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05.19 Engaging Ideas - 5/19/2017

Friday, May 19th, 2017 | PUBLIC AGENDA


Partisan politics in the age of Trump? These N.J. Republicans work with Democrats (
"It's always a better product when we're working together," LoBiondo told NJ Advance Media. "On any of the big issues, it's got to be bipartisan."

5 facts about U.S. political donations (Pew Research)
Here's two: Democrats were twice as likely as Republicans to say they donated last year. Higher-income, more educated and older Americans are more likely to donate.

John Kasich: The time for bipartisanship is now (CNN)
Americans are relying on leaders in Washington to fix our health care problems, but if recent history is any indication, the search for solutions in the current environment will inevitably lead to an unproductive partisan standoff.


Without More Census Funding, Disadvantaged Communities Risk Being Overlooked Most (Governing)
Many predict severe, long-term consequences for the 2020 count and all the programs that rely on it.

Fighting Poverty with Data (NationSwell)
This New York City office uses an evidence-based approach to address inequality.

If You Live in an Area with High Income Inequality, You’re More Likely to Burn Out at Work (Harvard Business Review)
In the United States, according to the 2016 Work and Well-Being Survey conducted by the American Psychological Association, more than one in three working adults report job insecurity as a significant source of stress.

New Analysis Turns Up Surprise on Long-Term Wage Trends (Real Clear Markets)
When we combine the earnings trends for men and women, the rise in inequality appears much slower than when we examine trends among each sex separately.


How can schools engage young people in democracy? (The Guardian)
A lesson from across the pond: here’s how to use Brexit and the general election to inform students about politics and voting.

K-12 Education

DeVos To Unveil School Choice Plan Monday (Politico)
Secretary DeVos is set to deliver a major policy speech Monday that will lay out the administration's plans for expanding school choice. According to Caitlin Emma's reporting at Politico, DeVos will unveil some sort of education tax credit scholarship proposal that will not be mandated by Washington but will give states the flexibility to opt in or out. Some experts doubt that any school choice proposal with the word "federal" attached to it will make it through this Republican Congress so we shall see how the administration tries to thread the needle.

Children Must Be Taught to Collaborate, Studies Say (Education Week)
Debates over perceived teacher shortages often conflate different problems and Learning to work in groups in the classroom doesn't come naturally, research shows. Teachers have to lay the groundwork.

Can Teacher Residencies Help With Shortages? (Education Week)
Scholars at AERA take up the topic. Only about 50 programs nationwide use comprehensive teacher residencies. Each of those residencies produces five to 100 new teachers a year—not enough to fill gaps in teacher pools nationwide. But Roneeta Guha, a researcher with the Learning Policy Institute, and her colleagues found residencies were more likely to produce new teachers from minority backgrounds; 45 percent of residency teachers nationwide in 2015-16 were teachers of color, compared with only 19 percent of new teachers overall. Moreover,across the 50 residency programs studied, 82 percent of graduates were still teaching four years later, 10 percentage points higher than other new teachers.

Higher Education & Workforce Development

Report Raises Question: Why Are So Few Pell Students in Elite Schools? (Real Clear Education)
A new report from the Georgetown Center on Education and the Workforce has sparked an interesting debate over class-based affirmative action. The report found that a significant number of Pell Grant recipients are qualified to attend elite colleges but don't (for a variety of reasons). Christopher Beach takes a close look at the study and spoke with a few of the colleges that the report singled out for enrolling a very low number of Pell students.

Report: The Federal-State Higher Education Partnership: How States Manage Their Roles (Urban Institute)
This brief describes differences across states in per student funding levels, distribution of funding across postsecondary sectors, systems for determining these funding patterns, and state grant aid offered to students who enroll in these institutions. It examines how these policies interact with federal subsidies for college students and how they further or counteract the goals underlying federal policies.

Mixed Views on Higher Ed (Inside Higher Ed)
Americans see the work force and societal value of getting a college degree, a survey from New America finds, but community colleges have more support than do other sectors.

Bipartisan Push on Career Education (Inside Higher Ed)
U.S. Representative Foxx, a North Carolina Republican who leads the House education committee, spoke at the American Enterprise Institute on the eve of her committee’s planned markup of a bill that would reauthorize the Carl D. Perkins Career and Technical Education Act, the primary federal law that oversees career education programs.

As Graduates Obsess About Jobs, Colleges Cut Spending On Career Services (Hechinger Report)
Higher education institutions have collectively reduced career budgets 11.4 percent.

Health Care

How to improve diabetes outcomes under value-based care (Medical Economics)
Working diligently to motivate patients—especially those with diabetes—is something that primary care physicians must do if they want to be successful under Medicare payment reform.

Hey, Millennials: Want to Help The Underserved? Sign Up For Insurance (NPR)
I want my peers to realize that what keeps health care affordable for people like me is for those with fewer medical needs to sign up for insurance. Health insurance functions kind of like splitting a cab ride — the more people in the pool, the less it costs any one person.

Healthcare execs expect value-based care to disrupt industry more than science in decade ahead (Becker's Hospital Review)
C-level executives and investors from across the healthcare industry rank pricing and reimbursement as the No. 1 strategic pressure facing the healthcare industry today, according to a survey.

