets, school closures and new school construction. As such, it is extremely important for school board leaders to engage the greater community of parents and taxpayers in order to sustain a good working relationship that encourages inclusive decision making. School districts in Western New York are leading on this front.

New York state school districts are supported by Boards of Cooperative Educational Services (BOCES). BOCES are liaison organizations for New York State’s Department of Education. They partner with districts and provide a variety of shared support services and programs. These services include professional development to foster a culture of shared decision making.


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02.08 One Week in Manila: Democracy, Development, and "Transforming Governance"

Monday, February 8th, 2016 | Matt Leighninger



This week, I will join a group of people from around the world meeting in Manila to talk about how to make democracy work in newer, better ways. Convened by Making All Voices Count, a collaborative of the Omidyar Network, the US Agency for International Development, the UK Department for International Development and the Swedish International Development Cooperation Agency, the group will include Asian and African democracy advocates, civic technologists and researchers.

In the Manila meeting, the participants will be using the term “transforming governance” to describe the changes they seek. The central question of the gathering is: If we want to ensure that citizens have meaningful roles in shaping public decisions and solving public problems, can technologies play a role in helping them do so?

They are asking a very old question, but with new hypotheses, new tools and new principles in mind. It is increasingly clear that the older democracies of the Global North do not have all the answers: citizens of those countries have increasingly lost faith in their political institutions. Northerners cherish their human rights and free elections, but are clearly looking for something more. Meanwhile, in the Global South, new regimes based on a similar formula of rights and elections have proven fragile and difficult to sustain. And in Brazil, India and other Southern countries, participatory budgeting and other democratic innovations have emerged.


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