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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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02.18 Only Authentic Community Engagement and Empowerment Can Begin to Restore Flint

Thursday, February 18th, 2016 | WILL FRIEDMAN, PH.D.



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

The Flint crisis is perhaps the worst example of what can go wrong when people have no voice in the decisions that affect their lives: A generation of children faces the irreversible effects of lead poisoning. Nine people are dead. Trust has vanished. Residents saw their rights and dignity violated.

There's no question that Michigan officials failed their citizens. It's an extreme example, but this kind of tragedy is the inevitable result when officials govern without listening to and showing respect for the people they were elected to serve.

To not only address the problem but also to make sure it never happens again, leaders will need to pay as much attention to the health of local democracy as to the immediate health of residents. Restoring trust and democracy will take time, effort and patience on the part of local officials and community members alike.

In the short term, here are five actions officials should take to lay the groundwork on the long road of righting relationships and fixing democracy:

Listen to residents and meet their immediate needs. Make up for past failures. Provide water, as much as they need, when they need it. Replace pipes. Repay water bills. Set up funds to support the health and education of children affected by the crisis. Give residents the space to be angry. And listen to them and respond when they talk about what else they need. In concert with such ameliorating actions, take ownership of bad decisions and apologize.

As you respond to immediate needs, build durable mechanisms for ongoing and authentic public engagement. Transform city council and other public meetings into meaningful opportunities to interact with residents. Use civic tech to gather information and provide people with additional ways to weigh in on decisions. Empower communities through innovative democratic practices like participatory budgeting, and though more traditional ones, like citizen advisory boards.

Provide timely information and practice transparency. From the beginning, the decisions that led to the current crisis have been riddled with opacity and a lack of accountability. Now is the time to be transparent with residents. Give them the information they need, in a timely manner, in ways they can absorb, and continue that practice beyond the current crisis.

Partner with and empower community leaders whom people trust. With faith in official leadership gone, local officials will need to work with community members who ARE trusted. Identify respected leaders and organizations and build those relationships. But be careful to do so in an authentic, transparent way -- the last thing officials want is for the public to distrust by association the motives of local community members.

Pursue activities that slowly but surely rebuild the broken bond. Create opportunities for positive, problem-solving interactions between residents and officials that address real issues. Over time, these smaller efforts may help officials earn back residents' trust. Visit homes and listen. Organize and attend recreational activities for area children. Deliver meals to elderly or disabled residents. Do well on a million small acts of governance that build the social capital and know-how to tackle bigger and tougher challenges down the line.

Such measures can lead to a Flint where residents have true ownership in decisions that affect their lives and where officials consult with residents as partners in formulating and implementing solutions. What's done is done, but officials and other leaders must do all they can to make sure that this never happens again. They can best do so by taking democracy to heart and pursuing it with passion.

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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!



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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 CABRAL




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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02.05 Engaging Ideas 2/5

Friday, February 5th, 2016 | Public Agenda



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

Democracy

How Citizens Can Have a Genuine Voice in Policymaking (Governing)

There's a lot that our governments could do beyond giving people three minutes at a public-hearing podium.

Effective Civic Engagement Requires Balanced Viable Plan and Intentionality (Politics 365)

Evidence based civic engagement is a fairly nascent field. In fact, up until 20 years ago, what people now think of as civic engagement for “people of color” was characterized naively as just minority outreach. Therefore, it’s no wonder that many organizations and efforts struggle to identify what an effective civic engagement plan is and by what method to execute one successfully. First, it’s tough to pinpoint a distinct all-encompassing explanation of what civic engagement is. Second, it’s equally as difficult to find an all-inclusive formula for putting together a viable program. Lastly, the moment an approach is successful it’s dismissed as predictable or characterized as a chance occurrence so we can’t learn anything new from those experiences.

Democracy Reinvented: Participatory Budgeting and Civic Innovation in America (Brookings)

Democracy Reinvented is the first comprehensive academic treatment of participatory budgeting in the United States, situating it within a broader trend of civic technology and innovation. The book places participatory budgeting within the larger discussion of the health of U.S. democracy and focuses on the enabling political and institutional conditions. Author and former White House policy adviser Hollie Russon Gilman presents theoretical insights, in-depth case studies, and interviews to offer a compelling alternative to the current citizen disaffection and mistrust of government. She offers policy recommendations on how to tap online tools and other technological and civic innovations to promote more inclusive governance. While most literature tends to focus on institutional changes without solutions, this book suggests practical ways to empower citizens to become change agents and also includes a discussion on the challenges and opportunities that come with using digital tools to re-engage citizens in governance.


Polling and the Election

Did the Iowa Caucus Results Discredit Polls? (The Brian Lehrer Show)

President Will Friedman chatted with Brian and Harry Enten, senior political writer and analyst for FiveThirtyEight, and asked whether polling is a meaningful and useful tool in democracy.


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02.02 To Revive the American Dream, Work Locally, Work Smart, Work Together

Tuesday, February 2nd, 2016 | WILL FRIEDMAN, PH.D.



"The middle class is trying—we’re trying to grab and trying to hold on, but it’s hard…The last 20 years we’ve been going sideways. You’re not getting ahead. You’re just going sideways. You’re just trying to keep your head above water."
- Focus group participant, Secaucus, NJ, December 2015


For an increasing number of Americans, disappearing opportunity is a source of anxiety and frustration. They feel unable to find a foothold in the economy and, over time, better their lot in life. They talk about how unaffordable the essentials of middle-class life have become, the eroding American Dream, the stubbornness of poverty, the unfairness of the forces that ensnare people in it, and the growing gap between the wealthy and everyone else.

We've seen this anxiety expressed in our research. In a national survey, 43 percent of Americans told us that "even people with a strong work ethic and good values are becoming increasingly shut out from the American Dream." In a survey with residents of the New York region from last year, just 16 percent said opportunities to get ahead are improving.

People are worried for good reason. Wages for most Americans have been stagnant for decades. Stable, middle-class jobs are becoming a thing of the past. Whereas expanding opportunity creates pathways out of poverty, supports strong communities, moderates inequality, and forges the economic and social foundation upon which democracy can flourish, diminishing and unequal opportunity is a blight on the American Dream and a danger to democracy. In Dan Yankelovich’s words:


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