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03.21 On Health Care Quality, What Does the Public Think?

Monday, March 21st, 2016 | DAVID SCHLEIFER, PH.D.

Experts have a lot to say about measuring quality in health care. But what qualities matter most to patients like you and me?

What do you think makes for a high-quality doctor? When asked this question, most Americans say they focus on doctor-patient relationships and doctors’ personality, according to a 2014 nationally representative survey from the Associated Press-NORC Center for Public Affairs Research.

But do people think differently about quality when they're faced with a potentially more serious situation such as joint replacement, diabetes or childbirth? People facing such situations may be interested in personality and relationships. However, they may also want to choose doctors and hospitals who are “the best.” But the best at what exactly? And according to whom?

We've seen a lot of progress on ratings systems that measure and communicate the quality of care that doctors and hospitals provide. Organizations like the Leapfrog Group, for example, have for many years reported on hospital quality and safety. They have found that a person on Medicare has a one in four chance of experiencing injury, harm or death when admitted to a hospital.

Several other non-profit organizations, private companies and state governments also now publicly rate the quality of hospitals and physician groups. The Centers for Medicare & Medicaid Services recently released core quality measures for treatment in seven areas of health care. These measures are designed to improve consumer decision-making and facilitate value-based payment, among other goals.

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03.21 The Call to Grapple With Housing Affordability

Monday, March 21st, 2016 | WILL FRIEDMAN, PH.D.

As a boy growing up in New York City's Upper West Side and West Village neighborhoods in the '60s, I kept my lunch money in my shoe and witnessed a cops and robbers shootout at a Western Union on Broadway.

I returned to live in the Upper West Side four decades later. These days, the neighborhood is safer, sure, but it's absurdly expensive. The high cost of living means the area lacks a true middle class, which I was part of growing up. There is fleetingly little diversity, and none of the street energy I knew playing handball against the pre-war buildings when I was a kid.

The neighborhood I called home is no longer a place where the son of a second-generation professor of American literature at the Brooklyn College of Pharmacy and a third-generation aspiring actress could live. And it's certainly not an affordable place for my aspiring-actress daughter and most other young people without a trust fund or relatively rare job in a high-wage industry.

New York's housing affordability problem has steadily crept outward from Manhattan to encompass the entire region. In fact, in a recent survey we conducted, 80 percent of those residing in the New York metro area said the high cost of housing was one of the area's most serious problems.

New York is not alone. It's among a growing number of economically powerful cities that face a crisis of affordability and inequality. This crisis threatens to choke off the very factors that drive these cities' success.

Cities thrive because diverse, ambitious, talented people intersect in ways that foster innovation and opportunity. City scholar Edward Glaeser puts this case in the strongest possible terms when he writes, "The strength that comes from human collaboration is the central truth behind civilization's success and the primary reason why cities exist."

If diverse, talented people cannot afford to come here or stay here to find opportunity and make their mark, cities like New York will lose their vital edge. That's why it's so important, from the perspective of both fairness and smart economics, to make sure great cities tackle the problem of housing affordability.

At the same time, policies that affect our housing and our neighborhoods also affect our daily lives. The public has a personal stake in housing policy. It should also have a voice.

Over the next year, Public Agenda will conduct research to understand where the public stands in the search for bold solutions to housing affordability in New York. We will share these findings with policy and decision makers so they make choices grounded in and informed by the will of the public. And we will create materials that communities can use to better understand, discuss and act on the issue themselves.

To kick off this project, we hosted a panel discussion in early April with WNYC's Brian Lehrer, NYC Commissioner for Housing Preservation and Development Vicki Been, New York Community Trust's Patricia Swann and New York University's Steven Pedigo. You can read a recap of the event on our blog, where we'll also post regular updates about our progress.

Do you worry about keeping our cities affordable and sustainable engines of innovation and progress for all its residents? You can support Public Agenda's efforts to elevate the public's voice on housing solutions by making a tax deductible donation. Your donation will help us do this work at the scale needed to make a real difference!


