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06.09 Engaging Ideas - 6/9/2017

Friday, June 9th, 2017 | PUBLIC AGENDA




Democracy

Comey Testimony a Prism for Viewing American Politics (New York Times)
For some, the proceedings were seen through the prism of the partisan divide. For others, they were less about Democrats and Republicans than about a dystopian sense that American governance has veered off the rails.

We’re Not in a Civil War, but We Are Drifting Toward Divorce (National Review)
At an increasing rate, Americans separate themselves into culturally and ideologically homogeneous enclaves.

Frank Denton: Is stress taking a toll on democracy? (The Florida Times-Union)
Between the presidential campaign last summer and January, the overall average stress levels of Americans intensified from 4.8 to 5.1 on a scale of 1-10 — the first significant increase in the 10 years of the APA Stress in America survey.


Opportunity/Inequality

It’s not just the money; it’s the instability (Boston Globe)
Everyone’s seen the charts that document yawning income inequalities in the United States. The picture around wealth inequality is worse. But a large and growing number of Americans suffer because of a third gap — between those who enjoy financial stability and those who don’t.

The American dream? Top 20% pulling away from the rest, study finds (The Guardian)
Economics professor Richard Reeves says the upper middle are ‘opportunity hoarding’ – and pulling up the drawbridge behind them.

What happens if you replace every social program with a universal basic income (Vox)
As two big new reports on the impact of basic income show, “how would we fund it” is a massively important question.

Using Mapping to Understand Gentrification, Prevent Displacement (Government Technology)
A number of cities have found mapping to be a powerful tool for observing gentrification trends, allowing them to intervene before low-income residents are seriously affected.


Engagement

For the People: Improving Governments with Technology (Harvard Political Review)
Civic tech is a somewhat nebulous concept. Most people define it only in terms of technology and government.

Can direct democracy reenergize West's disillusioned voters? (Christian Science Monitor)
Innovative activists across Europe and the US are launching experiments to involve people more actively in political life, though with some mixed results.


K-12 Education

Lots of people are excited about career and technical education. But new international research points to a potential downside (Chalkbeat)
Trump’s budget actually cuts CTE funding, but, at least in theory, there’s wide support across the ideological spectrum for helping more students learn career-specific skills in high school. Yet new international research points to a significant downside of such programs.

New study shows school reform efforts didn't pay off in Michigan (Michigan Radio)
A school reform plan implemented in Michigan in 2012 didn't actually improve schools. That’s according to a new working paper published this week by the National Bureau of Economic Research.


Higher Education & Workforce Development

First-Gen Faculty (Inside Higher Ed)
University of California plan forges connections between students and professors who were the first in their families to attend a four-year institution.

College grads face next hurdle: Paying back student loans (Washington Post)
After all their hard work, the college class of 2017 is finally enjoying the real world and all its “perks,” including having to pay back their student loans.

The High Price of Not Completing College in Four Years (Wall Street Journal)
How can you save over $20,000 on college costs? Graduate on time. At four-year schools, only about 40% of full-time students graduate on time, according to the National Center for Education Statistics, part of the U.S. Department of Education.

IBM is Partnering With More Community Colleges to Train Tech Workers (Fortune)
IBM announced Wednesday that it is expanding its partnerships with community colleges in an effort to train more workers for what the company describes as "new collar jobs"—skilled positions in fast growing tech fields that don't necessarily require a traditional four-year degree.


Health Care

Worried sick about your health care? You’re not alone (Bankrate)
While politicians battle over whether to dump Obamacare in favor of a “Trumpcare” replacement, the country is in the grips of a bad case of health care insecurity.

Is value-based care making a difference? (Healthcare Dive)
Early results on value-based payment initiatives show mixed results, but that may improve with time.

Teaching Hospitals Cost More, but Could Save Your Life (New York Times)
Perhaps not evident to many patients, there are two kinds of hospitals — teaching and nonteaching — and a raging debate about which is better.

Comment

06.02 Engaging Ideas - 6/2/2017

Friday, June 2nd, 2017 | PUBLIC AGENDA




Democracy

How Twitter Is Being Gamed to Feed Misinformation (The New York Times)
Twitter’s design also promotes a slavish devotion to metrics: Every tweet comes with a counter of Likes and Retweets, and users come to internalize these metrics as proxies for real-world popularity. Yet these metrics can be gamed. Because a single Twitter user can create lots of accounts and run them all in a coordinated way, Twitter lets relatively small groups masquerade as far larger ones. If Facebook’s primary danger is its dissemination of fake stories, then Twitter’s is a ginning up of fake people.

