Health Care

Health Care http://tcf.org/healthcare/rss-2/rss In the U.S., there is a growing consensus among experts, lawmakers, employers, and the public that the existing system is dysfunctional--and this support will generate support for the transformation of U.S. health care financing and delivery. 2012-02-23T17:30:08Z vice A Quiet Triumph of Obama Care urn:syndication:795bd7cf-4b7c-11e1-8cf1-002219154821 http://www.washingtonmonthly.com/ten-miles-square/2012/01/a_quiet_triumph_of_obama_care035079.php Harold Pollack and Greg Anrig write in Washington Monthly. 2012-02-21T15:39:50Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>Harold Pollack and Greg Anrig write in Washington Monthly.</p> <div style="float: right"> <img src="http://tcf.org/in-the-news/2012/1/a-quiet-triumph-of-obama-care/image" /> <span></span> </div> <p>http://www.washingtonmonthly.com/ten-miles-square/2012/01/a_quiet_triumph_of_obama_care035079.php</p> <div><p>Harold Pollack and Greg Anrig write in <i>Washington Monthly.</i></p></div> </body> </html> Questions for #policychat on The Affordable Care Act urn:syndication:ab16d770-59b2-11e1-a4d4-002219154821 http://botc.tcf.org/2012/02/questions-for-policychat-on-the-affordable-care-act.html Prepare for TCF's Twitter #policychat on Feb. 22 2012-02-17T21:41:35Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>Prepare for TCF's Twitter #policychat on Feb. 22</p> <div style="float: right"> <img src="http://tcf.org/in-the-news/2012/2/questions-for-policychat-on-the-affordable-care-act/image" /> <span></span> </div> <p>http://botc.tcf.org/2012/02/questions-for-policychat-on-the-affordable-care-act.html</p> <div><p>Prepare for TCF's Twitter #policychat on Feb. 22</p></div> </body> </html> What You Missed - May 2011 urn:syndication:ab1b410f-913a-11e0-9707-002219154821 http://tcf.org/videos/2011/what-you-missed-may-2011 What you missed from The Century Foundation in May of 2011. 2012-02-09T16:42:45Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>What you missed from The Century Foundation in May of 2011.</p> <div style="float: right"> <img src="http://tcf.org/videos/2011/what-you-missed-may-2011/image" /> <span></span> </div> <div><p>What you missed from The Century Foundation in May of 2011. View other videos from the <a class="internal-link" href="../../special-projects/series/what-you-missed">What You Missed</a> series.</p></div> </body> </html> The Efficacy of the Affordable Care Act urn:syndication:c72c2a61-4ceb-11e1-bcaa-002219154821 http://maddowblog.msnbc.msn.com/_news/2012/01/31/10279932-the-efficacy-of-the-affordable-care-act Rachel Maddow's blog cites TCF's Greg Anrig and Harold Pollack on how Health Reform is helping people today. 2012-02-01T15:41:45Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>Rachel Maddow's blog cites TCF's Greg Anrig and Harold Pollack on how Health Reform is helping people today.</p> <div style="float: right"> <img src="http://tcf.org/in-the-news/2012/1/the-efficacy-of-the-affordable-care-act/image" /> <span></span> </div> <p>http://maddowblog.msnbc.msn.com/_news/2012/01/31/10279932-the-efficacy-of-the-affordable-care-act</p> <div><p>Rachel Maddow's blog cites TCF's Greg Anrig and Harold Pollack on how Health Reform is helping people today.</p></div> </body> </html> The Good News in the CBO's Medicare Reform Studies urn:syndication:9b4bcb8a-4359-11e1-aa07-002219154821 http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330168e5d0537a970c Supporters of health care reform were discouraged this week by a Congressional Budget Office report that synthesized research on Medicare pilot... 2012-01-20T16:58:20Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p> Supporters of health care reform were discouraged this week by a Congressional Budget Office report that synthesized research on Medicare pilot...</p> <div style="float: right"> <img src="http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330168e5d0537a970c/image" /> <span></span> </div> <div><p>Supporters of health care reform were discouraged this week by a Congressional Budget Office <a href="http://www.cbo.gov/doc.cfm?index=12664" target="_self">report</a> that synthesized research on Medicare pilot programs focusing on disease managment and care coordination. The CBO <a href="http://cboblog.cbo.gov/?p=3158" target="_self">concluded</a> that most such projects have not reduced Medicare spending and that, on average, they had little or no effect on hospital admissions. A similar CBO <a href="http://www.cbo.gov/doc.cfm?index=12665" target="_self">review</a> of studies on value-based payment initiatives similarly found that only one of four demonstrations yielded significant savings for Medicare.</p> <p>Because such innovations are considered to be among the best hopes for constraining Medicare's growth rate while improving the quality of care -- and are key components of the Affordable Care Act -- those deflating headlines provided new ammunition to politicians who want to repeal the legislation. But a closer reading of the CBO reports, and some of the particular studies they review, provide all kinds of useful insights about relatively successful strategies that can be more broadly emulated while avoiding approaches that clearly don't work.</p> <p>The Medicare pilot programs were a collection of experiments that varied in a multitude of ways. Like trial-and-error processes in laboratories, they are extremely valuable in pointing the way toward future modifications in the next wave of experiments drawing on the lessons gleaned from the first set. That is how progress is made. It would have been miraculous if the pilot programs had been uniformly successful given the incredible complexity of the health care system and the Medicare program, the deeply entrenched practices and culture of health care providers, the inherent difficulty of treating older patients with multiple chronic ailments, and the limited experience with these kinds of reforms. Moreover, most of the pilot projects lasted only three years and affected a relatively small number of patients, leaving little time to ramp up fairly dramatic changes, allow for adaptation, and produce meaningful results in relation to a control group.</p> <p>Even still, some of the pilot programs were found to have produced impressive outcomes. Four of the 34 disease management and care coordination initiatives reduced hospitalizations by 15 percent or more and another 7 yielded hospitalization reductions of 6 percent to 15 percent. Because reducing hospitalizations of chronic care patients save substantial costs while demonstrating that those individuals have been able to maintain better health, they are a key measure of success. So it is good news that a substantial subset of the pilot programs were able to make significant progress on that front, providing models that might be pursued and expanded upon in other settings. At the same time, the approaches used elsewhere with less success are now known to be ineffective -- so we have learned about mistakes to avoid.</p> <p>One example of a relatively successful pilot program, analyzed in great depth in this <a href="http://www.massgeneral.org/news/assets/pdf/fullftireport.pdf" target="_self">162-page study</a>, was Massachusetts General Hospital's "Care Management for High-Cost Beneficiaries Demonstration." Relative to a control group, it succeeded in reducing hospital admissions by 19 percent to 24 percent (the different figures were connected to different time periods and different groups of patients.) In addition, the program achieved significant cost savings: For every dollar invested in the program's management fees, Medicare received $2.65 in savings on beneficiary health care services. Lyle Nelson of the CBO explains why the Mass. General program may have produced better results than most of the other pilots:</p> <blockquote> <p>Unlike nearly all other programs testedin these six demonstrations, the program at Massachusetts General is closely integrated with the health care delivery system. The program has the strong backing of the hospital’s senior management and the physician group, and physicians have been involved in the program’s initial design and evolution. The care managers are staff members of primary care physicians’ practices, and they have access to patients’ electronic medical records. Patients of Massachusetts General Hospital and its affiliated physician group reportedly obtain the vast majority of their health care within that integrated system, so the electronic medical records provide care managers with current information on nearly all of their patients’ medical care.</p> <p>Moreover, the hospital notifies care managers when their patients are hospitalized or admitted to the emergency department. The care managers interact with patients by telephone and in person during physician office visits and hospital stays, and they have access to a pharmacist to address potential problems with patients’ medications.