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05.17 Let's Talk Numbers: Americans Want Price Transparency and Cost Conversations

Wednesday, May 17th, 2017 | REBECCA SILLIMAN

Originally published on (May 17, 2017)

When looking for a new apartment recently, I narrowed my choices to those that were in my current neighborhood and had a lot of windows. But when it came down to deciding where I should make a move, what really mattered most was cost—and specifically, finding the best apartment at the greatest value.

In making these sorts of significant decisions, it’s hard to think of a situation in which I would settle for anything outside of a good deal. (Why would I pay more for a worse apartment?) Yet the reality is I do it all the time when it comes to my healthcare. Like many people, I go to the doctor not having any idea how much it might cost, and then am surprised by how much I am charged. It turns out I am not alone: 77 percent of Americans have been surprised by how much a doctor, hospital or medical facility charged them.

What do consumers think about cost?

In a time when Americans are taking on more of their healthcare costs, there has been an increased effort from insurers, state governments, employers, and others to make price information more transparent and publicly available. The thought is that when healthcare has a clearer “price tag”, people will be encouraged to compare two or more providers’ prices and consider price in their healthcare decision-making, with the ultimate outcome that people choose less expensive care. However, before we can make this assumption, there are some questions that must be answered: Are people willing to look for price information? Will people actively choose less expensive care? Will looking for information help people save money?

My team and I at Public Agenda recently released research findings that addressed these specific questions and offer insight into how people think about their healthcare costs. There is good news. We found that 70 percent of Americans do not think higher prices are a sign of better quality medical care. And among Americans who, prior to receiving care, tried to compare multiple providers’ prices to find out how much they would have to pay out of pocket, 53 percent said that they ultimately saved money. Additionally, 40 percent of Americans who have never tried to find price information say they would be inclined to choose less expensive doctors if they knew the prices in advance.

Encouraging people to be more active in shopping around for healthcare prices may be a piece in helping to reduce the burden of healthcare costs. However, it is not as simple as just telling people to go find price information. This key caveat is clear in our finding that 63 percent of Americans say there is not enough information about how much medical services cost.

Where do consumers turn for cost information?

Our research found that of the Americans who tried to find price information, 55 percent turned to a friend, relative or colleague; just 46 percent turned to their doctor. What I find interesting is that friends and family are the preferred source for price information, but a majority of people – 77 percent – say they trust or would trust their doctors as a source of information about the price of medical care. Just 58 percent say they trust their friends, relatives, and co-workers.

People want more than basic cost information from their doctors; they want to have a conversation with doctors and their staffs about prices. Seventy percent of Americans think it’s a good idea for physicians to talk about prices before referring patients to specialists, or ordering or performing tests or procedures.

Unfortunately, we found that only 28 percent of Americans say a doctor or their staff has brought up the price of a test, procedure, or referral to a specialist before doing or ordering it. And as one woman in a New Hampshire focus group pointed out, the doctors may not be prepared to have these conversations. When we asked her about talking with doctors about prices, she said “the doctors have no idea.”

Starting the cost conversation

Despite recent efforts to make prices more transparent, a gap remains between the information people need and what’s available. One way to shrink this gap is to equip doctors and their staffs with the tools and skills needed to discuss prices with patients, or at least refer patients to reliable sources of price information.

While it may seem like a lot to ask of providers who are already short on time, an easy first step is to start discussing costs and coverage generally, and then guide patients toward more specific price information sources. It might even spark new thinking on care options. Engaging conversations around prices may just be one of the simplest keys to unlocking a good deal in healthcare.


05.12 Engaging Ideas - 5/12/2017

Friday, May 12th, 2017 | PUBLIC AGENDA


Writing about campaign finance: A tip sheet (Harvard’s Shorenstein Center)
Running for office in the U.S. can be an expensive affair. This tip sheet helps journalists find and track the influence of money in politics.

Are election hacks the new normal? (MIT Technology Review)
Russian hackers tried, unsuccessfully, to hijack the French election—the U.K. and Germany are likely to be targeted next.


Economic mobility nearly halved in the United States since the 1940s (ZME Science)
If children born in 1940 had a 90% chance of earning more than their parents, this dropped fast to only 50% in the 1980s, the team reported in the journal Science.


Collaboration at Stanford leads to Mongolian parliament passing law on public opinion polling (Stanford News)
For those interested in ways deliberative practices can be institutionalized, this development in Mongolia may be of interest. A national Deliberative Poll was held last weekend, as required by the new "Law on Deliberative Polling" to consider possible constitutional amendments. Results will be released soon.

Making time for civic engagement when you have errands to run (Daily Breeze)
When you want change in government, you need to make your voice heard. You need to call your elected officials. You need to speak up at town halls. You need to fund organizations supporting your cause, pen letters to the editor and seize every opportunity to incite change.

Advancing the Art of Collaboration (Stanford Social Innovation Review)
This series, produced in partnership with BBB's, calls on the social sector to embody a new and pioneering collaborative spirit based in trust so that it can reach broader audiences, share the risk involved in experimentation, and accomplish more than any single organization could do alone.

K-12 Education

#ShowTheEvidence: Building a Movement Around Research, Impact in Ed Tech (The 74)
This is the first in a series of essays surrounding the EdTech Efficacy Research Symposium, a gathering of 275 researchers, teachers, entrepreneurs, professors, administrators, and philanthropists to discuss the role efficacy research should play in guiding the development and implementation of education technologies. This series was produced in partnership with Pearson, a co-sponsor of the symposium co-hosted by the University of Virginia’s Curry School of Education, Digital Promise, and the Jefferson Education Accelerator.