We, the people, must demand civility from our politicians (The Hill)
We all know that the bitter, vicious turn politics has taken isn’t going to change until we demand it. Reasoned discussion, which can occasionally lead to raised voices, is part of living in a democracy. But we must hold the people seeking our votes to the highest of standards and make them act like the leaders they claim to be or refuse them the job they seek by not giving them our votes.

Election blind dates: John Whittingdale and Jess Phillips (BBC)
An experiment in the UK: What happens when two strong-minded individuals from opposite sides of the political debate sit down for dinner?


Engagement

Can Talking to a Stranger Change Your Life? (NBC News)
A new project connects strangers from all over the world in one-on-one video conversations about their lives and perspectives.

What If Politicians Studied the Social Fabric Like Economists Studied GDP? (The Atlantic)
One of Washington’s most conservative legislators on an age of polarization, inequality, and fragmentation.


K-12 Education

The Political Classroom: Evidence and Ethics in Democratic Education (Spencer Foundation)
In their book, Diana Hess and Paula McAvoy argue that schools are, and ought to be, political sites — places that engage students in deliberations about questions that ask, "How should we live together?"

Education Today (RealClearEducation Newsletter)
As a new and highly consequential case moves toward the Supreme Court, teachers' unions are bracing for some dramatic changes. Mike Antonucci of The 74 examines how teachers' unions are preparing to lose thousands of members. And if you want to get into the weeds of ESSA, Matthew Di Carlo takes a deep dive into how states can improve accountability measurements in their ESSA implementation plans.

Our Schools Have an Equity Problem. What Should We Do About It? (Education Week)
Just as our federal education laws have changed and evolved, so too have our nation's demographics. It is significant that the federal role is downsized just as economic inequality is at its highest and mobility from poverty is at its lowest since the ESEA was enacted.

A Bipartisan Approach to School Funding Boosts Equity (Education Week)
When Nevada's Republican governor, Brian Sandoval, was re-elected in 2014, the GOP won majorities in both houses of the legislature for the first time in 85 years. In 2015, the governor bucked party orthodoxy and crossed the political divide to broaden the tax base and fund his education initiatives. These initiatives include boosting early education and attending to the state's depleted teacher ranks. As a result, funding for specific pre-K-12 programs will more than double, to $1.3 billion, during his eight-year tenure, which ends in 2019.


Higher Education & Workforce Development

On Second Thought: U.S. Adults Reflect on Their Education Decisions (Gallup-Strada Education Network)
This report -- the first of a three-year series that will explore individuals' perceptions of their education paths -- provides initial insights and sets a foundation to help students most effectively and efficiently achieve their economic and personal goals. This first look focuses on three key questions asked of U.S. adults who previously enrolled in or completed postsecondary education or training.

The Case for Community College (Time)
Without a particular career in mind, Anderson enrolled at Lake Area Technical Institute (LATI) in Watertown, S.D., a relatively inexpensive two-year college 30 minutes from his home. There, his classrooms were hangar-size spaces filled with wind turbines, solar panels, ethanol distillers and miniature hydroelectric dams. It seemed more like his dad's garage, where Anderson would spend hours tinkering with his 1971 Chevrolet pickup truck, than a place to learn math. But trigonometry began making sense when you used it to fit together piping systems. Basic computer code seemed worth learning when you could program an assembly-line robot.

Mass. Gov and Boston Mayor Announce Tuition-Free College Pilot Program (AP)
In an era of increased political polarization, here's a noteworthy story out of Massachusetts: Republican Governor Charlie Baker and Marty Walsh, the Democratic Mayor of Boston, have joined together to launch a tuition-free college program for low-income students in Boston. The Boston Bridge program will commence for 2017 high school graduates. To qualify, students must meet the federal Pell Grant income standards and then enroll full time at Bunker Hill Community College, Roxbury Community College or Mass Bay Community College. According to the AP, "The students will be required to complete their associates’ degrees within two and a half years before transferring to state public colleges or state universities."

College Access Index Shows Shrinking Levels of Economic Diversity (NPR)
NPR's Robert Siegel speaks with New York Times columnist David Leonhardt about how this year's college access index shows that economic diversity is shrinking at American colleges.


Health Care

Few Clinicians Accurately Estimate Costs of Emergency Care (American Journal of Managed Care)
Healthcare professionals working in the emergency department may be unaware of the costs of the care they deliver, according to a new study that asked clinicians to guess the cost of 3 hypothetical visits.