</p> </blockquote> <p>Other nuggets from the longer study of the Mass. General program that may help to explain its relative success:</p> <ul> <li>In the early stages of the CMHCB demonstration, CMP leadership learned that many<br />highcost, complex patients have mental health issues that were not effectively addressed by the current model of health care delivery or its pilot program. As a result, the program allocated greater resources to support mental health, hiring a social worker to assess the mental health needs of CMP participants and support them in accessing psychiatric care as needed or provide treatment if appropriate.</li> <li>Since many members of the CMP population have complex medication regimens, MGH<br />enlisted the support of a pharmacist to review the appropriateness of medication regimens and assist patients with access to medications. The pharmacist also evaluated medication regimens to identify opportunities to reduce the number of medications and to suggest alternative therapies. Lessons learned during the early stages of the demonstration helped to motivate a change in MGH’s medication delivery services—MGH began providing home delivery of medications 5 days per week rather than 2 days per week.</li> <li>Case managers assigned to each practice met with physicians at the practices to describe<br />the program, the skills that they bring to the physician practice, and their interest in collaborating to support patients in their efforts to manage their medical conditions. Case managers collected information from providers about how they could add value to the medical practice.</li> <li>MGH invested considerable personnel resources to develop and implement its CMP. At<br />the time of the initial site visit, the program was staffed with 11 nurse case managers who<br />received guidance from the program leadership and support from the project manager, an<br />administrative assistant, and a community resources specialist. Each case manager was located in a physician practice and provided case management support to a group of 180 to 220 patients who received their primary care from a provider in that group. In addition, almost all case managers also “floated” to one or two additional small physician practices, which had five or fewer MGH CMP eligible patients. Responsibilities included conducting patient assessments, visiting patients who were hospitalized at MGH (when feasible), contacting patients who visited the emergency department or were recently discharged from the inpatient services, calling patients scheduled for office visits each week, following up with patients who missed office visits each week, making followup calls to provide case management services, and promoting the MGH CMP to physicians.</li> <li>MGH developed a series of clinical dashboards using data from the MGH electronic<br />medical record (EMR), claims data, and its enrollment tracking database. The dashboards<br />allowed MGH to examine trends in health care utilization and outcomes, overall and by<br />enrollment status, physician practice, and/or case manager, as well as activities of its case<br />managers. Examples of indicators included in the dashboard are: number of assessments<br />completed within 90 days, number of referrals or interventions conducted, number of advanced directives in place, number of participants screened for depression, number of participants with a positive screen for depression referred to mental health, and the top 10 discharge diagnoses.</li> <li>MGH enlisted physician support to help ensure the success of its CMP in providing highquality care to patients. Physicians were asked to conduct the following activities: encouragebeneficiaries to participate in the program and enroll them in the program when possible; collaborate with case managers to review initial assessment findings and develop care plans for each patient; inform case managers about patient events and refinements to patient care plans during the demonstration period; and discuss advance directives with enrolled patients.</li> </ul> <p>Obviously, such ambitious interventions will be difficult to replicate elsewhere in settings that lack the physical and human resources available to Massachusetts General Hospital. But what they did there genuinely worked and was quite different from what the other pilot programs studies did. So the challenge going forward is to try to get more of these initiatives to do what they can to imitate Mass General's approach, to the extent that they can. The payoff is very real. From the study's conclusion:</p> <p> </p> <blockquote> <p>Based on extensive qualitative and quantitative analysis of performance, we find that<br />MGH’s CMP had success at improving primary care providers’ satisfaction with their quality of work life and improving some measures of beneficiary experience with care and functional status. We also find that MGH’s CMP had substantial success reducing acute care hospitalizations and ER visits and mortality, and achieving substantial cost savings. We find these latter successes within both the original and refresh intervention groups. The financial savings is particularly noteworthy given the relatively small sample sizes and regression to the mean effects.</p> </blockquote> <p>That's pretty terrific news for supporters of health care reform.</p> <p> </p> <p> </p></div> </body> </html> No, Doctors Don't Hate Obamacare urn:syndication:b274e938-42d7-11e1-9e88-002219154821 http://www.tnr.com/blog/jonathan-cohn/99827/no-doctors-dont-hate-obamacare#.TxhyNkh3URA.twitter Harold Pollack published in The New Republic. 2012-01-19T19:50:12Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>Harold Pollack published in The New Republic. </p> <div style="float: right"> <img src="http://tcf.org/in-the-news/2012/1/no-doctors-dont-hate-obamacare/image" /> <span></span> </div> <p>http://www.tnr.com/blog/jonathan-cohn/99827/no-doctors-dont-hate-obamacare#.TxhyNkh3URA.twitter</p> <div><p>Harold Pollack published in The New Republic.</p></div> </body> </html> Suzanne Mettler urn:syndication:9c669340-41dc-11e1-b399-002219154821 http://tcf.org/about/fellows/suzanne-mettler Suzanne Mettler is the Clinton Rossiter Professor of American Institutions at Cornell University, where she conducts research and teaches on American politics and public policy. 2012-01-18T13:50:18Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>Suzanne Mettler is the Clinton Rossiter Professor of American Institutions at Cornell University, where she conducts research and teaches on American politics and public policy.</p> <div style="float: right"> <img src="http://tcf.org/about/fellows/suzanne-mettler/image" /> <span></span> </div> <div><p><b>Suzanne Mettler </b>is the Clinton Rossiter Professor of American Institutions at Cornell University, where she conducts research and teaches on American politics and public policy. Her most recent book is The Submerged State: How Invisible Government Programs Undermine American Democracy (University of Chicago Press, 2011). Her earlier books include Dividing Citizens: Gender and Federalism in New Deal Public Policy (Cornell University Press, 1998), which was awarded the Kammerer Award of the American Political Science Association for the best book on U.S. national policy, and Soldiers to Citizens: The G.I. Bill and the Making of the Greatest Generation (Oxford University Press, 2005), which also won the Kammerer Award as well as the Greenstone Prize of the Politics and History section of the American Political Science Association. She is coeditor, with Joe Soss and Jacob Hacker, of Remaking America: Democracy and Public Policy in an Age of Inequality (Russell Sage Foundation, 2007), and coeditor with Lawrence R. Jacobs of a special issue of the Journal of Health Policy, Politics, and Law focused on “Public Opinion, Health Policy and American Politics.” She has published articles in several journals, including American Political Science Review, British Journal of Political Science, Perspectives on Politics, and Studies in American Political Development, and numerous book chapters in edited volumes.</p></div> </body> </html> The Year in Review: 2011 urn:syndication:b8287638-2a66-11e1-a491-002219154821 http://tcf.org/commentary/2011/the-year-in-review-2011 The Century Foundation fellows discuss the best and worst public policy issues and decisions of 2011. 2011-12-31T15:29:32Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>The Century Foundation fellows discuss the best and worst public policy issues and decisions of 2011.</p> <div style="float: right"> <img src="http://tcf.org/commentary/2011/the-year-in-review-2011/image" /> <span></span> </div> <div><p>The Century Foundation fellows discuss the best and worst public policy issues and decisions of 2011:</p> <p><span class="messageBody"> </span><a class="external-link" href="http://botc.tcf.org/2011/12/the-best-and-worst-news-for-progressives-in-2011.html">The Eight Best Developments for Progressives in 2011</a><span class="messageBody"> by Greg Anrig.