Linking Professional Development to Teacher Evaluations (Education Week)
The Boulder Valley school district built an online portal, called MyPassport, to help educators tap into the professional development offerings that match their needs.

One way to boost test scores? Make sure students get morning sunshine, new research shows (Chalkbeat)
The study, published last month in the peer-reviewed Journal of Human Resources, looks at districts in Florida and uses a novel approach: the fact that some areas in the state operate in the central time zone while others use eastern time. That means that if one district starts school at 8 a.m. Eastern and one right next door starts at 8 a.m. Central, students are actually heading to school at different times, relative to the sunrise — creating a natural experiment for the researchers to study how that affects student achievement.

When Elmo And Big Bird Talk To Refugees (NPR)
Sesame Workshop is creating educational programming for refugee children around the world. But first, it's doing a lot of homework to make sure the lessons it teaches are the right ones.

Higher Education & Workforce Development

Educating the Public on the Value of a College Degree (The Chronicle of Higher Education)
In contradiction to all the evidence of the increasing value of postsecondary education, a clear majority of our focus-group participants said they believed that the economic value of a college degree has stagnated or even declined. Do half of all student-loan borrowers owe less than $13,000? Yes. But that is not what a majority of the focus-group participants believed. And fewer than half of them think that colleges and universities focus on managing costs and limiting tuition increases to the best of their ability.

Varying Degrees: How America Perceives Higher Education (New America)
This week, New America hosted a graduation-week event to take a closer look at America’s thoughts and perceptions of higher education and discuss the implications of these findings for students, institutional leaders, and policymakers. Only one in four Americans agrees that our higher education system is fine just the way it is. Millennials -- who are on track to be the most educated generation to date and therefore have the most experience with the system -- are more likely than other generations to think this (only 13 percent agree higher education is fine how it is). Follow the conversation online with #VaryingDegrees.

Essay: What Policies for Improving Graduation Rates Actually Work? (Inside Higher Ed)
As students across the country prepare to receive their degrees, five authors -- Nicholas A. Bowman (University of Iowa), Tricia A. Seifert (Montana State), Gregory C. Wolniak (NYU), Matthew J. Mayhew (Ohio State) and Alyssa N. Rockenbach (North Carolina State), the authors of How College Affects Students -- explore how to increase their numbers.

Common Application Says New Transfer App Will Better Serve Nontraditional Students (The Chronicle of Higher Education)
The Common App’s current transfer application closely resembles the version that high-school seniors use to apply to four-year institutions. Yet asking a 35-year-old with a full-time job and two kids for the same parental information that teenagers provide isn’t an ideal way to engage so-called nontraditional students, Ms. Rickard said. "That’s not acknowledging who they are and where they’re coming from."

Interactive Chart: Putting Your Major to Work: Career Paths after College (The Hamilton Project)
The 3.4 percent of English majors who become managers earn a median salary of $77,000, while the 8.3 percent of their counterparts who become elementary and middle school teachers earn $51,000. Different career paths and the associated earnings differences for students with the same college major are pervasive and important for understanding both the benefits of college majors and of college itself.

Health Care

Should Value-Based Care Measures Become Patient-Centric? (Patient Engagement HIT)
Healthcare leaders should develop value-based care measures that are patient-centric and assess what is important to health consumers.

Administrative job growth in healthcare isn't good for America (The Hill)
There is a widely held consensus that job growth is good: we want any new jobs we can get. But, do we? Might there be job growth that we don’t want?

Why America needs a 'do-over' on Medicaid reform (Econo Times)
Republican leaders have argued the current Medicaid system is failing and in need of reform. Democrats, including former President Obama, have charged that the AHCA harms the well-being of poor and vulnerable groups. These writers wholeheartedly agree – with both sides. We question the wisdom of steep cuts to an already underfunded Medicaid system. But the status quo is not working either. So what should we do?


05.11 Why We Can't Find The Health Care Info We Want

Thursday, May 11th, 2017 |

At Public Agenda, we’re helping build pathways out of poverty, a stronger middle class and a democracy that works for everyone. We fuel progress on tough issues like K-12 education, higher education, jobs, health care and other critical components of social mobility, thriving communities and a healthier democracy.

Americans remain burdened by rising out-of-pocket medical costs. And while there is no quick fix to the broken health care system, understanding public perspectives on the solutions that are on the table is a step in the right direction. Last month, we released new research that examined how people are finding and using health care price information and whether that information can help them save some money.

Our friend Parie Garg, Ph.D., Partner, Health & Life Sciences, Oliver Wyman, shares in this guest blog post findings from her research on health care price information included in her report “Right Place Right Time.” Parie offers insight into why the health care industry is not taking steps to provide people with better cost information at the right place and at the right time.

While the health care consumer is increasingly seeking price information prior to seeking care (as reported in the recent, insightful Public Agenda report), the industry lags behind in the provision of that information. For many health care consumers, obtaining cost information that is trustworthy, usable and easily compared across providers is a significant challenge.

In fact, the “Right Place Right Time” study conducted by Oliver Wyman and Altarum Institute, with support from the Robert Wood Johnson Foundation, found that many health care consumers are not getting the cost information they want or need. According to the survey, which encompassed over 4,000 respondents, approximately 50 percent of respondents are not satisfied with the level of cost information available.

