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01.04 Turning the Clock Back Isn't Enough: The Nasty Surprise Awaiting the GOP on Health Care and the Deficit

Tuesday, January 4th, 2011 | Scott Bittle and JEAN JOHNSON

Reprinted from the Healthcare Blog

The Republicans who will take control of the House this January have made it clear there are two things they hate: deficits and President Obama’s healthcare reform. They’ve promised to reduce the first and repeal (or at least hobble) the second. But if you’re worried about deficits, repealing the Obama plan won’t do any good unless you’ve got a better idea. In fact, the numbers say repealing it could make the government’s budget problems worse.

Despite the outrage over spending on the Wall Street bailout, the stimulus or the Iraq war, at least these costs are temporary. But the combination of an aging population and health costs that keep rising faster than inflation means that spending on Medicare, Medicaid and Social Security are going up – - and they’ll keep going up for years on end. With an aging population, there will be more older people eligible for these programs. The health care they need will cost more on top of it.

When people argue about the costs of an aging America, they often lump Social Security and Medicare together like they were the identical twins of public policy. If they are twins, they’re more like the 1980s movie Twins, featuring Arnold Schwarzenegger and Danny DeVito as the world’s most improbable pair of brothers. Maybe you remember the iconic movie poster. It shows the two dressed alike, but with an enormous Schwarzenegger looming over DeVito. In the budget world, Medicare and Social Security are both problems, but Medicare is definitely played by Arnold. Here’s why.

Health care spending has been rising faster than the inflation rate for decades. In 2007, the Consumer Price Index went up 2.8 percent, and health spending went up 6 percent. In 1997 inflation went up 2.3 percent, and health spending went up 5.4 percent. In 1990, when inflation was 5.4 percent, health spending climbed nearly 11 percent.

That’s why Medicare is the real budget buster. The Government Accountability Office likes to explain the budget problem by talking about the $56 trillion in “unfunded liabilities,” the country faces over the next few decades, commitments the government has made to provide Social Security and Medicare for people paying into these programs now. About $34 trillion of that is Medicare alone.

That’s a mind-boggling number. You could throw out the $700 billion Wall Street bailout, the $787 billion stimulus package, the more than $1 trillion spent on Iraq and Afghanistan, even the $4 trillion the government will take in if we let the Bush tax cuts expire, and in the long term, we’ll still be in trouble if Medicare stays as it is now.

That means – and so few people in politics will say it flat out –that the government will go broke if it doesn’t either change Medicare or the broader health care system to control costs. That was true before the Obama plan was ever passed.

And after? Yes, the Obama plan costs more than $800 billion over the next decade to expand coverage and implement other changes. But the nonpartisan Congressional Budget Office says because the plan reduces Medicare spending, it will trim the deficit slightly over the next decade ($143 billion by 2019) and by $1 trillion or more after that. Plus, the Medicare trustees say the changes in the bill extend the life of Medicare’s trust fund by 12 years, to 2029, which is significant.

How can that be? Well, the Obama plan cuts what Medicare pays to doctors and hospitals down the line, raises some fees and taxes, and pays for research on ways to provide health care more cost-effectively. The projections depend on Congress following through on these changes planned in the law. If it doesn’t, there obviously won’t be any savings. What’s more, the projections assume the law actually succeeds in making the health care system more efficient, such as through new research into the best ways of providing care. If that doesn’t work – - and critics, including Medicare’s own actuary, are skeptical – - Medicare will cost more than projected.

So if we just repeal the Obama plan, and don’t find another way to cut Medicare’s costs, we’re back where we started: on our way to national bankruptcy. The same is true if Republicans go through with their plan to block the various provisions in the law. Given the way Washington often works, it would be easy – - all too easy – - for Congress to jettison the unpopular cost-cutting provisions of the Obama plan and keep the expensive (but more popular) parts that will expand and improve coverage.

In today’s hyperpartisan political climate, too many people believe it’s enough to block the other guy’s plan. That counts as a victory. But the truth is the status quo is not an option. And it’s not at all clear that the Republican ideas on health care, such as a voucher system for Medicare or eliminating the tax breaks to employers to provide insurance, are going to be any more popular with the public than the Democratic plan or do any more to reduce costs. The Republicans have mostly ridden the wave of “not this.” They haven’t done the hard work of preparing the public for “what now?” But “what now” on health care is the question that really matters on the budget. If we don’t answer it, a lot of the other ideas might turn out to be Band-Aids.

Scott Bittle, author of “Where Does the Money Go? Rev Ed: Your Guided Tour to the Federal Budget Crisis,” is the executive editor of Public Agenda Online and has won two Golden Quill awards for feature articles and was honored by the Philadelphia Press Association for daily newspaper writing.