</span></p> <p><a class="external-link" href="http://botc.tcf.org/2011/12/the-best-and-worst-in-education-2011.html">The Best and Worst in Education 2011</a> by Richard Kahlenberg.</p> <p><span class="messageBody"><a class="external-link" href="http://botc.tcf.org/2011/12/the-best-and-worst-of-2011-the-world.html">The Best and Worst of 2011: The World</a> by Jeffrey Laurenti</span></p> <p><span class="messageBody"><a class="external-link" href="http://botc.tcf.org/2011/12/best-and-worst-health-policy-stories-of-2011.html">Best and Worst Health Policy Stories of 2011</a> by Harold Pollack</span></p> <p><span class="messageBody"><a class="external-link" href="http://botc.tcf.org/2011/12/the-year-in-transnational-crime-and-corruption.html">2011 in Transnational Crime and Corruption</a> by Patrick Radden Keefe</span></p> <p><a class="external-link" href="http://botc.tcf.org/2011/12/policycast-tova-wang-on-voting-rights-in-2011.html">Voting Rights in 2011</a>, Tova Wang on PolicyCast Podcast</p> <p><a class="external-link" href="http://nationalinterest.org/commentary/the-year-erdogan-6301">The Year of Erdogan</a>, by Morton Abramowitz (posted on <i>The National Interest</i>)</p> <p>Listen to podcasts:</p> <p><a class="external-link" href="http://botc.tcf.org/2011/12/policycast-tova-wang-on-voting-rights-in-2011.html">Voting Rights in 2011</a><span>, Tova Wang on PolicyCast Podcast</span></p> <p><a class="external-link" href="http://botc.tcf.org/2011/12/policycast-patrick-radden-keefe-discusses-the-roots-of-corruption.html">The Roots of Corruption</a>, with Patrick Radden Keefe</p> <p><a class="external-link" href="http://botc.tcf.org/2011/12/policycast-harold-pollack-talks-health-policy-for-2011.html">Harold Pollack Talks Health Policy for 2011</a>, PolicyCast</p> <p><a class="external-link" href="http://botc.tcf.org/2011/12/policycast-richard-kahlenbergs-the-best-and-worst-in-education-for-2011.html">Richard Kahlenberg's the Best and Worst in Education 2011</a>, PolicyCast</p> <p> </p> <p><i style="text-align: left; ">Stay tuned for more.</i></p></div> </body> </html> PolicyCast: Harold Pollack Talks Health Policy for 2011 urn:syndication:0cbe29c0-33af-11e1-a548-002219154821 http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330162fea27b6a970d Working from his Year in Review 2011 piece , Best and Worst Health Policy Stories of 2011 , TCF fellow Harold Pollack talks about the details... 2011-12-31T12:56:08Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p> Working from his Year in Review 2011 piece , Best and Worst Health Policy Stories of 2011 , TCF fellow Harold Pollack talks about the details...</p> <div style="float: right"> <img src="http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330162fea27b6a970d/image" /> <span></span> </div> <div><p>Working from his <a href="commentary/2011/the-year-in-review-2011" target="_self" title="Year in Review 2011">Year in Review 2011</a> piece , <a href="http://botc.tcf.org/2011/12/best-and-worst-health-policy-stories-of-2011.html" target="_self" title="Best and Worst Health Policy Stories of 2011">Best and Worst Health Policy Stories of 2011</a>, TCF fellow Harold Pollack talks about the details of some of those stories. From the failures of the partisan confirmation process to the successes of initial implementaton of the Affordable Care Act <a href="http://tcftakingnote.typepad.com/files/harold-pollack-2011-best-and-worst-health-policy.mp3" target="_self">download it here</a> or listen to:</p> <p class="asset asset-audio at-xid-6a00e54ffb969888330162fea212fa970d"><a class="inline-player" href="http://tcftakingnote.typepad.com/files/harold-pollack-2011-best-and-worst-health-policy.mp3">Harold Pollack 2011 Best and Worst Health Policy</a></p> <p> </p></div> </body> </html> Best and Worst Health Policy Stories of 2011 urn:syndication:4beda24a-2cb1-11e1-8916-002219154821 http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330154388ba3dd970c In health policy, 2011 was a nail-biter of a year. With the Supreme Court set to weigh in on the individual mandate and related matters, with the... 2011-12-27T11:18:10Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p> In health policy, 2011 was a nail-biter of a year. With the Supreme Court set to weigh in on the individual mandate and related matters, with the...</p> <div style="float: right"> <img src="http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330154388ba3dd970c/image" /> <span></span> </div> <div><p>In health policy, 2011 was a nail-biter of a year. With the Supreme Court set to weigh in on the individual mandate and related matters, with the Affordable Care Act (ACA) steadily but slowly moving forward before the 2012 election, there is much to celebrate, and much to lament. Below are my candidates for the “best” and “worst” stories in health policy for this year.</p> <p><strong>The Worst: We’re Kicking Out Good People, While We Wait for Health Reform’s Main Pillars to Kick In</strong></p> <p>The “worst” category has too many worthy entries this year. The <a href="http://theincidentaleconomist.com/wordpress/donald-berwick-and-the-lack-of-professionalism-in-american-government/">Senate’s shabby treatment of Dr. Donald Berwick</a>, outgoing leader of the Center for Medicare and Medicaid Services, may be the most depressing. Unlike some other Obama administration officials thwarted by the Senate confirmation process, Berwick is a technocratic figure who isn’t especially identified as a partisan Democrat. His was simply an available scalp in the crusade against ObamaCare.</p> <p>There is an unavoidable partisan dimension to this fight—Republicans have compiled an astonishing record of obstructing the Obama administration. There is also a broader institutional issue—the increasingly obvious dysfunction of the United States Senate. Both parties have a strong stake in a more professional process that does less to deter excellent people from entering American government. Sadly, the United States Senate <a href="http://theincidentaleconomist.com/wordpress/more-on-fixing-the-confirmation-mess/">evinces little interest in doing what needs to be done</a>.</p> <p>What has <strong>not</strong> happened remains the worst story of 2011. Tens of millions of uninsured people, and millions of others, are waiting until 2014, when the main pillars of health reform kick in. This raises obvious political dangers, particularly given President Obama’s difficult road to reelection.</p> <p>More important, many people just don’t have time to wait. When I was on the campaign trail, I met a family <a href="http://www.huffingtonpost.com/harold-pollack/can-we-forgive-each-other_b_100619.html">selling trinkets while waiting for a liver transplant</a>. I also remember <a href="http://www.tnr.com/blog/the-treatment/the-ride-lifetime">staffing a 2007 campaign phone bank</a>, and calling a plainspoken disabled South Carolina man who asked me how candidate Obama would help him pay his medical bills. I wonder if he will be alive in 2014.</p> <p><strong>The Best: Real Help Has Arrived for Sick Kids and Young Adults</strong></p> <p>Not all the news is grim. I was reminded of this after a near-collision the other day. Distracted by my iPhone, I was nearly struck by a vehicle that whipped past me. A masked and reckless driver was at the wheel. He swerved a bit, and only narrowly missed running over my foot. The unregistered vehicle, a 0.005 ton Bigwheel, was driven by a small boy. Underneath a bright surgical mask, he was pretty bald. Undaunted by the near hit-and-run, he kept going down the hallway of a Ronald McDonald House I happened to be visiting.</p> <p>The facility partners with a nearby children’s hospital that serves as the tertiary care center for infants, children, and youth for hundreds of miles around it. Life at such care sites is filled with beautiful, hopeful, and devastating moments. This hospital treats young people with cancer, congenital heart defects, infants who were born prematurely. I have huge respect for the men and women who skilled and sometimes heartbreaking work in these places. I envy them the significance of what they do.</p> <p>The patients whom these men and women treat face many medical challenges. They face other challenges, too. I chatted with two clinical social workers who work with sometimes desperately ill children and adults. These two women noted the obvious fact that it’s incredibly expensive to have a chronic, life-threatening illness. Some working parents must leave their jobs for weeks or months to be with a sick child. A child in the pediatric intensive care unit can easily hit annual or lifetime limits on her health insurance. Many of these children also face lifelong illnesses and return to this hospital throughout their youth and sometimes their adulthood. Cancers can recur. Mended hearts may need further repair. Congenital conditions may require complex surgeries. Powerful chemotherapies, steroids, and anti-rejection medications cast shadows on future health. Many patients have faced special problems after they graduated high school, and from their parents’ employer-based health plans.