Comment

06.01 Student Voices: Leaving College, Concerns About Going Back and What to Look for in the Future

Thursday, June 1st, 2017 | Megan Rose Donovan



As college graduates are congratulated and "Pomp and Circumstance" ushers them into the work world, we notice that some faces are missing from the class. Who is not donning a cap and gown this spring? Many more students than you think, and they don't fit a particular mold. Those inside the so-called traditional mold of an 18 year-old who is financially dependent on their parents and attending college full time account for as few as 16% of college students today.

Adults looking to attend college account for about a third of first-time college students in the U.S. This new traditional student doesn't live in an on-campus dorm, attend classes in person 5 days a week and graduate in 4 years. Many are older and juggle families, jobs and school, among other responsibilities. They have a long and winding road ahead before they can step on stage, shake the dean's hand and collect a diploma.

We spoke with new traditional students to understand why they left college, what concerns they have about returning, and what they're now looking for in a school. These one-minute illustrative videos below were shot as part of a larger project to better understand the needs and aspirations of new traditional students with support from The Kresge Foundation.


Why I Left College

“I wanted to get my associates, and then my bachelor’s, and, you know, then go get my masters. I even wanted to get my Ph.D. My dad wanted me to help him with his business so I ended up basically slowly taking two classes per semester, one class twice a week, and then eventually I just stopped.”

– Jennifer, 31


My Concerns About Returning to College

“I am very scared of going back to college because I am a single mother. You know, I still have to work. But my biggest fear is starting it and all of a sudden, something else happens.”

– Lashanti, 32

“What I worry about is being able to succeed and fully finish it, and also, learn.”

– Christopher, 53


What I Look For in a School

“I want to know how soon did they obtain the job, where did they obtain the job, did they choose to drop out of the job market? I think the statistics really need to be a little more detailed.”

– Samuel, 39


Helping these adult prospective students be successful requires the coordination and collaboration of higher education institutions, policymakers, businesses and the broader community. We’re working on this issue so that clear and defined pathways exist from high school onto college and the workforce. Use our community engagement resources and discussion starters, particularly the “Success is What Counts” guide to effective community engagement practices, to better understand these issues in higher education and help enact reform that can lead to greater student success.

Comment

05.26 Engaging Ideas - 5/26/2017

Friday, May 26th, 2017 | PUBLIC AGENDA




Democracy

Civic Resilience Beyond the Beltway (New America)
James Fallows, national correspondent for The Atlantic, described in human terms the local resilience that he has witnessed in his travels and research for his American Futures project. What he saw was a sense that people all across the country feel that their city is doing better than the rest of America—that despite the forces of globalization, digitization, growing inequality, and civic disconnection that contribute to a brittle relationship at the national level, their place is still coming together to solve problems. The unifying factor across the cities he has visited is the sense of agency people feel in the face of a changing world. Fallows’ observations weren’t a one-off, though.

Bipartisanship? It may be possible thanks to this little-known group (The Hill)
The work of a little-known and geeky-sounding federal commission may hold the key to more effective policymaking and a renewed culture of bipartisanship in a badly divided Congress.

Fed-Up Republicans, Dems Form New Centrist Party in Utah (Newsmax)
Utah Republicans and Democrats disgusted with the "extremism" of the two major political parties have launched a centrist alternative called the United Utah Party.

What Tom MacArthur learned after getting roughed up at a town hall (Washington Examiner)
For five hours, MacArthur fielded questions (and lectures) from a mostly hostile crowd angry with him for supporting a bill that would partially repeal Obamacare.


Opportunity/Inequality

Employees look to employers for financial stability (Employee Benefit News)
As the American dream of financial security continues to slip out of reach for many U.S. workers, employers — seen as trusted partners by employees — will need to step up to restore faith in retirement readiness.

The Unfreeing of American Workers (New York Times)
Paul Krugman writes: America is an open society, in which everyone is free to make his or her own choices about where to work and how to live. Everyone, that is, except the 30 million workers now covered by noncompete agreements, who may find themselves all but unemployable if they quit their current jobs; the 52 million Americans with pre-existing conditions who will be effectively unable to buy individual health insurance, and hence stuck with their current employers, if the Freedom Caucus gets its way; and the millions of Americans burdened down by heavy student and other debt.


Engagement

8 Ways to Get a Difficult Conversation Back on Track (Harvard Business Review)
Despite our best intentions, conversations can frequently veer into difficult territory, producing frustration, resentment, and wasted time and effort. Take David, one of my coaching clients. Recently appointed to a business school leadership role, he was eager to advance his strategic agenda. Doing so required building his team members’ commitment to and sense of ownership over the proposed changes.

UTSA researcher examines how city governments use Facebook to engage citizens (UTSA Today)
Social media can help boost citizens' voluntary participation and involvement in local government, according to Chris Reddick, chair of the Department of Public Administration at The University of Texas at San Antonio (UTSA).


