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04.24 The Need For Public Engagement On Health Care

Thursday, April 24th, 2014 | Megan Rose Donovan

How much do average Americans care about public issues like health care?

According to the Kaiser Family Foundation’s index, less than half of Americans were closely following news coverage of Affordable Care Act enrollment - a surprising figure given its headline dominance.

That number looks even starker compared to the more than three-quarters of Americans that said they "very" or "fairly closely" followed coverage of the missing Malaysia Airlines flight.

These numbers alone don't reveal why so many of us seem disinterested in following health care policy, though in many ways the disinterest is understandable. At the same time, we believe there is immense potential to ignite meaningful public conversation about solutions on out-of-control health care spending.

One reason for the public's lack of interest may be our lack of agency when it comes to health care policy. As our co-founder Daniel Yankelovich wrote, “From the perspective of experts, the public has nothing to contribute to strategic policy thinking and has been effectively left out of the conversation.”

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04.17 The Common Core - Why Isn't Public Support More Robust?

Thursday, April 17th, 2014 | JEAN JOHNSON

Bill Gates and the U.S. Army back it, along with a whole slew of educational associations, business leaders and think tanks. And despite the partisanship we often see in politics today, the development and adoption of the new, voluntary Common Core learning standards in literacy and math got off to an amazing start. Set in motion in 2009 by an alliance of Republican and Democratic governors, Common Core standards were quickly adopted by 45 states and the District of Columbia.

Cyrus McCrimmon/ Denver Post/ Getty Images

So how did an idea that started off with such impressive support become so controversial?

A wide range of critics, including some parents, teachers, education experts, Tea Party activists and liberal groups have begun pushing back against the Common Core — or at least the way it’s being implemented. One state, Indiana, has already dropped the standards, and other states are considering doing so as well.

In surveys, most people seem open to the general idea of national standards and guidelines for learning. A 2010 study from Public Agenda showed that about 8 in 10 parents see having national standards in math and science as helpful. A new survey from the education reform group Achieve shows that 69 percent of voters support implementation of Common Core when presented with a description of it. And support is even stronger among African-Americans, Hispanics, and "public school moms."

But the Achieve study also exposes a fault line. Just 16 percent of voters have read or heard "a lot" about the Common Core; and, among those who have, about 4 in 10 oppose it. Analysts at Achieve say the growing controversy is "leaving a more negative 'impression' among voters." Surveys from Education Next-Harvard PEPG showed that the percent of people opposed to the Core nearly doubled between 2012 and 2013.

A closer look at public and parent thinking suggests some additional reasons why the Common Core hasn’t been attracting more robust support. Consider:

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04.07 How Dialogue is Helping Transfer Students

Monday, April 7th, 2014 | Megan Rose Donovan

Earlier this semester, a group of transfer students gathered in room 3-190 at Baruch College to read and discuss approaches to creating, consuming and conserving energy sources. First, students read through a Choicework discussion guide, which outlined the debates about energy production and consumption. Then, they immediately dove into a lively conversation about their visions to address energy issues in the future.

These group discussions are part of a semester-long seminar to help transfer students acclimate to student life at Baruch. Over the course of ten weeks, students come together to discuss their transition and receive support and advice on the many facets of college life. They also spend six sessions sharing their perspectives with fellow students about three social issues that may hit close to home: jobs and the economy, immigration and energy. Their discussions are framed with tailored versions of our Citizens' Solutions Guides.

We've heard about and been troubled by the hurdles college students face when continuing their education at a new institution. The sessions at Baruch are part of an effort to see how group dialogue on politicized social issues can help transfer students build community while also conveying the mission of their new institution. What we’ve seen so far is more than just acclimatization – it’s collaborative problem solving and community building.

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04.01 Research Team Expands at Public Agenda

Tuesday, April 1st, 2014 | Allison Rizzolo

We'd like to extend a warm welcome to the newest, and cutest, member of the Public Agenda team: Franka Valentina Gastelo. Franka is the first child for Carolin Hagelskamp, our director of research, and her husband Francisco. Weighing in at 8 pounds, Franka was born February 24th.

Carolin, Francisco and Franka are all healthy and happy. Congratulations to all!


03.21 Not All Students Are Becoming Savvier Shoppers

Friday, March 21st, 2014 | Carolin Hagelskamp, Ph.D.

Reprinted from The Chronicle of Higher Education - March 20, 2014

This year’s Freshman Survey from the Cooperative Institutional Research Program (“Cost and Financial Aid Increasingly Influence Students’ Choice of College,” The Chronicle, March 6) highlights a startling gap in the way traditional and nontraditional students conduct their college searches.