</p> <p>Without fanfare, these problems have become more manageable for many people with the ongoing progress of the Affordable Care Act. In my eyes, this was one of the best, and most overlooked health policy success stories of 2011.</p> <p><a href="http://thinkprogress.org/wp-content/uploads/2011/12/Google-ChromeScreenSnapz284.png">Igor Volsky</a>, <a href="http://www.tnr.com/blog/jonathan-cohn/98525/young-adults-under-25-insurance-obamacare-cdc-hhs">Jonathan Cohn</a>, <a href="http://theincidentaleconomist.com/wordpress/the-census-report-is-out/">Aaron Carroll</a>, and others (including <a href="http://botc.tcf.org/2011/09/hey-jaded-young-adults-health-reform-is-already-making-a-difference.html">me</a>) have celebrated the rising proportion of young people who hold insurance coverage. This trend is surprising. It bucks a punishing recession that has been particularly hard on young adults. It bucks the continued cost-induced erosion in the general market for private insurance. It runs counter to the manifest willingness of many young people to gamble and to go uninsured. Despite all of these things, the percentage of young adults age 19-25 with health insurance has strikingly increased.</p> <p><a href="http://botc.tcf.org/2011/09/hey-jaded-young-adults-health-reform-is-already-making-a-difference.html">Government and private experts have stated the most likely explanation</a>: the provision in last year’s health reform that allows adults younger than age 26 to remain on their parents’ employer-based insurance policies. Young adults can be married, living alone or in school, and even hold a job and still be eligible to receive coverage on their parents’ health plan.</p> <p><a href="http://tcftakingnote.typepad.com/.a/6a00e54ffb969888330154388ba23b970c-pi"><img src="http://tcftakingnote.typepad.com/.a/6a00e54ffb969888330154388ba23b970c-800wi" alt="Young_adult_insurance" class="asset asset-image at-xid-6a00e54ffb969888330154388ba23b970c image-full" title="Young_adult_insurance" /></a></p> <p>Last week, experts at the Department of Health and Human Services released <a href="http://aspe.hhs.gov/health/reports/2011/YoungAdultsACA/ib.pdf">a report</a> showing that the number of young adults with health insurance has increased by from 64 percent to 73 percent, an increase of 2.5 million people, by June of this year. Expanded coverage for young adults became operative September 23, 2010. As shown in the above graph from their report, the third quarter of 2010 was precisely the moment at which coverage for young adults sharply improved. I’ve been doing policy research for almost two decades now. It’s rare to see such dramatic ocular confirmation of a policy’s positive effects.</p> <p>It’s great to see the national trends. It’s also great that the two hospital social workers told me that they see patients helped by this policy within their clinics. Adolescents and young adults with cardiac problems, cancers, and other serious conditions are returning for care insured on their parents’ insurance policies. Fewer of these patients are uninsured or underinsured. Moreover, more present with private insurance rather than Medicaid. This is important for the hospital, given serious shortfalls in Medicaid reimbursement rates.</p> <p>If anything, the above graphs and figures understate ACA’s value for young people with serious health concerns. For young people needing specialty cancer care, this is obvious. Millions of young adults suffering from diabetes, major depression or other psychiatric disorders, autism, intellectual disability, or other common conditions are much more likely to obtain decent and affordable coverage through their parents’ employer than they are through their own jobs, or through the medically underwritten market for individual and small-group insurance coverage.</p> <p>ACA took other important steps, too. Insurance plans that cover children <a href="http://www.healthcare.gov/law/features/rights/childrens-pre-existing-conditions/index.html">can no longer exclude, limit, or deny coverage to children under the age of 19</a> solely based on a preexisting condition. (The analogous measures for adults kick in in 2014.)</p> <p>Lifetime limits on most essential benefits are now prohibited. ACA restricts and phases out annual dollar-coverage limits on most covered health benefits. For this upcoming year, no insurance plan can set an annual dollar limit lower than $1.25 million: for a plan year or policy year starting on or after September 23, 2011 but before September 23, 2012. Next year, the minimum rises to $2 million, with annual dollar limits prohibited altogether in 2014. (See <a href="http://www.healthcare.gov/law/features/costs/limits/index.html">here</a> for more details.) Many of these issues are pretty invisible and technical. You probably won’t read much about them in the front page of your local newspaper. If you were staying in some Ronald McDonald House while your child was receiving chemotherapy at the fancy hospital next door, such provisions might be the thing that lets you keep your home.</p> <p>I still wish that the full apparatus of health insurance exchanges, affordability credits, Medicaid expansion, and (yes) the individual mandate were in place right now. Moreover, ACA’s protections for young people are most useful to those who have parents who hold jobs with good insurance plans. If you’re a sick kid and your mom is a supermarket cashier with bad benefits, you still have to wait to 2014.</p> <p>Yet it’s worth taking a moment to celebrate the tangible progress that was made—this past year—which has made our health care financing system more inclusive and more humane for literally millions of young people. That’s no small achievement.</p></div> </body> </html> Drug policy--Bloggingheads edition urn:syndication:87356f5e-2d79-11e1-a1a6-002219154821 http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330162fe3cf715970d (cross-posted with RBC) 2011-12-23T15:05:46Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p> (cross-posted with RBC)</p> <div style="float: right"> <img src="http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330162fe3cf715970d/image" /> <span></span> </div> <div><div> <p>(cross-posted with RBC)</p> <p>My colleague Mark Kleiman and I go Bloggingheads on drugs and HIV in the Russian Federation, poppy eradication in Afghanistan, Mexican drug violence, California marijuana, and new ways to address drug using and drug selling in United States.</p> <p> </p> </div></div> </body> </html> Drug policy--Bloggingheads edition urn:syndication:8749b1e3-2d79-11e1-a528-002219154821 http://botc.tcf.org/2011/12/drug-policy-bloggingheads-edition.html Harold Pollack on Bloggingheads. 2011-12-23T15:03:57Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>Harold Pollack on Bloggingheads.</p> <div style="float: right"> <img src="http://tcf.org/in-the-news/2011/12/drug-policy-bloggingheads-edition/image" /> <span></span> </div> <p>http://botc.tcf.org/2011/12/drug-policy-bloggingheads-edition.html</p> <div><p>Harold Pollack on Bloggingheads.</p></div> </body> </html> The Eight Best Developments for Progressives in 2011 urn:syndication:e9ecaa1c-2a69-11e1-8d23-002219154821 http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330162fdb7fa9c970d Optimists about the U.S. economy continue to see green shoots where there are still mostly tumbleweeds. But even in that grim environment, 2011... 2011-12-22T21:39:05Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p> Optimists about the U.S. economy continue to see green shoots where there are still mostly tumbleweeds. But even in that grim environment, 2011...