03.18 Engaging Ideas - 3/18

Friday, March 18th, 2016 | Public Agenda

Every week we curate recent stories and reports on complex issues including democracy, public engagement, opportunity, education and health care.


At SXSW, Obama Calls for More Civic Engagement in Digital Age (

Ronald Barba writes: President Barack Obama made his inaugural appearance at this year’s SXSW to discuss the importance of utilizing today’s digital tools and technological advancements to greatly improve and support civic engagement. Sitting with Evan Smith of The Texas Tribune, the President talked over many topics, including the increasing role of government in streamlining the process for aspiring entrepreneurs, how a private-public partnership between The White House and Silicon Valley is helping to solve our nation’s problems, and even touched upon the civil liberties issues surrounding Apple’s privacy case. More relevant to our election season, though, President Obama called for a better process to engage citizens in the electoral process.

Mediating Political Gridlock (WNYC)

Being a political mediator is no easy gig. Just ask seasoned mediator, Mark Gerzon, president of Mediators Foundation and the author of The Reunited States of America: How We Can Bridge the Partisan Divide. He's advised a number of groups, political actors, and corporations on bipartisanship. Listen as Gerzon mediates a conversation between a guns rights enthusiast and an anti-guns skeptic.


The Power of Convening for Social Impact (Standford Social Innovation Review)

Bringing people together in an environment that encourages and facilitates idea exchange is one of the most powerful communications strategies for driving change.

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03.17 It's Voting Week for Participatory Budgeting in NYC

Thursday, March 17th, 2016 | Chloe Rinehart

Photo: Costa Constantinides.

Next week, tens of thousands of New York City residents across 28 neighborhoods will have a voice in improving their community. Starting Saturday, March 26th, residents will go to the voting booths for the city's fifth year of participatory budgeting (PB), a process by which community members have direct decision-making power over local budget decisions.

Voting week is the culmination of many months of hard work, time and collaboration from community volunteers, city and district staff, and community-based organizations. Residents gather at a series of community meetings to present, listen to and collect ideas. Volunteers and city agency staff develop and vet projects. Finally, volunteers design and draft concrete project proposals.

During voting week, NYC residents who live or work in a PB-participating community can choose their preferred projects at a number of different voting stations located throughout their area, including libraries, schools, their council member’s offices and even beer gardens. Residents might also come across a “pop-up” voting table on a busy street corner.

Each voting location has ballots that describe the PB projects proposed for that particular community, with a brief description and cost for each project. Ballots are translated into languages other than English that are typically spoken in the community.

Many NYC residents are eligible to cast their PB vote even if they would not be eligible to vote in municipal elections. Residents as young as 16 (and in some cases 14), residents who were formerly incarcerated, and residents who lack citizenship status are all welcome and encouraged to participate in the vote.

How Research Helped Expand PB in NYC

As we have written previously, PB has expanded exponentially in the U.S. and Canada the past few years. New York City has driven much of that growth, where PB has expanded from 4 participating communities to 28 in 5 years.

The growth and expansion of PB in NYC has not happened in a silo. Research and evaluation led by Alexa Kasdan and Erin Markman of the Community Development Project (CDP) at the Urban Justice Center has played an integral role in development and expansion of PB in NYC.

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03.17 Flying Below the Radar: Making Local Progress in Spite of National Dysfunction

Thursday, March 17th, 2016 | WILL FRIEDMAN, PH.D.

If you haven't read James Fallows' chronicle of local progress in The Atlantic, do yourself a favor and click over to read it when you're done here.

In it, Fallows writes about his small-plane travels to four dozen small cities throughout the U.S. Through his journey, we discover an alternate narrative of America, one celebrating the power of local determination, democracy and problem solving.

Nationally, we are utterly incapable of collaboration, compromise or making any progress on solving problems. The very rare exceptions only make the dominant pattern more visible.

Yet in cities big and small, where most people live and work, the ability of residents and officials to solve problems has not abated and may actually have picked up.