My organization, Public Agenda, recently surveyed adults between 18 and 55 who don’t have college degrees but who are planning to go back to college. We also spoke to currently enrolled community college and for-profit college students. The experiences of these students are markedly different from those represented in the Freshman Survey—all full-time students at four-year colleges:

  • While most full-time undergraduates at four-year colleges have looked at multiple schools before deciding on where to enroll, most undergraduates in our research were not making any comparisons at all. Just 37 percent of community college students and 39 percent of students at for-profit colleges said they looked at more than one school before enrolling. Moreover, most learn about colleges from family, friends, or from advertising paid for by the college.
  • Even though improving job prospects weighs heavily on the minds of the currently enrolled students we spoke to, few know information about the types of jobs and salaries typical of graduates from their school. Among adult prospective students, few believe that knowing this information would be essential during their college searches.

It may very well be the case that some students are becoming savvier college shoppers, but certainly not all of them. Traditional students—e.g. those who attend school full time at four-year colleges—may be discerning and carefully comparing different schools to inform college choice. But this seems to not be the case among nontraditional students.

As the nontraditional students population steadily grows, and becomes the new traditional, we must make sure these students are not left out in the cold.


03.19 For Better Internet Discourse, "Respect" This

Wednesday, March 19th, 2014 | Allison Rizzolo

With the arrival of spring, we're trying a fresh approach to the way you can interact with our online content.

We believe that engaging with fair-minded perspectives that we may not agree with is good for democracy. This practice helps us break out of a simplistic "for or against" framework toward an issue and come to a rounder comprehension of the issue and approaches to resolving it.

Unfortunately, the civil exchange of opposing perspectives is hard to find on the Internet, where interaction feels like the Wild West. Inherent anonymity doesn't help, and neither does the click-bait game. Conflict, after all, is newsworthy. (This is something we certainly struggle with here!) All of this animosity on the Internet could actually be doing some real damage.

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03.18 What's Missing When We Talk About Regulating Higher Ed

Tuesday, March 18th, 2014 | Allison Rizzolo

Ask a college president or a higher ed policy wonk what they think about for-profit colleges, and they'll likely have a strong opinion. But ask the same of a student who's attending a for-profit college and you'll probably receive a blank stare.

For-profit colleges dominate headlines - not only in education media, but also in mainstream press. One of the reasons for-profits are so newsworthy is because they're controversial.

Not all for-profits are the same. Many innovate quickly, offer skills and training directly applicable to the workforce, and provide the flexibility modern students need. At the same time, many are unscrupulous, leaving students saddled with debt and without a legitimate credential.

The federal government is trying to crack down on these less-scrupulous institutions. Via what's known as the gainful-employment rule, the government will withhold federal financial aid from any career education program (for-profit or not-for-profit) that fails to meet certain criteria. For example, average loan payments should not eat up 8 percent or more of a typical graduate's total earnings.

The gainful-employment conversation is mainly relegated to experts, and is relatively meaningless to many students who remain ignorant about for-profit higher education. Forty-seven percent of current undergraduates at a for-profit college say "nothing comes to mind" when they hear the term "for-profit college." Students at community colleges are also unfamiliar with the term, as are adults without degrees who anticipate returning to college. Furthermore, 65 percent of students enrolled in a for-profit college are unsure if their school is for-profit or not.

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03.11 Do Americans Really Loathe The Federal Government?

Tuesday, March 11th, 2014 | JEAN JOHNSON

What does it mean when fewer than 1 in 5 Americans say they are satisfied with the federal government? Over the last few years, survey researchers have fielded dozens of questions that seem to show the public’s contempt for the federal government.

In a Pew poll last year, just 12 percent of Americans said they were “basically content” with the federal government, while 30 percent were angry about it, and 55 percent were frustrated. Just 19 percent of the public says it trusts the government in Washington to do what is right most of the time. It’s a stunning number. When Presidents Eisenhower and Kennedy were in office, that number was above 70 percent.

But if so many Americans are so dismissive of government, then why were so many of us appalled by the government shutdown last fall? Is this just further proof that Americans will happily indulge in anti-government rhetoric, but that they really like government and what it does for them? Or are there more complex and consequential questions lying beneath the surface—questions that deserve much more careful analysis and discussion?

Here is a quick tour of some of what lies beneath.

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03.07 Joint Ventures Between Communities and Schools

Friday, March 7th, 2014 | Public Agenda

The following is an interview with Carolyn Farrow-Garland, of the Kettering Foundation, about recent research from Public Agenda and Kettering. The research, "Joint Ventures," explores what could happen when communities and schools work together to tackle improving local education.

Carolyn, why did Kettering and Public Agenda take on this project?

For communities where education reform has gotten bogged down, we wanted to offer an idea for a process they could use to spark progress. This project also enables us to highlight how different actors in public education— administrators, teachers, and parents— feel about the accountability trends in education, so that everyone involved in the problem can see other actors' side of it. It’s an outgrowth of research we conducted over the past few years looking at how the public defines “accountability” compared to how experts and professionals generally think about it.