</p> <div style="float: right"> <img src="http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330162fdb7fa9c970d/image" /> <span></span> </div> <div><p>Optimists about the U.S. economy continue to see green shoots where there are still mostly tumbleweeds. But even in that grim environment, 2011 offered progressives some genuine reasons to be hopeful. This year there were signs that maybe -- just maybe -- better days are coming for those who believe government should play a much more energetic role in addressing the nation's myriad challenges. Here are the eight best things that happened in 2011 from the standpoint of progressivism:</p> <p><strong>1. The Birth of the Occupy Wall Street Movement. </strong>It has been apparent for a long time that the emergence of a genuine political movement would be needed to fundamentally shift debate in Washington to focus on America's central economic problems. With wealthy donors and corporate lobbyists exerting disproportionate influence over both Democratic and Republican lawmakers, Congress throughout the year had been blithely acting as though the economy were already back on track. It was as if the financial, housing, and jobs crises were distant memories that had already been solved. But then this fall, the large protests that started in lower Manhattan before quickly spreading across the country started to shake the powers-that-be out of their stupor. Although the policy agenda of the Occupy Wall Street movement remains unclear, it has already accomplished the goal of heightening attention to the issue of economic inequality. One <a href="http://www.politico.com/blogs/bensmith/1111/Occupy_Wall_Street_is_winning.html" target="_self">analysis</a> showed that media references to "income inequality" soared over the period when the protests first began to take hold. And President Obama's rhetoric, most notably in the December 6 <a href="http://www.guardian.co.uk/world/2011/dec/07/full-text-barack-obama-speech" target="_self">speech</a> he delivered in Osawatomie, Kansas, has increasingly emphasized formerly unspoken concerns about the hardships confronting a large portion of the population. We are still a long way off from any meaningful political action that would begin to narrow the ever-widening gaps between the very wealthy and everyone else, and that would put the nation on a path to shared prosperity. But already the fledgling movement has had an impact simply by changing the conversation to the central economic challenges of our time. The next test will be whether the protesters can get behind a specific<a href="http://botc.tcf.org/2011/10/what-think-tanks-owe-the-people-in-the-park.html" target="_self"> policy</a> <a href="http://botc.tcf.org/2011/10/10-reasons-to-eliminate-the-tax-break-for-capital-gains-.html" target="_self">agenda</a> that they hold politicians accountable for.</p> <p><strong>2. The Failure of the Super Committee. </strong>Even though unemployment remained stuck above the historically high level of 9 percent throughout most of 2011, Congress perversely fixated on deficit reduction -- a misguided priority that would directly exacerbate rather than alleviate joblessness. After much squandered time, the so-called Super Committee empanelled to come up with recommendations for significantly reducing government spending ultimately dissolved without reaching a deal. That was good news, because some Democrats on the committee were prepared to make counterproductive concessions in the form of cuts to Social Security, Medicare, Medicaid, and other programs that continue to provide a modicum of essential support to average families. Only the intransigence of the Republican members in opposing any tax increases prevented what would have been a <a href="http://botc.tcf.org/2011/11/7-reasons-to-celebrate-the-not-so-super-committees-failure.html" target="_self">much worse outcome for the country</a>. The committee's failure, combined with the new political energy provided by the Occupy Wall Street movement, helps to set the stage for debate during the presidential campaign cycle that concentrates on addressing what voters care most about: the bad economy, not the government's balance sheet.</p> <p><strong>3. Big Progress on Gay Rights. </strong> This year New York legalized same-sex marriage, joining the much smaller states of Massachusetts, Connecticut, Vermont, New Hampshire, and Iowa. In addition, following on legislation enacted at the end of 2010, the military's "don't ask, don't tell" policy was officially repealed as of September 20. As a result, openly gay and lesbian individuals can now serve in the military. Those two major changes advancing the long-standing progressive values of freedom, opportunity, and equality were the outgrowth of intensive grass-roots efforts. Only a decade ago, few would have imagined that gay marriage and an end to DADT were even remotely on the horizon. The enormous success of the gay rights movement over a relatively short period of time should encourage progressives working on other issues who have become frustrated over their difficulties in achieving progress.</p> <p><strong>4. Signs That Health Care Reform is Starting to Work.</strong> Most provisions of the Patient Protection and Affordable Care Act, which was enacted in 2010, won't take full effect until 2014. But nonetheless, this year some evidence emerged that it may already be having a positive impact. New data from the <a href="http://www.tnr.com/print/blog/jonathan-cohn/98525/young-adults-under-25-insurance-obamacare-cdc-hhs" target="_self">Centers for Disease Control </a>showed that the number of American adults aged 19 to 25 without health insurance fell from about 10.5 million to 8 million between the middle of 2010 and the middle of 2011. The reason why the Affordable Care Act is likely responsible, especially when insurance coverage declined for other non-elderly adults, is the provision already in effect that enables young adults up to the age of 26 to remain covered by their parents' plan if they have no access to employer sponsored coverage. Another promising development was that the rate of <a href="http://www.bloomberg.com/news/2011-08-24/medicare-spending-slows-as-hospitals-improve-care-peter-orszag.html" target="_self">Medicare's cost increases slowed significantly</a>. While the explanation for that news is uncertain, and no one knows if it will last, there is growing evidence that hospitals are already reorganizing in anticipation of the legislation in ways that have proven to promote greater cost-efficiency. A third positive development connected to health care reform is the reduction in the "donut hole" in Medicare drug coverage, enabling more than 2.5 million seniors to save, on average, $569. The increased coverage for young adults, the slowdown in Medicare cost inflation, and the improved Medicare prescription drug package are three promising reasons to believe that health care reform really will help to improve America's deeply dysfunctional health care system.</p> <p><strong>5. The Defeat of Ohio's Anti-Union Law. </strong>The most significant referendum to appear on a state ballot this year called for a repeal of Ohio's law, pushed by Republican Governor John Kasich, that stripped most collective bargaining rights from public employees. That law, which was passed by the state Senate in the spring, came on the heels of Wisconsin Governor Scott Walker's attack on public sector unions and threatened to lead to more widespread conservative steamrolling of labor. As it turned out, Ohio voters <a href="http://atlasproject.net/daily-blog/what-ohio-sb5-means-for-2012/" target="_self">resoundingly supported repeal</a> of the anti-union law by a margin of 61 percent to 39 percent. The rejection of Kasich's aggressive move in such an electorally important state heading into the presidential campaign <a href="http://news.firedoglake.com/2011/11/09/a-good-election-night-for-rearguard-actions-for-liberals/" target="_self">may help to further energize the grass-roots</a> while shifting them from a defensive posture to more proactively supporting progressive candidates and policies.</p> <p><strong>6. Elizabeth Warren's Senate Candidacy. </strong>When Senator Edward M. Kennedy died in 2009, the nation lost a leader who articulated a clear, powerful vision of liberalism while achieving more than anyone in the modern era for progressive causes. So it is rejuvenating that Republican Scott Brown, who took Kennedy's seat, is now being challenged by someone who in her own right has demonstrated a singular ability to articulate and fight for progressive values: Elizabeth Warren. A Harvard Law School professor, Warren has written extensively about the economic forces squeezing the American middle class and <a href="http://www.democracyjournal.org/5/6528.php?page=all" target="_self">created the idea</a> for the Consumer Financial Protection Bureau that became an important element of the Dodd-Frank legislation. Although many hoped that Warren would be nominated to run the bureau, instead she has entered the political fray in Massachusetts. A <a href="http://www.cbsnews.com/8301-503544_162-20110042-503544.html" target="_self">video</a> of her passionately explaining in plain English that "there is nobody in this country who got rich on his own" went viral and excited Americans who have become frustrated with the inability of politicians in either party to persuasively communicate why the country seems to keep heading in the wrong direction. Warren just might become Senator Kennedy's successor as the leading voice of progressivism in America.</p> <p><strong>7. The End of U. S. Combat Engagement in Iraq. </strong>The U.S.