K-12 Education

Why Did The Top Student Aid Official Under Betsy DeVos Resign? (NPR)
Conscience or incompetence? Two competing narratives — along partisan lines — have emerged to explain the sudden departure of the head of the Federal Student Aid Office.

Research Groups Plan Advocacy Path (Education Week)
The White House budget proposal for fiscal 2018 would keep spending roughly the same for most of the Education Department's research arm, the Institute for Education Sciences, but it would deliver cuts to several major education and child development research areas in the National Science Foundation and National Institutes of Health.

We Need More STEM Teachers; Higher Ed. Can Help (Education Week)
Four recommendations for sending more STEM majors into teaching. The first: Conversations about teaching—between STEM majors (who are not enrolled in teaching-prep programs) and their professors—can change the status quo. In other words, those in higher education are in a position to make a difference, just by encouraging this dialogue. And yet, there is evidence that many university and college professors, particularly in the STEM fields, do not discuss the option of middle and high school teaching with their students.

The Little-Known Statistician Who Taught Us to Measure Teachers (The Upshot)
William Sanders’s data-driven method of evaluating the effectiveness of teachers was a once-revolutionary idea that has gained wide acceptance.

Why It's So Hard To Know Whether School Choice Is Working (NPR)
Students are never randomly assigned to a school. A school's population is always affected by local demographics. With schools of choice, by definition, parents and students are making a decision to attend that school, so their enrollment is even less random. It's hard to know how schools of choice — charter or private — are performing. Researchers say that's precisely because they are schools of choice. But here's what we do know.


Higher Education & Workforce Development

The Assault on Colleges — and the American Dream (New York Times)
Over the last several years most states have cut their spending on higher education, some drastically. Many public universities have responded by enrolling fewer poor and middle-class students — and replacing them with affluent students who can afford the tuition. The situation is particularly demoralizing because it’s happening even as politicians from both parties spend more time trumpeting their supposedly deep concern for the American dream.

Study Examines Health Care Access, Quality, Ranks Nations; U.S. Scores Low Given Expenditures, Study Author Says (New York Times)
Over the last 25 years, China, Ethiopia, the Maldive Islands, Peru, South Korea, and Turkey had the greatest improvements in "deaths avoidable through health care at their economic level," a complex but intriguing new measure of global mortality described last week in the Lancet. By that standard, the United States improved slightly over the same period, 1990 to 2015. But the American ranking is still so low that it’s "an embarrassment, especially considering the U.S. spends $9,000 per person on health care annually," said the report’s chief author, Dr. Christopher J. L. Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation.

An Affordable Pathway to a Bachelor's Degree (Inside Higher Ed)
Despite the frequent loss of credits, transferring from a community college to a university is less expensive than starting at a four-year institution, a new study finds. “The bottom line is if you complete, it’s cheaper to go to the community college,” said Clive Belfield, a professor of economics at Queens College of the City University of New York system, who co-authored the paper. “Students lose a lot of credits, maybe 10 to 15 credits, and that’s a whole semester, but it doesn't change the calculation.”


Health Care

A Bipartisan Way To Improve Medical Care (New Yorker)
A straightforward change would save money and improve health. So why isn’t Congress talking about it?

Measuring Value Based On What Matters To Patients: A New Value Assessment Framework (Health Affairs Blog)
As health care spending continues to grow and as we appropriately drive the health care system toward a payment system that rewards value instead of volume, it is imperative that we promote conversations on how to define value. To do this, it is critical that we first answer the question: value to whom?

We should research our health care at least as well as our cars (Baltimore Sun)
As consumers, we spend more time researching television, vacation and vehicle purchases than making health care spending decisions.

Comment

05.19 Engaging Ideas - 5/19/2017

Friday, May 19th, 2017 | PUBLIC AGENDA




Democracy

Partisan politics in the age of Trump? These N.J. Republicans work with Democrats (NJ.com)
"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.


Opportunity/Inequality

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.


Engagement

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.

Comment (1)

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

Wednesday, May 17th, 2017 | REBECCA SILLIMAN



Originally published on health.oliverwyman.com (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.

Comment

05.12 Engaging Ideas - 5/12/2017

Friday, May 12th, 2017 | PUBLIC AGENDA




Democracy

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.


Opportunity/Inequality

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.


Engagement

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 Give.org, 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?

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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.

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05.05 Engaging Ideas - 5/5/2017

Friday, May 5th, 2017 | PUBLIC AGENDA




Democracy

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.


Opportunity

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

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.


Engagement

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.

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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.

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