These findings, taken together with the Public Agenda research, reveal a wide gap between what consumers want—when it comes to cost information—and what consumers actually get. But the results likely do not come as a surprise to the health care industry. As published in the “Right Place, Right Time” companion study that surveyed about 100 stakeholders across the health care ecosystem, payers and providers are aware of the challenges that consumers face as they seek cost information.

So why isn’t the industry taking steps to provide better cost information at the right place, at the right time? There are a few reasons that stand out:

  1. Exact cost of procedures is a closely-guarded secret: Most providers negotiate specific rates with their contracted health plans. These rates are not publicly available, however, as releasing this information would have ramifications in terms of market competition, as well as payer leverage during negotiations.
  2. Lack of an ROI: While it is clear that consumers are looking for cost information, providing that information at the right place and at the right time is not easy. And (perhaps most significantly), there is no clear ROI established as a result of providing this information. Consumers can be fickle, and health care decisions can often be based on emotion as much as cost. As an example, a cancer diagnosis often leads to a patient seeking out the best care, with or without a price comparison. Consequently, cost comparison tools may not provide the best return on investment.
  3. Competing priorities: Over the past several years, the health care market has been in a constant state of upheaval. With the American Health Care Act just having been passed through the House of Representatives, there is likely to be continued uncertainty over the next two years. In times like this, payer and providers have a lot to be worried about, and, unfortunately, consumer engagement tools are often on the bottom of their priority list.

Despite these significant roadblocks, it should be noted that payers and providers are realizing that patients are behaving more like consumers than ever before. The technology-savvy younger generations have little patience for industries that cannot quickly tell them how much things are going to cost. And with the possibility of the American Health Care Act nearly doubling contribution limits of Health Savings Accounts, providers and payers have more of a mandate to consider provisions of cost oriented tools and information. Individuals will hopefully have a leading role to wholesale change in the usability and reach of cost transparency tools in the future.


05.05 Engaging Ideas - 5/5/2017

Friday, May 5th, 2017 | PUBLIC AGENDA


The Johnson Amendment In 5 Questions And Answers (NPR)
Conservative groups that favor a greater role for religion in the public space, such as the Alliance Defending Freedom, have long sought to repeal the amendment, arguing that it restricts free speech by censoring the content of a pastor's sermon. Overturning the law, however, would also have major implications for campaign finance. If churches or clergy are allowed to participate in political campaigns, tax-free donations to the churches could go to support a political candidate. Religious organizations could become bigger money players in politics.

Three-fourths of Americans regularly talk politics only with members of their own political tribe (Washington Post)
As politics has become more partisan in recent decades, it gets harder to talk to people across the political divide. Research on the 2016 election underscores how common this has become, with three-quarters of voters most often talking about politics only to people who shared their views.


Why people are rich and poor: Republicans and Democrats have very different views (Pew Research)
The public overall is about evenly divided over which has more to do with why a person is rich: 45% say it is because he or she worked harder than most people, while 43% say it is because they had more advantages in life than others, according to a survey conducted April 5-11 among 1,501 U.S. adults.

Poor Rich Kids? The Mysterious Decline in Mobility at the Top (Forbes)
A new research study on economic mobility from the Equality of Opportunity Project has the remarkable finding that absolute economic mobility—the likelihood that children will out-earn their parents—has declined dramatically over the last 40 years.

Seven Ways to Think Like a 21st-Century Economist (The Brian Lehrer Show)
The ideas that shape mainstream economic thought are out of date. Kate Raworth, senior visiting research associate and advisory board member at Oxford University’s Environmental Change Institute and author of Doughnut Economics: Seven Ways to Think Like a 21st-Century Economist (Chelsea Green, 2017), sets out to move beyond the way economics is currently taught and reliance on measurements like GDP. She's working with some of the world's best stop-motion animators to bring new economic thinking to life on screen.


Inequality and the Fracturing of American Democracy (National Review)
Where underlying inequality expands we can see the development of increasingly intense grievances at both ends of the spectrum: Those at the bottom feeling less and less competitive in important areas, while those at the top feel increasingly resentful about the proportion of tax coming from them and insist that those below start paying more. If the bidding-power gap grows wide enough it is possible to imagine the system crumbling through a combination of frustration, illiberal measures, populist demagoguery, repression, and stagnation — the sorts of cycles that Latin American countries, with the highest inequality levels in the world, go through regularly. So what should policymakers do?

To Help Tackle Inequality, Remember the Advantages You’ve Had (The New York Times)
A psychological quirk leads us to remember headwinds more than tailwinds. But if we recall our advantages, we will be closer to reducing inequality.


The New Faces of Activism (Rhode Island Monthly)
Are first-time activists making a difference in Rhode Island?

Immigrants, the Economy and Civic Engagement (Western City)
California cities use a variety of strategies to engage their residents in civic life and foster inclusive, welcoming communities. Cities with policies and practices focused on inclusion build trust and relationships that lead to increased economic and civic engagement of immigrants and the broader community.

K-12 Education

School Vouchers Aren’t Working, but Choice Is (The New York Times)
Hard-core reformers, like DeVos, support vouchers and charters. Hard-core traditionalists oppose both. The rest of us should distinguish between them, because their results differ. Vouchers have been disappointing. They are based on the free-market theory that parents will choose good schools over bad ones. It’s a reasonable theory, and vouchers can have benefits, like allowing children to leave dangerous schools.