-led invasion that initiated the war in Iraq has widely become recognized as a terrible mistake, launched under false pretenses. Most <a href="http://www.americanprogress.org/issues/2011/12/iraq_ledger_update.html" target="_self">estimates</a> of total deaths exceed 100,000, including nearly 4,500 Americans. More than 30,000 U.S. service men and women were wounded, and many thousands of others are suffering from mental health repercussions. The total cost of the war to the U.S. government is estimated at more than $800 billion, with about another half-trillion dollars to be paid in veterans' health care and disability costs. One clear difference between the presidential candidates in 2008 was Barack Obama's commitment to end U.S. combat engagement in Iraq, and this year he is delivering on that promise. Bringing home the remainder of combat troops from the terrible misadventure in Iraq is an important step toward more constructively re-setting American priorities.</p> <p><strong>8. The Conservative Movement Remains Bereft of Ideas. </strong>At the end of the George W. Bush administration's two terms, it had become clear that the implementation of conservative ideas about governance had produced <a href="http://www.amazon.com/Conservatives-Have-No-Clothes-Right-Wing/dp/0470044365" target="_self">one policy failure after another</a>, culminating in the housing and financial crises that arose in large part due to the absence of meaningful regulation. During the 2008 presidential campaign, Republican nominee John McCain put forward <a href="http://www.washingtonpost.com/wp-dyn/content/article/2008/08/01/AR2008080103061.html" target="_self">no new substantive policy </a>proposals of his own. Now, four years later, it is clear from the scramble for the Republican presidential nomination that leading conservatives still lack any credible ideas for governing effectively. Beyond the usual proposals to further cut taxes for the rich and reduce government regulations -- the same basic agenda that left the country in the mess it is still trying to dig out of -- the Republican candidates demonstrate<a href="http://www.washingtonmonthly.com/political-animal/2011_12/the_gop_policy_problem034102.php" target="_self"> little evidence</a> that they have learned anything from past mistakes. We will find out next year what voters have learned.</p></div> </body> </html> Berwick comes out smoking, but why now? urn:syndication:7bce6d57-24d9-11e1-9cb1-002219154821 http://tcf.org/blogs/blog-of-the-century/6a00e54ffb9698883301543816e5e2970c Dr. Donald Berwick, administrator, until last Thursday, of the Centers for Medicare & Medicaid Services, has been out doing some great television and radio interviews this week. He’s come out swinging about death panels, rationing, the need for universal access to care, quality improvement, and other delivery reforms. 2011-12-12T15:31:35Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>Dr. Donald Berwick, administrator, until last Thursday, of the Centers for Medicare & Medicaid Services, has been out doing some great television and radio interviews this week. He’s come out swinging about death panels, rationing, the need for universal access to care, quality improvement, and other delivery reforms.</p> <div style="float: right"> <img src="http://tcf.org/blogs/blog-of-the-century/6a00e54ffb9698883301543816e5e2970c/image" /> <span></span> </div> <div><p><i>(Cross-posted at the Reality-Based Community)</i></p> <p>Dr. Donald Berwick, administrator, until last Thursday, of the Centers for Medicare & Medicaid Services, has been out doing some great <a href="http://upwithchrishayes.msnbc.msn.com/_news/2011/12/04/9205987-up-exclusive-interview-with-dr-donald-berwick">television</a> and <a href="http://onpoint.wbur.org/2011/12/06/donald-berwick">radio</a> interviews this week. He’s come out swinging about death panels, rationing, the need for universal access to care, quality improvement, and other delivery reforms.</p> <p>But here’s my question: Why now, after Republican filibuster threats have already chased him out of the Obama administration? Why did we roll the same videotape for <a href="http://www.nytimes.com/2011/06/06/opinion/06diamond.html?_r=1&hp">Nobel Laureate Peter Diamond</a>? Also filibustered out of a job, Diamond also came out swinging after his credentials to serve on Federal Reserve Board of Governors were publicly deemed inadequate by that noted monetary authority, Alabama Senator Richard Shelby.</p> <p>Again and again, Republicans block superbly-qualified nominees and officials with the most flimsy justification, and Republicans pay little price for it. A few, such as Elizabeth Warren, are prominent outspoken liberals. And of course the problem reflects the larger dysfunction of the United States Senate. Yet the degree of Republican obstruction is striking when compared to reasonable historical norms. And they repeatedly obstruct the appointments of precisely the kind of respected experts we need to operate American government.</p> <p>For reasons I don’t entirely understand, the Obama administration and Senate Democrats seem to have issued marching orders that quiet their party’s own people facing the harshest Republican attacks. This isn’t making visible progress in getting people confirmed. Moreover, many of those muzzled are also the most articulate advocates for the Obama administration’s signature achievements. Below the fold, for example, is Don Berwick quoted in yesterday’s <a href="http://www.boston.com/Boston/whitecoatnotes/2011/12/don-berwick-five-principles-for-change/qWyl3sMa8yXCFd97qKLF0H/index.html">Boston Globe</a>. We need more people standing up like this, while they are still in office where they can make the biggest difference.</p> <p>Berwick's comments:</p> <blockquote> <p><i>It is one of the great and needless tragedies of this stormy time in health care that the “death panel” rhetoric has denied patients the care that they want, denied caregivers the information they need to give that care, and denied our nation access to a mature, open, informed, and balanced discussion of the challenge of advanced illness and the commitment to individual dignity. It is a travesty. </i><i> </i></p> <p><i>If you really want to talk about “death panels,” let’s think about what happens if we cut back programs of needed, life-saving care for Medicaid beneficiaries and other poor people in America. What happens in a nation willing to say a senior citizen of marginal income, “I am sorry you cannot afford your medicines, but you are on your own?” What happens if we choose to defund our nation’s investments in preventive medicine and community health, condemning a generation to avoidable risks and unseen toxins? Maybe a real death panel is a group of people who tell health care insurers that is it OK to take insurance away from people because they are sick or are at risk for becoming sick. Enough of “death panels”! How about all of us – all of us in America – becoming a life panel, unwilling to rest easy, in what is still the wealthiest nation on earth, while a single person within our borders lacks access to the health care they need as a basic human right? Now, that is a conversation worth having. </i></p> <p><i>And, while we are at it, what about “rationing?” The distorted and demagogic use of that term is another travesty in our public debate. In some way, the whole idea of improvement – the whole, wonderful idea that brings us –thousands – together this very afternoon – is that rationing – denying care to anyone who needs it is not necessary. That is, it is not necessary if, and only if, we work tirelessly and always to improve the way we try to meet that need. </i></p> <p><i>The true rationers are those who impede improvement, who stand in the way of change, and who thereby force choices that we can avoid through better care. It boggles my mind that the same people who cry “foul” about rationing an instant later argue to reduce health care benefits for the needy, to defund crucial programs of care and prevention, and to shift thousands of dollars of annual costs to people – elders, the poor, the disabled – who are least able to bear them. </i></p> <p><i>When the 17 million American children who live in poverty cannot get the immunizations and blood tests they need, that is rationing. When disabled Americans lack the help to keep them out of institutions and in their homes and living independently, that is rationing. When tens of thousands of Medicaid beneficiaries are thrown out of coverage, and when millions of Seniors are threatened with the withdrawal of preventive care or cannot afford their medications, and when every single one of us lives under the sword of Damocles that, if we get sick, we lose health insurance, that is rationing. And it is beneath us as a great nation to allow that to happen. </i></p> </blockquote></div> </body> </html> The Snapshot: The American Public Still Backs Health Reform urn:syndication:ad03a128-1f5b-11e1-8c85-002219154821 http://tcf.org/commentary/2011/the-snapshot-the-american-public-still-backs-health-reform By Ruy Teixeira 2011-12-05T15:52:35Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>By Ruy Teixeira</p> <div style="float: right"> <img src="http://tcf.org/commentary/2011/the-snapshot-the-american-public-still-backs-health-reform/image" /> <span></span> </div> <div><p>The best way to track how Americans feel about the Affordable Care Act is to follow the monthly Kaiser Health Tracking Poll. The latest edition of this poll shows that, despite Americans’ contradictory feelings about the new health care reform law, conservative attempts to repeal it are likely to be met with resistance from the public.