Jean Johnson, co-author of “Where Does the Money Go? Rev Ed: Your Guided Tour to the Federal Budget Crisis,” is the Executive Vice President of Public Agenda, Jean Johnson has more then 20 years of experience understanding public attitudes on a broad range of issues. She has also written for various publications such as USA Today, Education Week, and the National Institute of Justice Journal.

For more information please visit and follow the authors on Facebook and Twitter.


12.22 Lessons From The Movies, About Making Choices

Wednesday, December 22nd, 2010 | Scott Bittle


12.22 Tackling The Tough Issues - With Your Help

Wednesday, December 22nd, 2010 | Scott Bittle

It's been a tumultuous year for the country: economic hardship, political change, and a full slate of pressing problems that seem more intractable than ever. The challenges facing the nation have never been greater, and neither has the need to engage citizens in shaping their own future.

Public Agenda has been working all year to address that need, producing groundbreaking opinion research and citizen engagement programs around major domestic policy issues. Through those initiatives, and on the web and through social media, we've helped to educate and empower citizens by helping them consider the challenges facing our nation, including:

  • Insightful Research on Why Too Many Young People Don't Finish College: With Their Whole Lives Ahead of Them and Can I Get A Little Advice Here?, funded by the Bill & Melinda Gates Foundation, probe the reasons behind sometimes-surprising barriers young people face in getting a postsecondary diploma.

  • Engaging Communities to Improve Lagging High School Graduation Rates With funding from the W.K. Kellogg Foundation, Public Agenda supported the Carlsbad, New Mexico School District in its efforts to engage local parents, students and educators in increasing high school completion rates. We provided technical assistance and training for a local "Graduation Summit."

  • Survey On Math & Science Education in America Our study done with the support of the GE Foundation, in which we asked parents and the general public how well the schools are getting the job done, continues to be cited on a regular basis by educators and others concerned about the U.S. maintaining a competitive position in the world.

  • Bridging the Gap between Leaders and the Public on Climate, Energy and Science Through presentations to scientists, like this one made by Public Agenda co-founder Dan Yankelovich at the American Association for the Advancement of Science; books, and blog posts, we've encouraged some of the world's most prominent scientists to change the usual - and largely ineffective - model used to engage with the public on issues like climate change.

  • Helping the Public Make Fiscal Choices In the Choosing Our Fiscal Future initiative, in partnership with the National Academy of Public Administration, with support from the John D. and Catherine T. MacArthur Foundation, we work to help citizens think through the options for dealing with our rising national debt.

As a subscriber of Public Agenda's Alert, we hope you will contribute to ensuring that Public Agenda will continue to meet these central goals in 2011. We greatly appreciate contributions of any size from people like you who help make our work possible. To make a secure, online donation, click here.

Or, if you prefer, you can also make a donation by mail: Public Agenda, 6 East 39th St., Floor 9, New York, N.Y. 10016, or by phone: contact Alex Trilling at 212-686-6610 ext. 20.

Thank you for your support of our work.


12.09 Sputnik Moments, And Getting Above Average

Thursday, December 9th, 2010 | Scott Bittle

So what does a "Sputnik moment" look like? And does it mean the same thing to the public as it does to our leaders?

The usual definition is that it's a moment when the United States has been bested in technological competition – something that gives the American public a kick in the pants to move forward. That's what happened during the original Sputnik moment in the 1950s, when the Soviet Union was first to put a satellite into orbit, and the first American attempt to do the same turned out to be a humiliating, televised, flop.

President Obama and others say the latest international education scores should serve as another Sputnik moment. Students from Shanghai, China, in their first appearance in the standings, came out first in the world in science, while American students improved to the point where their scores are now "average." Leaders in business, science and academia have been beating the drum on science and math education for years now, warning that the U.S. risks losing its edge and falling behind on innovation.

And that may be the heart of the problem. Public Agenda's Are We Beginning to See the Light research, funded by the GE Foundation, found that both parents and the general public think math and science education is important, but they don't share leaders' sense of urgency.

Overwhelming majorities of Americans say that in the future there'll be a lot more jobs requiring advanced math and science skills, and that students with those skills will have a big advantage in getting into college. Majorities are also open to a lot of different ways of improving math and science in schools.

At the same time, few Americans think it is "absolutely essential" for students to understand advanced sciences like physics (28%) and advanced math like calculus (26%). When it comes to their own child, few parents want more emphasis on advanced math and science like physics (42%) and calculus (42%). Additionally, nearly 7 in 10 Americans say science can wait until middle and high school.

And that's on the heels of a long series of reports showing American students falling behind.