AERA: What Do We Mean When We Talk About Teacher Shortages? (Education Week)
Debates over perceived teacher shortages often conflate different problems and make it more difficult to find sustainable ways to get every student a good teacher. That was the consensus at one of the opening symposiums of the American Educational Research Association's (AERA) annual conference last Thursday. Linda Darling-Hammond, founder of Learning Policy Institute, a think tank, led researchers debating how educators and policymakers can better understand what influences teacher shortages from state to state.

A Path Out Of Poverty: Career Training + Quality Pre K (NPR)
A new study on the first year impact of Tulsa's Career Advance shows that, so far, Career Advance is working well for both parents and their children. In fact, the study says, CAP Tulsa's program is working better than similar combined job training and pre-K programs elsewhere in terms of job certification, employment, income and overall well-being for the parent. And, the report shows, the program has boosted attendance and reduced absenteeism among participating children.

Higher Education & Workforce Development

Working Paper: Strengthening Transfer Paths to a Bachelor's Degree: Identifying Effective Two-Year to Four-Year College Partnerships (Community College Research Center)
The goal of improving transfer outcomes cannot be fully achieved until colleges nationwide are provided with commonly accepted metrics and methods for measuring the effectiveness of transfer partnerships. Using the individual term-by-term college enrollment records from the National Student Clearinghouse for the entire 2007 fall cohort of first-time-in-college community college students nationwide, this paper introduces a two-stage, input-adjusted, value-added analytic framework for identifying partnerships of two- and four-year institutions that are more effective than expected in enabling community college students to transfer to a four-year institution and earn a bachelor’s degree in a timely fashion.

From For-Profits to Community Colleges (Inside Higher Ed)
A new paper by researchers at the Federal Reserve Bank of Philadelphia found that many of for-profit students don’t abandon postsecondary education altogether -- instead, they enroll at community colleges.

A 'Playbook For Trustees' Highlights Innovative Practices for Campus Change Initiatives (EdSurge)
The report from the American Council of Trustees and Alumni offers examples from different universities, including Arizona State University, University of Colorado and Purdue University, colleges referred to as “Blueprints of Reform.” With each campus, the guide details efforts around affordability and administrative changes all targeting “improved student outcomes and efficiency without compromising academic quality and student options,” a press announcement reads.

When a Southern State Led the Nation on Free College (OZY)
This isn’t the story of the free-tuition plan passed by New York last month, but that of another ambitious program that aimed to greatly reduce the cost for in-state students. Georgia’s HOPE Scholarship, created in 1993, revolutionized schools in the Peach State and now serves as a telling example of both the possibilities and pitfalls that await the Empire State.

Health Care

5 things to watch while awaiting a Senate health care bill (USA Today)
There are still some key developments to watch out for that could have a dramatic effect on the debate over repealing and replacing the Affordable Care Act. Does CBO issue a terrible score of the House bill? Does the administration withhold cost-sharing subsidies? Does the Senate start over? Do more insurers drop out? Will there be more angry town halls?

Surprising benefits of price transparency and how to utilize them (Medical Economics)
The days of being a doctor or outpatient facility and passively waiting for referrals is waning. As patient networks narrow and deductibles grow, the mindset of the consumer is changing. They're beginning to understand that sometimes costs are lower even if they disregard their network and find an equally qualified provider.

Doctors Prescribe More Generics When Drug Reps are Kept at Bay (NPR and ProPublica)
When teaching hospitals put pharmaceutical sales representatives on a shorter leash, their doctors tended to order fewer promoted brand-name drugs and used more generic versions instead, a study published Tuesday in JAMA, the journal of the American Medical Association, shows.

How the Affordable Care Act Drove Down Personal Bankruptcy (Consumer Reports)
Expanded health insurance helped cut the number of filings by half.


05.05 Thursday 5/11: Webinar on Price Transparency in Health Care

Friday, May 5th, 2017 |

Whether you consider yourself a health care policy expert or not, conversations about the price of health care are happening all around you. The research we’ve done focuses on the nuances of who is looking for price information (half of all Americans) before getting medical care and what sources they are going to (see the shortlist here). It’s also shown that people want more of this information and they want an easy, accessible and reliable way to get to it.

Most Americans believe there is not enough information out there on the price of medical services, and some are dissatisfied and even distrusting of sources of this information. What are the policies and marketplace fixes that will address these issues?

Next week, Director of Research David Schleifer will present the latest survey data on how people find and use prices in their decisions before getting medical care. He’ll join a group of experts in the health care consumer research and advocacy realm to discuss some promising ideas that can help Americans save money.

You’re invited to join the webinar next Thursday, May 11th at 2pm Eastern Time. You can also follow the conversation with #PriceTransparency. We hope to see you there!

Speakers include:

  • Suzanne Delbanco, Catalyst for Payment Reform
  • Chris Duke, Altarum Institute
  • Doris Peter, Consumer Reports Health Ratings Center
  • David Schleifer, Public Agenda
  • Amy Shefrin, New York State Health Foundation

Moderated by:

  • Andrea Ducas, Robert Wood Johnson Foundation

Register for the webinar here.


