Public Agenda Alert -- Thursday, April 3, 2014
This Week's Headlines
On Health Care Costs, the Conversation Isn't Over
Hearing the Plight of the Community College Transfer Student
Engaging Ideas
Quick Links

Follow us on Twitter Like us on Facebook Find us on Pinterest
Join Our Mailing List

On Health Care Costs, the Conversation Isn't Over

Seven million people have enrolled in health insurance under the Affordable Care Act. But though the window for open enrollment has closed, the door to the discussion on health care costs must remain wide open.


Increasing coverage is just the first step in addressing our very complex health care system, where high costs do not always match up with good results. 


While the ACA includes several provisions to reduce health care costs, it's uncertain whether the law will ultimately control spending. And if we look at Massachusetts, whose health care law was the model for the ACA, for a clue, steep costs may remain a big problem.


Here's a review of some of our recent resources that can help you understand and think about our health care system and efforts to reduce its costs:


Curbing Health Care Costs: Are Citizens Ready to Wrestle with Tough Choices?


We gathered a group of insured and uninsured adults around the country to deliberate over several approaches to curb costs. While participants' initial understanding of health care costs was incomplete, they were open and eager to discuss even highly technical solutions. But they needed the space, tools and guidance to do so. Valuable citizen insights should not be lost because they lack these resources. 


The report includes strategies to help community leaders and others in policy, health care and philanthropy meaningfully include citizens in the health care policy conversation.


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


The cost containing approaches that we explored in the above study included reforms to our payment system. Currently, we reimburse doctors and hospitals on a fee-for-service system. Payment reform is a key element to legislative plans to reduce costs.


Helping consumers understand the current payment system and leveraging their concerns about out-of-pocket spending may help move payment reform forward. In this post on Health Affairs, senior researcher David Schleifer explores how. 


Tough Choices on Health Care - Ready or Not, Here They Come


Opinion polls suggest that the public broadly supports reducing health care costs -- because, who wouldn't? But a deeper look shows most Americans aren't thinking about health costs the same way experts do. This post from senior fellow Jean Johnson is part of our Beyond the Polls column, which takes a more holistic look at public views on critical issues.


We Must Help, Not Hinder, the Public on Understanding Health Care Reform


Similarly, this post also argues that, before we continue basing consequential health care decisions on public opinion, we must take a more nuanced look at how the public is really thinking.


Health Care: A Citizens' Solutions Guide


This guide provides a good basis for discussion with friends and colleagues. It outlines a few of the varied approaches to health care reform and ways to weigh the benefits and consequences of each. 

Hearing the Plight of the Community College

Transfer Student

A first step for policymakers and education leaders looking to improve higher education policies should be to understand the views and experiences of college students firsthand. 


To this end, we recently conducted focus groups with college students across Indiana. We wanted to understand the barriers and opportunities these students encounter when preparing for and navigating transfer from community college to a school in the Indiana University system.


For students seeking a bachelor's degree, the idea of starting at a community college is a sensible one. Students could save money and build a strong foundation for success by figuring out the best way to handle college-level work in their lives. Unfortunately, this rationale is belied by the reality that many students experience college as a maze and not a straight path forward.


Most students we spoke to shared stories about false starts, costly wandering, poor advisement, time wasted and money lost. These roadblocks can have serious impacts on student persistence and completion. The problem is especially acute as a significant majority of students served by these institutions arrive at college unconfident or underprepared.


But these insights and experiences also suggest a host of opportunities for improvement at every level. To read more about the obstacles these students reported encountering as well as strategies for overcoming them, download the report.


This project is the latest in our effort to inject the voices of students in higher education policy. If this is a cause you care about, you may also be interested in the following resources:


Profiting Higher Education: What Students, Alumni and Employers Think About For-Profit Colleges


Is College Worth it For Me? How Adults Without Degrees Think About Going (Back) to School


Guided Pathways to Student Success: Perspectives from Indiana College Students and Advisors


Student Voices on Community College Completion


One Degree of Separation: How Young Americans Who Don't Finish College See Their Chances for Success


With Their Whole Lives Ahead of Them: Myths & Realities About Why So Many Students Fail to Finish College 

Engaging Ideas

A collection of stories and reports from the past couple weeks that caught our attention and sparked consideration on ways to make progress on divisive issues. 
A physician gives an account on an experience with a patient as an example of the dissonance between achievable goals and quality measures in this post on the New York Times' Well blog.

A group of European and American researchers looked at patient files and nurses' qualifications at 300 hospitals across nine European countries and found that vocational training and higher patient to nurse ratios correlated to an increase in mortality. 
A poll from Gallup shows that 57% of Americans say that the U.S. should emphasize more conservation by consumers of existing energy supplies, while 34% say to emphasize production of more oil, gas, and coal supplies. 

Federal Accountability and Financial Pressure: A Survey of Presidents
A new survey from Inside Higher Ed of 846 college chief executives shows a consensus that agrees on reporting information about their graduates careers, but without federal assistance or interference.

Participatory Budgeting - the process by which citizens choose how to allocate part of a public budget - is working. This map lets you see where and how.

About Us
Public Agenda is a nonprofit organization that helps diverse leaders and citizens navigate complex, divisive issues. Through nonpartisan research and engagement, it provides people with the insights and support they need to arrive at workable solutions on critical issues, regardless of their differences. Since 1975, Public Agenda has helped foster progress on K-12 and higher education reform, health care, federal and local budgets, energy and immigration. Find Public Agenda online at

Help our nation make progress on its toughest challenges. Donate today.