So if our Sputnik moments fall flat, how do we get the public engaged in this challenge? In our Opportunity Knocks report, we found one way is to talk about opportunities: ways in which learning more math and science can build better careers and better lives for young people.

It's not as dramatic as a rocket exploding on the launch pad – but it may be more effective. After all, parents may be a lot more concerned about whether their own child has a good career ahead than about whether their child outscores another child half a world away.





11.23 Are the Debt Reduction Stars Aligned?

Tuesday, November 23rd, 2010 | Francie Grace

Is Washington really ready to act on our fiscal problems? On Nov. 30, The National Academy of Public Administration invites you to a panel discussion on the findings from Public Agenda's latest update to its "The Buck Stops Where?" survey, which measures the attitudes of Washington policymakers and "beltway influencers" on the issue of the national debt.

Panelists include Bill Hoagland, vice president of public policy and government affairs at at CIGNA and former staff director of the U.S. Senate Budget Committee; Norm Ornstein, resident scholar at the American Enterprise Institute; Ruth Wooden, president of Public Agenda and a member of the Committee on the Fiscal Future of the United States; and moderator Martha Kumar, professor of the Department of Political Science, Towson University. It's free and you can RSVP at this link.


11.17 Training The Teachers

Wednesday, November 17th, 2010 | Scott Bittle

A major new report this week calls for turning teacher-education programs "upside down," inspired by medical schools, to focus more on "clinical" experience in the classroom. Eight states have already agreed to adopt the recommendations from the panel, set up by the National Council for the Accreditation of Teacher Education.

But what do new teachers themselves think about how well they're prepared for that first day of school? Based on research by Public Agenda and Learning Point Associates, there may be a major gap between the way reformers and teachers see teacher education. Our survey of first-year teachers showed that most feel they're well prepared for the classroom – but there's a significant difference depending on the kind of classroom they face.

In our Lessons Learned series of surveys of new teachers, eight in 10 said they felt "very prepared" (42 percent) or at least "somewhat prepared" for the classroom. Almost all said their coursework included classes on children's development, and roughly half said those courses helped "a lot" in the classroom. Nearly seven in 10 said their training in direct instruction helped "a lot."

Where their training failed them most, however, was in dealing with ethnically and racially diverse classrooms. Only 39 percent of new teachers thought their training helped "a lot" there. (One of the recommendations is more structured training in diverse settings).

There's also a notable difference between elementary and secondary teachers. More than half of high school and middle school teachers (53 percent) say their training was too theoretical, compared to just 4 in 10 elementary teachers. High school and middle school teachers were also less confident their students were responding to their efforts.

So as we overhaul teacher training to focus more on the classroom, there may need to be more dialogue with teachers on the need for change and new approaches and more thinking from experts on how to help teachers be effective in the classroom situations they find most challenging.

To learn more about the issues in education reform, check out our studies on the issue and our Education Insights section.


11.11 Zeroing In On The Achievement Gap

Thursday, November 11th, 2010 | Scott Bittle

The achievement gap between black and white students is one of the most persistent, troubling problems in American education, with a new report out this week calling it a "national catastrophe." Public Agenda's research shows some insights into what black and Hispanic students see happening in their schools – and how that might impact the gap.

The Council of the Great City Schools report released this week said "young black males are in a state of crisis" on many different educational fronts, including readiness to learn, reading and math skills, and being prepared for college or a career. The group, representing large urban school systems, called for a White House conference on the problem and a national plan of action.

Public Agenda has done a lot of opinion research on education, and one of the most striking findings on this problem came from our series of Reality Check surveys. When we asked parents and students several years ago about their experiences in school, we found black and Hispanic families were more likely than whites to report serious problems in their schools. In fact, if an adult were forced to work under such conditions it might be considered a hostile work environment.

For example, three in 10 black youngsters reported "very serious" levels of disruption and unrest in their schools – not just "somewhat serious," but "very serious." Black students are twice as likely as white students to say that the schools not getting enough money is a very serious problem in their community. Nearly a third of black and Hispanic youngsters say that "only some" or "very few" of their teachers give students extra help when they fall behind, compared with one in five white students.

It isn't just students, either. Minority parents are also more likely to report serious academic and social problems in their schools. Half of black (49%) and Hispanic (52%) parents say that it is a very serious problem that local schools are not getting enough money to do a good job, compared to a third of white parents (33%). Minority parents are also twice as likely as white parents to say fighting and weapons are very serious issues and are more likely to question whether local school district superintendents do enough to ensure that schools are safe and orderly. Teachers in minority schools are more likely to complain about large classes, poor teaching conditions and lack of parental support.