04.28 How PB Analytics Helps Build Neighbourhood Engagement in Hamilton, Canada

Friday, April 28th, 2017 |

Public Agenda has been building a network of researchers and evaluators who are working locally with participatory budgeting (PB) sites to better understanding how PB in the US and Canada is growing, how it is working, what impacts it may have on local communities and also to learn more from year to year about how to best improve PB implementation. Evaluators and researchers of PB in the US have a strong collective interest to support and produce research and evaluation findings that are practical and relevant to the work of the people who are actually implementing PB processes in their cities and districts. But how do findings from evaluation and research get used by the implementers of PB processes in their work to help improve their processes in real time?

Sonja Macdonald, co-founder and a Principal with Civicplan, a community planning and public engagement firm, tells how data helps drive process improvements in the PB process in Hamilton’s Ward One process, “forWard one.”

Since 2012, residents of Ward 1 in Hamilton, Canada have worked together to determine how approximately $7.5 million (CAD) would be spent on local infrastructure projects. The ward’s participatory budgeting (PB) process, “forWard one,” has grown in popularity year after year. In its first year (2012), just over 400 residents participated. The 2016 process recorded the highest levels of participation yet with over 2,100 residents participating. There are many reasons for the success of this process, one of which is how data is used to focus improvements in participation.

Civicplan has built into the design of the process PB analytics, which provides detailed tracking of metrics that help assess whether and how forWard one is meeting its goals. Neighbourhood equity has always been one of these central pillars, given that the ward encompasses a diversity of communities with different challenges and pressures.

Two key metrics that Civicplan measures year over year are designed to help determine progress toward this goal. The first metric measures the distribution of voting by neighbourhood as compared to the total number of votes for the Ward. The second metric illustrates the changes in actual participation within each neighbourhood year over year.

The data captured under these metrics provides the Ward Councillor, the members of PBAC (the PB Advisory Committee, comprised of community members) and the community at large with insights into where to improve the process to approach greater neighborhood equity. This was the case in the 2016 process in the neighbourhood of Ainslie Wood.

This neighbourhood sits opposite the major local post-secondary institution, McMaster University, and as such has many related pressures including a large student population, absentee landlords and high turnover in residents. All of this contributes to challenges in participation. In 2014, Ainslie Wood represented 15 percent of the vote distribution, one of two neighbourhoods with the lowest rates of participation. In order to improve this, the forWard one team took specific steps to improve participation from Ainslie Wood in the following ways.

  • New members from Ainslie Wood were welcomed onto the PBAC, including long-time residents with strong connections to neighbourhood institutions.
  • These individuals identified and encouraged new community champions to generate and submit ideas for community focused projects.
  • The community champions engaged in promoting their projects, and the forWard one process, to a more diverse resident base to improve voting.

The results of taking a targeted approach to improve Ainslie Wood’s involvement in forWard one paid off. While the voting participation for all neighbourhoods increased in 2016, the growth in the Ainslie Wood neighbourhood was the most significant, with voter participation increasing by three times previous years, from 186 in 2014 to 566 in 2016. More pointedly though, this resulted in the success of four significant Ainslie Wood projects in the final funded projects list. These included dedicating additional funds to create a recreation centre and community hub at a former elementary school site, funds to develop complete streets throughout the neighbourhood, as well as funding for improving two park areas, new facilities for one and naturalizing the other space.

Hamilton’s Ward 1 participatory budgeting process has been underway for a number of years now, and offers a number of lessons about engaging residents in municipal decision making. To achieve the goals of the process, including neighbourhood equity, forWard one needs to be flexible and adaptable in targeting concrete improvements annually. Civicplan’s PB analytics are a valuable tool employed in improving neighbourhood participation year over year. The success of improved participation in the Ainslie Wood neighbourhood in 2016 demonstrates the importance of data to inform targeted change, which may also result in increasing the reach of participatory budgeting to more diverse communities in the ward, leading to better investment for the whole of Ward 1.

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04.28 Engaging Ideas - 4/28/2017

Friday, April 28th, 2017 | PUBLIC AGENDA


Social media may not be to blame for our political divisions (Market Watch)
Never before have Americans seemed so politically divided. You can hear the divisions in conversations at restaurants (particularly if you live in a swing state). You can see the divisions via protest signs on the evening news. You can look at the final outcome of the U.S. presidential election. And sometimes, you can witness acrimony in the conversations on Facebook.

Unlikely Political Allies: Urban Democrats and GOP Governors (Governing)
Most states now are run by Republicans. Virtually all big cities, by contrast, have Democratic mayors. That has led to a lot of conflict and a considerable number of state laws preempting local initiatives. But while many Democratic mayors are struggling to get a hearing from Republican legislators, a fair number have been able to forge working partnerships with GOP governors.

How political nuance could save America (The Guardian)
Many progressives trade in stereotypes about Kansas with childlike pride, writes Sarah Smarsh. But to use geography to separate the righteous from the scourge is dangerously simplistic.

Wikipedia’s founder launched a fake-news fighting site. (The Guardian)
Jimmy Wales’ Wikitribune is an independent site for journalists and an army of volunteer community contributors to work together to report, edit, and fact check stories. The idea is that people who donate to the site will have a say in coverage.


Participatory Budgeting: The People’s Budget (WNYC)
“The people's budget is an opportunity for community residents to decide how a million dollars or more is spent in their community.”