I would add this observation to Fallows' encouraging chronicle: There are two distinct strategies and styles evident in many local success stories. One is a more technocratic, top-down, data-driven, often tech-enabled approach. The other is more deliberative and democratic, centered on civic engagement and community empowerment. Both have their strengths and can help address different classes of problems or different aspects of the same problem.

Top-down, technocratic problem solving can be good for technical problems. For example, it can identify where the potholes are, and how to speed up response time to a 911 call.

In New York, for instance, the former mayor, Michael Bloomberg, was a master of technocratic, top-down problem solving, and for many types of problems that worked very well-but not for all. It created an efficient 311 system that serves citizens well, and strengthened New York's anti-terrorism capabilities. But technocratic attempts to improve schools and police-community relations through corporate approaches of measurement and accountability fell flat and, in many instances, were counterproductive.

There are no purely technocratic fixes for many problems cities face, including poverty, inequality, educational disparities or diminishing opportunity. Such "wicked problems" (as the literature sometimes calls them) prove amazingly resistant to purely top-down solutions.

Instead, such problems require ongoing attention from many disparate actors, durable public support so experiments can prove themselves and blossom into policies and practices that drive progress, and tough choices among competing priorities about how we want to live.

Solutions to such problems can be data-informed but not data-determined because they are, to a very great extent, matters of values, priorities and the trade-offs we are willing to accept as a community. Do the pros outweigh the cons of a much higher minimum wage? Are we willing to experiment to find out? Should we permit bigger buildings in historic neighborhoods if doing so will make rents more affordable? If not, what measures should we take instead? Are we willing to provide the resources to ensure that all schools have adequate and safe facilities and well-trained teachers, or not? If so, how?

This is fertile ground for deliberative democratic work, and in fact that's the only approach that will bear fruit in the long term. In his most compelling examples of renewal and progress, Fallows feature cities where many different groups of people - experts and non-experts, officials and everyday residents, conservatives and liberals - work together on solutions.

As technocratic approaches reach their limit, we have the opportunity to help cities make progress on their big problems. We can do so by engaging the public and diverse stakeholders, by working through trade-offs and strengthening public judgment, by developing strong lines of communication and by celebrating our successes rather than wallowing in our failures.


03.15 The Need for Engagement in Higher Education

Tuesday, March 15th, 2016 | ALISON KADLEC, PH.D.

Few issues enjoy the same widespread bipartisan agreement that higher education does, even amidst the unparalleled polarization we are seeing in this year's election season. Regardless of party affiliation or ideological orientation, a vast majority of leaders in this country agree that we need a more educated population and significantly more people with high-quality postsecondary credentials.

Despite the encouraging (and probably short-lived) cross-partisan agreement among policymakers of every stripe, conversations on college campuses—where the real work must be done—are rife with hostile, polarizing and often ideological rhetoric.

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03.10 Engaging Ideas - 3/10

Thursday, March 10th, 2016 | Public Agenda

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


The Poisoning of Our Politics: Partisan Elections (Governing)

Mark Funkhouser writes: Those who want greater turnout in elections, more successful women and minority candidates, less gerrymandering, less ideological extremism and more pragmatic policymaking have a ready tool: Take the electoral machinery back from the private organizations that have given us the broken system of governance we have now.

The End of American Idealism (The New York Times)

Charles Blow writes: There is palpable discontent in this country among those who feel left out and left behind in the bounty of America’s prosperity. How long can the center hold? How long can the illusion be sustained? How long before we start to call this the post-American idealism era?

The Risk I Will Not Take (Bloomberg View)

Michael Bloomberg writes: “We cannot “make America great again” by turning our backs on the values that made us the world’s greatest nation in the first place. I love our country too much to play a role in electing a candidate who would weaken our unity and darken our future -- and so I will not enter the race for president of the United States. However, nor will I stay silent about the threat that partisan extremism poses to our nation. I am not ready to endorse any candidate, but I will continue urging all voters to reject divisive appeals and demanding that candidates offer intelligent, specific and realistic ideas for bridging divides, solving problems, and giving us the honest and capable government we deserve.”