Accountability has been such a strong theme in education reform over the past decade, but we’ve seen key differences in the way leaders and members of the public talk about it. Leaders often focus on holding teachers, principals, and schools accountable for student learning and using test scores as a main way to judge that. Parents and the broader public often bring a broader set of issues to the table, including the idea of holding parents and communities more accountable for children’s learning. Parents interpret accountability as being relational rather than informational, so they want school officials to use communication strategies that help them understand why certain policy changes are implemented.

So our question for this project was: Can education leaders and professionals join with parents and community members to “co-frame” goals for their schools, and what happens when they do?

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02.28 Patients' Views On Reforming The Physician Fee-For-Service Payment System

Friday, February 28th, 2014 | DAVID SCHLEIFER, PH.D.

Reprinted from Health Affairs Blog (February 28th, 2014).

Virtually all serious proposals for health care cost containment include reforming the fee-for-service payment system. Last fall’s bipartisan proposal to fix Medicare’s sustainable growth rate included provisions to reward physicians for providing high-value rather than high-volume care. Ostensibly, realigning physicians’ financial incentives would lead to higher quality, better coordinated, and more appropriate care.

But would patients necessarily be aware that their physicians are being paid differently? And would they even care? A new research report from Public Agenda and the Kettering Foundation suggests that consumers could play a role in advancing payment reform. But in order to work through the trade-offs of changing the system, employers and payers must help members of the public understand that most reimbursement is currently fee-for-service.

Public Agenda asked a total of 44 insured and uninsured Americans, 40 to 64 years old, to deliberate together in focus groups over the pros and cons of several approaches to cost containment. Participants had some recent contact with the health care system as patients but none were seriously ill. They considered payment reform, price transparency, increased consumer cost-sharing, government price-setting, and expanded access to Medicare, among other approaches.

We held the deliberative focus groups in February and March 2013 in Secaucus, New Jersey; Montgomery, Alabama; and Cincinnati, Ohio, as well as a pilot in Stamford, Connecticut. After the groups, we followed up with participants for in-depth interviews. These focus groups do not provide information about how other types of consumers, particularly young people, view different approaches to addressing health care costs.

As we prepared for this research, we spoke with several health system executives, physicians, foundation leaders, and policy researchers who predicted that insured people would be uninterested in cost-containment because their insurance shields them from the true costs of their care. But contrary to their expectations – and consistent with recent findings from the Commonwealth Fund – we found that both insured and uninsured focus group participants were upset about high out-of-pocket costs and angry about administrative complexity. Moreover, participants routinely described physicians as greedy pushers of too many tests and procedures. A New Jersey woman joked that she would “have no blood left” if she submitted to every procedure her physician recommended.

But focus group participants did not know that the current reimbursement system is largely fee-for-service. When we explained this defining feature of the American health care system to them in basic terms, participants said that this helped them understand why they had so often been subject to care that they described as overly aggressive. They also were eager to grapple with how payment reform and other approaches to cost-containment would affect their own care.

Focus group participants saw pros and cons to paying physicians fixed amounts per patient or per episode of care. They thought it would help them better predict their own out-of-pocket expenses and help doctors focus more on patients than on paperwork. They also figured that it would prevent some of the excessive, inappropriate care that so many of them reported experiencing.

But participants also expressed some reservations about payment reform. Many were concerned that physicians would retaliate by skimping on care. As a man in New Jersey said, “I bet you the doctors won’t like it.” An Ohio woman asked, “Are you really giving me the full scope of everything you would if you were charging for every little thing?” Several participants assumed that if reimbursement were based on health outcomes, physicians would discharge people from hospitals prematurely or refuse to treat sicker patients.

Payment reform is not a magic bullet. But in the midst of economists‘ and policymakers‘ debates over projected health care spending growth, the success of payment reform could play a significant role in determining whether or not the current slowdown in growth proves durable. Given the difficulty of dispelling the myth of government death panels, it is reasonable to ask whether it is advisable to engage Americans on cost-containment measures such as payment reform. But in our experience, lack of meaningful citizen engagement on tough policy choices can lead to pushback. As Paul Ginsburg wrote recently, “failing to engage beneficiaries…exposes payment reforms to the risk of political backlash.”

In summary, qualitative focus group research does not provide generalizable data, but this research does provide a detailed picture of how this group of consumers thinks through different options for controlling costs, including payment reform. Our focus group participants were eager to discuss payment reform. They did so with an impressive degree of interest, thoughtfulness and, despite some differences of opinion, civility. Their suspicion that some physicians are motivated by profits indicates that some consumers may be eager to choose providers and insurance plans that embrace value over volume. Helping consumers understand that most physician reimbursement is fee-for-service and making use of their concerns about out-of-pocket spending may help to move payment reform forward.


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