Escaping Poverty Requires Almost 20 Years With Nearly Nothing Going Wrong (The Atlantic)
The MIT economist Peter Temin argues that economic inequality results in two distinct classes. And only one of them has any power.

'Fight Inequality!' Is a Poor Rallying Cry (Bloomberg View)
Inequality, of income or wealth, is one of the most frequently invoked ideas in policy discussions today. Yet a study of the concept reveals uncomfortable truths, namely that most Americans don’t mind inequality nearly as much as pundits and academics suggest.

K-12 Education

Student Voice Plays a Key Role in Townsend Harris Shakeup (WNYC)
Reporters for the school paper, The Classic, exposed problems and discontent with the interim principal for months. Now, the school is getting a new principal.

With New York City expected to unveil school diversity plan soon, advocates want the public to have a say (Chalkbeat NY)
“What we want the DOE to do is create an actual planning process that is inclusive of stakeholders across the city. That has not been the case,” said Matt Gonzales, who leads school integration efforts for the nonprofit New York Appleseed and is a member of ASID. “Any efforts towards integration or desegregation always, historically, have required local buy-in.”

Teacher-Powered Schools Take Root (Education Week)
Impact Academy at Orchard Lake in Minnesota is among a growing number of public schools where teachers have a say in what goes on, from the learning approach to staffing and scheduling.

Educators Share Their #BestPD, #WorstPD (Education Week)
We asked educators to share on Twitter the professional development that inspired them or that left them scratching their heads.

Higher Education & Workforce Development

ASAP Expands North and West (Inside Higher Ed)
Westchester Community College, which is part of the State University of New York System, and Skyline Community College in California are the latest campuses that are gearing up to try ASAP for the first time. At Skyline, officials are estimating the cost per student will fall between $1,200 and $1,400 a year. If the program goes full scale, or grows to about 500 students, the college estimates it will cost $1.5 million a year. Westchester estimates its ASAP model will cost between $3,000 and $4,500 a student. But with outside grants, funding from the college and tuition from increasing student persistence, Westchester is hopeful the program will become sustainable.

One possible solution for the future of career and technical education (Hechinger Report)
The 26 students, from four local public high schools, report to school at the Volkswagen plant, a major new employer in the region. (The program, which started in August, is expected to grow to include more students and other employment tracks.) Students spend the morning in “lab time,” a flexible period during which they are taking courses, such as algebra or trigonometry, through the Edgenuity platform on a computer.

Policy Snapshot: Guided Pathways to College Completion (Education Commission of the States)
Based on a review of 2016 legislative activity that encourages or requires higher education institutions to develop guided pathways strategies: At least six states considered guided pathways legislation. Ten bills were introduced. Two bills were enacted, six bills died and two bills are pending.

Health Care

Behind The Health Care Reform Eight Ball (Forbes)
The core issue dividing GOP factions focuses on driving down the cost of insurance premiums only. This narrow approach is a recipe for public relations and policy failure. But if you couple insurance reforms to transparency in our costs of actual care, a potent dynamic is unleashed. Our health care marketplace is missing actual price tags.

America’s Other Drug Problem (ProPublica)
Every year nursing homes nationwide flush, burn or throw out tons of valuable prescription drugs. Iowa collects them and gives them to needy patients for free. Most other states don’t.

It’s Almost Impossible to Find Out the Cost of a Medical Procedure. This Company Is Trying to Change That. (The Daily Signal)
Amino mines data from billions of health insurance claims from the private and public sectors. Amino then gives patients access to information on the cost of various procedures and how much experience doctors nationwide have in those procedures.


04.21 Engaging Ideas - 4/21/2017

Friday, April 21st, 2017 | PUBLIC AGENDA


Five hacks for digital democracy (Nature)
Beth Simone Noveck urges researchers to work out how technology can improve public institutions. There is a dearth of research on how public organizations engage with civil servants and the public online, and thus a lack of insight into how to design successful online engagement processes and institutions.

What Excellence Looks like in Local Government (Data Smart)
What Works Cities, an initiative of Bloomberg Philanthropies, pairs midsized cities with expert partners – the Government Performance Lab at Harvard Kennedy School, the Behavioral Insights Team, the Center for Government Excellence at Johns Hopkins University (GovEx), Results for America and the Sunlight Foundation – for technical assistance in better using data and evidence. After two years of work with 77 cities across the United States, the program identified the key characteristics of a city devoted to using data to comprehensively identify, well, what works.

Poll: Only One-Third Of Americans Know The Rich's Tax Rates Have Not Climbed (NPR)
Results of a new Ipsos poll conducted for NPR suggest Americans may be sending a garbled message when they voice their opinions on taxes.


Smart governments are crowd-sourcing community solutions (Quartz)
Take Singapore and San Diego: By making data open and accessible, city and state governments are inviting fresh thinking by firms, data scientists, and start-ups. Experts from Singapore’s Lee Kuan Yew School of Public Policy offer perspective about how
the resulting insights are helping make economic development smarter.

The Moment for Participatory Democracy (Stanford Social Innovation Review)
Where are these citizens? Where, precisely, are people congregating in public life in 2017 America?


Earth 2.0: Is Income Inequality Inevitable? (Freakonomics)
In a perfect economy, no one would be poor. Does that mean everyone should receive a basic income? Or would that lead to disaster? The "Earth 2.0" podcast series looks at whether rebooting the planet and designing our civilization from scratch would give us something better than what we’ve blundered our way into thus far.