What's the Answer to Political Polarization in the U.S.? (The Atlantic)

From partisan gerrymandering to exclusionary party primaries, a breakdown of the factors behind our polarized politics, and common proposals to fix it in a Jeopardy-style Q&A.

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03.09 Expanding Diversity in STEM Education

Wednesday, March 9th, 2016 | Erin Knepler

Earlier this month, I examined a tax-credit initiative designed to support community college graduates in President Obama's FY 2017 budget. In this post, I continue my examination of the higher education proposals in that budget. While the Obama budget has little chance of passing, I enjoy exploring commitments signaled by the budget and believe placing those commitments within the broader context of higher education to be a worthwhile effort.

Photo by Isabelle Saldana

A growing body of research suggests that diversity in groups bolsters their ability to solve problems. Increased diversity on college campuses has the potential to enhance students’ advanced thinking and leadership skills. In the workplace, it can improve innovation and strengthen the bottom line.

Expanding diversity in science, technology, engineering and mathematics (STEM) has been a major focus of President Obama throughout his administration. This commitment is mirrored by the American public, who are convinced that math and science skills are crucial for the future. Strong majorities of Americans say there will be more jobs and college opportunities for students with those skills. It is also mirrored by the efforts of many organizations, including AAAS, which recently focused on the power of mentoring to boost diversity in STEM.

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03.07 In a Thriving New York City, Residents Remain Anxious on Housing Costs

Monday, March 7th, 2016 | Allison Rizzolo

A Public Agenda Event Will Explore Approaches to Housing Affordability in NYC

Even as The New York Times today declared that New York City has "rarely been in better financial shape," residents are deeply anxious about their ability to afford living here.

In a recent Public Agenda/ WNYC survey, residents of the New York metro area ranked the high costs of living and of housing as the two most serious problems where they live.

Eighty-six percent of people living in New York City and surrounding communities say the high cost of living is a serious problem; 80 percent say the high cost of housing is a serious problem.

Residents of the five boroughs are especially worried about these issues, with 93 percent saying the high cost of living and 90 percent saying the high cost of housing are serious problems.

Can we afford to live here? What strategies could we pursue to make housing in our region affordable again? What are the trade-offs of those strategies, and which are residents most likely to embrace?

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03.04 Engaging Ideas - 3/4

Friday, March 4th, 2016 | Public Agenda

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


The Seven Habits of Highly Depolarizing People (The American Interest)

David Blankenhorn, the founder and president of the Institute for American Values, writes: If polarization is all around us, familiar as an old coat, what about its opposite? What would depolarization look and sound like? Would we know it if we saw it, in others or in ourselves? Perhaps most importantly, what are the mental habits that encourage it?

On Super Tuesday We Polarize. On Wednesday We Need To Start Listening to WHY. (Ben Berkowitz on Medium)

The CEO at SeeClickFix writes: In trying to listen to the other side I have only come to one tactic that works: Hear what the other side is saying, but listen to why they are saying it. In the current election cycle this empathy technique leads to a conclusion that we will be fighting each other to satisfy the same need at our core: Safety. Maslow placed Personal security, Financial security, Health and well-being, and Safety net against accidents/illness and their adverse impacts all under the ‘safety’ slice of his primal pyramid. Look at the movements that have fueled Bernie Sanders’ AND Donald Trump’s campaigns and you will find politicians playing on these insecurities in an attempt to divide us.

Nudges Aren’t Enough for Problems Like Retirement Savings (NYTimes)

“The insights from behavioral economics are beautiful from a research perspective,” said Eldar Shafir, a professor of psychology at Princeton who is an expert on decision-making and a leading proponent of the behavioral approach to economics. “But its popularity no doubt comes from a combination of lack of funds and political helplessness.” Given Washington’s political paralysis, it’s no surprise that “nudges” like these are all the rage in the Obama administration, which has brought in some leading behavioral experts.

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