</p> <p>On the one hand, more Americans are not in favor (44 percent) than in favor (37 percent) of the new law. But on the other, as the chart below shows, by majorities ranging from 57 percent to 84 percent, they are approve of almost all provisions included in the law. The sole exception is the individual mandate to purchase insurance, where just 35 percent are in favor.</p> <p><img src="http://www.americanprogress.org/issues/2011/12/img/snapshot120211_1.jpg" alt="Chart 1" /></p> <p>These views explain why 50 percent of respondents in the same poll say they would like Congress to either expand the Affordable Care Act or keep it as-is rather than repeal or replace it with a Republican-sponsored alternative (39 percent). It is also worth noting that since February, the number wanting to keep or expand the law has never dropped below 50 percent, while the number wanting to repeal or replace has never exceeded 39 percent.</p> <p><img src="http://www.americanprogress.org/issues/2011/12/img/snapshot120211_2.jpg" alt="Chart 2" /></p> <p>Conservatives are sworn enemies of the Affordable Care Act. These data suggest that their obsessive drive to dismantle the law is unlikely to generate high levels of public support and in fact may yield the contrary.</p></div> </body> </html> Welcome to the Blog of the Century urn:syndication:8c9939fd-d889-11e0-bd49-002219154821 http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330154352f6ed3970c Welcome to a new school year, a new blog name, and welcome to The Century Foundation. 2011-11-15T14:30:03Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>Welcome to a new school year, a new blog name, and welcome to The Century Foundation.</p> <div style="float: right"> <img src="http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330154352f6ed3970c/image" /> <span></span> </div> <div><div>Welcome to a new school year, a new blog name, and welcome to The Century Foundation.<br /> If you’re new here, that makes two of us. I started work just last week as the sixth president of the 92-year-old Century Foundation. I succeed Richard Leone, who served this institution long and well, and who has become a senior fellow.</div> <div><br /> Who are we? We’re a progressive think tank, founded in 1919 and funded by a man named Edward Filene. (You may associate his name with his store’s Basement, which was actually founded as a way to make goods affordable by working people.) At his death in 1937, he was a close associate of President Franklin Roosevelt, and one of the leading liberal businessmen in the country. Along the way, he was a leading champion of fair workplaces and employee ownership strategies, all with an eye to ensuring that economic opportunity was available to all. He thought big and he acted big, beginning by using his business as a laboratory for his ideas and, later, influencing national policy and the New Deal. <br /> Founded in 1919, we were called the Twentieth Century Fund until the end of the last century, and you may have heard of us under that name, or may remember us for work we published by such leading scholars as Gunnar Myrdal, or for our association with progressive thought leaders such as Theodore Sorensen, Arthur Schlesinger Jr., John Kenneth Galbraith, Justice Robert Jackson, J. Robert Oppenheimer, and many more. (A list of past Century trustees can be found<a href="about/former-board-of-trustees"> here</a>, and it is pretty impressive, I think you’ll agree.) And like Filene, who was a lifelong Republican, we embrace a progressive ideology, but are not partisan.</div> <div><br /> We’re not the best-known think tank these days, or the biggest (although we do have, I believe, the second largest endowment of all progressive think tanks). But we aim to turn out important work that can shape public policy debates in this country and around the world. <br /> We provide analyses and convene the best thinkers on questions such as how to make the<a href="economics"> U.S. economy</a> both a stronger safety net and a trampoline for working Americans, understanding what kinds of classrooms<a href="education"> really work for kids</a>, and how the United States can lead in a world of<a href="international"> more diffuse power</a>. Many of these projects, seeded by our endowment, “look around corners” at emerging issues, but we also work to make sense of what is happening today—through this blog, for example, or through one of my favorites, our<a href="special-projects/series/graph-of-the-day/"> graph of the day</a>.<br /> All of that said, and while many things will stay the same here at Century (notably our values), many others are about to change, and I’m glad you’re interested enough to have read this far.<br /> Most obviously (and probably least significantly), we’ve changed the name of our blog. (Our previous blog, which contained lots of memorable material, but under the unmemorable name Taking Note, can be found<a href="http://takingnote.tcf.org/"> here</a>.) A lot of our work is long form—there was a time when we mostly published books on public policy. But these days much of what needs to be said can be said more quickly, and in shorter form. This blog is the place for that, and much more. In re-naming it Blog of the Century, we hope we’ve made it an easier destination to recall, and also a sign that we take the fate of the nation very seriously, but ourselves somewhat less so.<br /> Of course, this Blog of the Century is only one way to follow our work. In addition to our papers, conferences, seminars, and books, there is also our Facebook page (you can become a fan by clicking<a href="http://www.facebook.com/TheCenturyFoundation"> here</a>) and our Twitter feed (follow us<a href="http://twitter.com/#!/search/tcfdotorg"> here</a>). I’d especially invite you to join our e-mail list, which will enable us to send you links to our most interesting work every week or so, perhaps more often as we go along (click<a href="https://app.e2ma.net/app/view:Join/acctId:1407853/signupId:1417824"> here</a> to sign up).<br /> A final word about, ahem, money. I mentioned that endowment. A couple of times. It enables us to take intellectual risks, and to provide a backstop to our work. Major foundation funders and others also underwrite additional work, and we hope to persuade them to do more of that. Beyond this, however, more money simply enables us to do more. So, also starting today, we’ll be asking on our website, and elsewhere, for money from you. It’s tax deductible, and will really make a difference. If you like what you see, I hope you’ll give what you can, <a href="https://npo.networkforgood.org/Donate/Donate.aspx?npoSubscriptionId=985" target="_self" title="Donate Now">by going here</a> and either using your credit card or following the instructions and sending a check.<br /> In any event, thanks for starting the school year with us, and welcome to the Blog of the Century.</div></div> </body> </html> Graph of the Day: Health Care Costs Continue to Rise urn:syndication:e177ba75-0c18-11e1-b683-002219154821 http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330162fc491088970d America's health care crisis may not be the front page news that it was back in 2009 and 2010, but that doesn't mean that costs have come down. On... 2011-11-11T03:40:11Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p> America's health care crisis may not be the front page news that it was back in 2009 and 2010, but that doesn't mean that costs have come down. On...</p> <div style="float: right"> <img src="http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330162fc491088970d/image" /> <span></span> </div> <div><p>America's health care crisis may not be the front page news that it was back in 2009 and 2010, but that doesn't mean that costs have come down. On the contrary, the latest data from the Commonwealth Fund’s <a href="http://www.commonwealthfund.org/Publications/In-the-Literature/2011/Nov/2011-International-Survey-Of-Patients.aspx" mce_href="http://www.commonwealthfund.org/Publications/In-the-Literature/2011/Nov/2011-International-Survey-Of-Patients.aspx">annual report</a> shows that U.S. health care costs are as out of control as ever, and still rising.