The achievement gap is measured by test scores, but scores aren't the whole story. There are multiple challenges that minority students face as they try to get ahead in life – and we need to work on all of them.


11.11 'Starting Point' From Deficit Panel Co-Chairs Ignites Debate

Thursday, November 11th, 2010 | Scott Bittle

Erskine Bowles and Alan Simpson, who are co-chairing President Obama's deficit commission, say the plan they put out yesterday is a "starting point" and they sure did start something, judging from the reaction today. It's important to remember that this isn't the actual deficit commission plan; it's just a basis for discussion for the panel, which is to vote December 1 on its recommendations. So far Bowles and Simpson are speaking for themselves, with no assurance of getting backing from a majority of the other commission members, Congress or the White House.

So why bother talking about it at all? Because the concrete details of this proposal are spurring an argument that this country needs to have: an argument over what it takes, what it really takes, to keep the federal budget on track and control the national debt. That debate needs to be about making choices and putting values to work in the way we spend our money: What's fair? What's important? Who pays? And what are we willing to do?

A good place to start is Fiscal Future Daily, the new blog launched as part of the nonpartisan Choosing Our Fiscal Future initiative from Public Agenda and the National Academy of Public Administration. We sum up the deficit debate from a wide range of views, put it in context, and focus on moving the debate forward.

Today's edition of Fiscal Future Daily tracks the fierce reaction to the Bowles-Simpson plan, and you can check out our archive of previous editions as well. You can also keep up with the latest with Fiscal Future's mobile phone apps, our Facebook page, @FiscalFuture on Twitter, and at


11.04 One Choice Leads To More

Thursday, November 4th, 2010 | Scott Bittle

Elections are one of the major ways we make choices as a nation, and this week's election results are certainly a big choice by the public, as Republicans take control of the House. But elections aren't the only way choices get made, and the choices between elections are just as important - and just as difficult.

That's particularly true when the choices are about money. The nation is facing both a difficult economy right now and a national debt that simply can't be sustained over the long term. That's a challenge that will stretch over the next two years, but a lot of choices will be put on the table in the next two months. The presidential deficit commission is scheduled to vote Dec. 1 on its final report. And Congress will have to decide whether to keep the Bush tax cuts, let them expire, or craft a compromise.

Dealing with these problems is going to require making choices and weighing tradeoffs: what we want as nation, and what we're willing to pay to get it. And these choices belong to the public.

One of the biggest problems in the debate over our national debt and the federal budget is that no one seems to agree on what a "good" budget is. Does that mean a balanced budget? Or one that's judged by the overall economy: small or no deficits in prosperous times; big deficits to stimulate the economy when times are bad? Is it based on the size of our national debt? Or maybe it's about whether the budget is sustainable in the long run?

Don't worry if the debate is confusing. One reason it's confusing is that economists and policymakers disagree on what should be done. The Committee on the Fiscal Future of the United States tried to address that sticking point by coming up with Six Questions To Ask About Any Federal Budget. We think a yardstick like this will be extremely important in the next few months, as crucial decisions are made and plans are put on the table.

And for more on the choices we face, take a look at our slideshow for scoping out the basics, and the Visual Budget Tool for crunching the numbers yourself. You can also keep up with the debate with Fiscal Future's iPhone and Android apps, and join us on Facebook and Twitter.


10.28 The College Cash Crunch

Thursday, October 28th, 2010 | Scott Bittle

College tuition continues to rise, but this year student aid went up as well, according to the latest figures from the College Board. While the extra $10 billion in federal aid will certainly help, no one seems to think this is a shift in the long-term trends - the "squeeze play" feeling many Americans get when it comes to college costs.

There are two colliding trends in public attitudes on college costs: the public feels a college education has become more and more necessary for success in life, even as they believe the cost of college is further and further out of reach.

Those trends may be feeding skepticism among the public that colleges aren't doing all they can to control costs. Public Agenda's most recent "Squeeze Play" survey found 6 in 10 Americans agree that "colleges could take a lot more students without lowering quality or raising prices." Over half (54 percent) say that "colleges could spend less and still maintain a high quality of education."

It's also important to remember that many students - particularly the ones who have trouble completing college - are paying their own way and may not even be eligible for aid. Our With Their Whole Lives Ahead of Them survey found about 7 in 10 of those who leave school report that they did not have scholarships or financial aid, compared with about 4 in 10 of those who graduate.

These trends make it all the more important for colleges to engage stakeholders in how to address cost and productivity. Engagement is critical to making progress on these challenges, and our report, Changing the Conversation About Productivity, examines ways colleges can bring faculty and other stakeholders together effectively. We also recommend Boosting Community College Success, our web page with tools for public engagement and other resources for educators, communities, parents and students.


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