K-12 Education

This Islamic School Helps Students Build Their American And Muslim Identity (NPR)
The Al Fatih Academy in Virginia is one of about 270 Islamic schools in the U.S. The staff aim to give their students a well-rounded education and promote civic awareness.

Making America whole again via civics education (Hechinger Report)
To harness student passion without bogging down in partisan muck, teachers are wielding a bevy of ed-tech tools — ranging from online role-playing games and issue quizzes to social media platforms where teachers share strategies for leading political discussions and students collaborate to try to influence public policy.

Report: Economic impact of NYC's "school-to-prison pipeline" is $746M (Center for Popular Democracy)
This report, released by the Center for Popular Democracy and Urban Youth Collaborative, reveals the staggering yearly economic impact of the school-to-prison pipeline in New York City, $746.8 million. In addition, it presents a bold “Young People’s School Justice Agenda,” which calls on the City to divest from over-policing young people, and invest in supportive programs and opportunities for students to thrive. New evidence of the astronomical fiscal and social costs of New York’s school-to-prison pipeline demand urgent action by policymakers.

Higher Education & Workforce Development

Report: Implementing Guided Pathways (Community College Research Center)
This report is intended to provide insight into how colleges are planning and implementing guided pathways reforms. It is based on CCRC research on the early work of 30 colleges across the country that are part of the American Association of Community Colleges’ (AACC) Pathways Project. These colleges have committed to redesigning their programs and student support services at scale following the guided pathways model adopted by AACC based on CCRC’s research.

Report: Even One Semester: Full-Time Enrollment and Student Success (Center for Community College Student Engagement)
Students with fluid attendance patterns frequently fall between the two extremes—and they often look more like always-full-time students than like always-part-time students. These findings indicate that any experience as a full-time student provides a benefit.

Community college presidents surveyed on enrollment, recruitment, pipeline (Inside Higher Ed)
Six in 10 leaders of community colleges say their enrollments have declined in the past three years, including 21 percent who say enrollment is down by 10 percent or more, according to Inside Higher Ed’s 2017 Survey of Community College Presidents conducted by Gallup.

Report: Sunshine Laws in Higher Education (Association of Governing Boards)
Arguably, there is no more important governance challenge for college and university leaders than dealing effectively with what diplomat and educator Harland Cleveland termed the “trilemma” posed by sunshine laws: respecting the public’s legitimate right to know, protecting individual privacy, and serving the public good. It seems no exaggeration to suggest that institutional effectiveness depends on deftly balancing these three imperatives.

Report: Framing the Opportunity: Eight State Policy Recommendations That Support Postsecondary Credential Completion for Underserved Populations (Jobs for the Future)
Includes eight recommendations for policy levers that improve access and success.

Health Care

A Focus on Health to Resolve Urban Ills (The New York Times)
Discrimination, poverty, inequality and violence create unbearable stress, and stress kills.

Montana Lawmakers Push Bills on Health Costs, Transparency (US News & World Report)
Congress may not know what to do about former President Barack Obama's Affordable Care Act, but Montana lawmakers are pushing through legislation they believe will bring down health care costs and increase price transparency regardless of what happens in Washington.

3 traits of good value-based payment programs (Fierce Health Care)
In order for value-based payment models to live up to their hype, they must generate more consistent benefits than they have so far, argue Jessica Farmer and Michael Hochman, M.D., of the Keck School of Medicine.


04.17 Helping Americans Save on Health Care

Monday, April 17th, 2017 | WILL FRIEDMAN, PH.D.

Part of our monthly "Progress Report" newsletter. To receive the latest email updates from Public Agenda, click here.

With the latest health care reform bill failing to gain traction, we're reminded that there is no easy fix to our broken health care system. Meanwhile, Americans remain burdened by rising out-of-pocket medical costs amid diminished economic opportunity and chronic political dysfunction. They feel stuck, as we explain in our recent report, The Fix We're In. Public Agenda is tackling critical issues such as these to help individuals, families, and communities build better lives.

With no panacea in sight to address our current health care system troubles, we looked at a piece of the puzzle that could help people save some money and perhaps help contain health costs overall. Earlier this month, we released new research that examined how people are finding and using health care price information.

Are Americans trying to find out about health care prices today?
Do they want more information?
What sources would they trust to deliver it?
Is this information helping them save money?

Despite efforts in recent years by insurers, state governments, employers and other entities to make price information more easily available, the research shows that obstacles remain. Among the findings, about half of Americans are still not aware that hospitals' prices can vary or that doctors' prices can vary. And for those that do know this, the information is still difficult to find, as our Director of Research, David Schleifer, shared in a personal story with The Economist, this week.

Sixty-three percent of Americans say there is not enough information out there. But an overwhelming majority says that it is important for their state governments to provide comparative price information. View the full report for more important findings.

Price transparency alone is not enough to make health care affordable, but by addressing the critical components of a broken system, we can help create greater economic opportunity and set the nation on a better path. Which is why we're excited to be currently analyzing new survey data about how people make tradeoffs between cost and quality in health care, and how they find information about the qualities that matter to them most.

Keep an eye out for this new research in early July. In the meantime, we'll keep the conversation going with you on Twitter and Facebook.


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