</p> <p>According to Commonwealth's 2011 report, more than one-in-four sick adults were unable to pay or experienced difficulty paying their medical bills in the past year. Nearly half of patients with complex health problems reported not visiting a doctor, not filling a prescription, or not seeking recommended care because they were worried about unaffordable costs or medical debt. That is double the number of people reporting similar problems in the eleven other industrialized nations that were polled, except for Australia, New Zealand, and Germany. Americans were also found to experience the worst health outcomes, despite spending more per capita on health care than any other country: nearly $8,000 per person annually. The next closest country, Norway, spent nearly $3,000 less.</p> <p><a href="http://tcftakingnote.typepad.com/.a/6a00e54ffb969888330162fc489f05970d-pi" mce_href="http://tcftakingnote.typepad.com/.a/6a00e54ffb969888330162fc489f05970d-pi"><img src="http://tcftakingnote.typepad.com/.a/6a00e54ffb969888330162fc489f05970d-800wi" alt="Health care costs" title="Health care costs" class="asset asset-image at-xid-6a00e54ffb969888330162fc489f05970d image-full" mce_src="http://tcftakingnote.typepad.com/.a/6a00e54ffb969888330162fc489f05970d-800wi" /></a><br mce_bogus="1" /></p> <p>Other data collected by the study reveal some admirable successes. While the American health care system was weighed down by the highest rate of obesity—and consequently three times the average number of diabetes-related amputations—the United States also had the fewest daily smokers of all but Sweden. And despite experiencing the highest number of deaths per capita amenable to health care, Americans also had the best five-year breast cancer survival rate and the most extensive cervical cancer screening program of any industrialized country.</p> <p><br /></p> <p><i>View more from the <a href="special-projects/series/graph-of-the-day/" mce_href="special-projects/series/graph-of-the-day/" target="_self">Graph of the Day Series. </a></i></p></div> </body> </html> The Balancing Act at the Center of Healthcare Reform urn:syndication:d9d23ecc-0a40-11e1-a8f3-002219154821 http://moneyland.time.com/2011/11/08/the-balancing-act-at-the-center-of-healthcare-reform/ Maggie Mahar published in TIME Moneyland. 2011-11-08T19:11:10Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p>Maggie Mahar published in TIME Moneyland. </p> <div style="float: right"> <img src="http://tcf.org/in-the-news/2011/11/the-balancing-act-at-the-center-of-healthcare-reform/image" /> <span></span> </div> <p>http://moneyland.time.com/2011/11/08/the-balancing-act-at-the-center-of-healthcare-reform/</p> <div><p>Maggie Mahar published in TIME Moneyland.</p></div> </body> </html> There Is No "Silver Lining" in Repealing Insurance Mandate urn:syndication:4cf39223-0733-11e1-8e24-002219154821 http://tcf.org/blogs/healthbeat/6a00d8341d843653ef0162fc23eb05970d Earlier this week, as the Supreme Court continued to mull over which of the four legal challenges to the health reform law they will choose to... 2011-11-04T18:23:22Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p> Earlier this week, as the Supreme Court continued to mull over which of the four legal challenges to the health reform law they will choose to...</p> <div style="float: right"> <img src="http://tcf.org/blogs/healthbeat/6a00d8341d843653ef0162fc23eb05970d/image" /> <span></span> </div> <div><p>Earlier this week, as the Supreme Court continued to mull over which of the four legal challenges to the health reform law they will choose to tackle, I found out that, in fact, there could be a “silver lining” to the repeal of the individual mandate—the requirement that all Americans purchase health insurance.</p> <p>In a post on <i>Politco</i>, <a href="http://www.politico.com/news/stories/1111/67393.html" target="_blank">Jennifer Haberkorn writes</a> that some “Democrats and supporters of the law” believe that if “the least popular part of the law goes away, they think what’s left could become stronger and more popular with the public."</p> <p>And who are these Democrats and supporters who take such a rosy view of what could be a huge disaster for Obama’s health law? The article quotes “strategists” and “pollsters” whose main concern is whether the President will be reelected next year. These folks, who supposedly are taking the pulse of Americans, report strong support among consumers for some of the Affordable Care Act’s provisions like guaranteed coverage for preventive care, maternity benefits, and the ability to keep children up to age 26 on their parent’s health plan.</p> <p>Sure, these are popular provisions, but they are not the most important parts of the ACA. The real power to transform health care and extend coverage to the 50 million uninsured is the requirement that no one be denied affordable insurance because of age, pre-existing condition or sex. It is also vitally important that the government offers subsidies to those who can’t afford premiums, and that Medicaid is extended to cover the working poor who make up the largest group of uninsured. There are many more provisions of the health law that we’ve discussed in great length on this blog over the last two years; reforming Medicare and the way services are delivered; increasing funding for community health centers; and insurance exchanges that allow consumers to choose coverage that best fits their needs.</p> <p>Without the individual mandate, many of the so-called “popular” parts of the health law become unaffordable and unlikely to come to fruition. Without every one “in the pool,” a significant number of the young, healthy, so-called “invincibles” will opt out coverage, while the majority of those who are sicker, older and utilize the most services will opt in. Like we just saw with the ill-fated CLASS Act and long-term care, without a mandate, real, transformative health reform becomes impossible.</p> <p>While formulating my own response to the absurdity of the “silver lining” reasoning, I came across a great piece by<a href="http://theincidentaleconomist.com/wordpress/will-anyone-benefit-from-the-removal-of-the-individual-mandate/" target="_blank"> Aaron Carroll at The Incidental Economist site </a> that puts the whole silver lining argument to bed:</p> <p>Carroll writes, “I have yet to see any convincing data that show there’s a significant portion of America that loves the ACA, but hates the mandate. I see no politicians running on a platform of removing the mandate, but leaving the rest of the law intact. I see no reason to believe that dropping the mandate will do anything to increase support for the President, the Democrats, or the ACA.<br /><br />“But that’s besides the point,” he continues. “The politics are silly. What matters is what will happen to actual people.”<br /><br />Carroll fashions some simple, yet compelling graphs using <a href="http://www.americanprogress.org/issues/2010/08/three_legged_stool.html" target="_blank">data originally derived from this post by Jonathan Gruber at The Center for American Progress</a> to show how getting rid of the mandate will increase insurance premiums, while at the same time decreasing the number of people who will be covered.</p> <p>Insurance premiums will go up, by an average of 25% over the next decade if we repeal the individual mandate:</p> <p><a href="http://thecenturyfoundation.typepad.com/.a/6a00d8341d843653ef015392ce970e970b-pi"><img src="http://thecenturyfoundation.typepad.com/.a/6a00d8341d843653ef015392ce970e970b-800wi" alt="Mandate-Premiums-500x399" class="asset asset-image at-xid-6a00d8341d843653ef015392ce970e970b" title="Mandate-Premiums-500x399" /></a></p> <p> </p> <p>And the number of uninsured now covered will drop from 32 million under the ACA to 7 million without the mandate:</p> <p><br /> <a href="http://thecenturyfoundation.typepad.com/.a/6a00d8341d843653ef0162fc23e359970d-pi"><img src="http://thecenturyfoundation.typepad.com/.a/6a00d8341d843653ef0162fc23e359970d-800wi" alt="Mandate-Coverage-2-500x393" class="asset asset-image at-xid-6a00d8341d843653ef0162fc23e359970d" title="Mandate-Coverage-2-500x393" /></a><br /><br /><br />The bottom line is that there is no sliver lining if the Supreme Court strikes down the individual mandate. It is a necessary part of the health legislation and repealing it will not signal the end of the other provisions signed into law last year. It will be very difficult for opponents to dismantle the ACA—but without the mandate, the financial viability of universal health coverage becomes far less certain.</p></div> </body> </html> Why we do social policy experiments—the impact of low-poverty neighborhoods on women’s health urn:syndication:564a91d7-03ca-11e1-9438-002219154821 http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330162fc00f8b1970d In 1971, the cancer researcher Sidney Farber testified before Congress regarding what would become the war on cancer. At the time there was a... 2011-11-04T15:35:03Z <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <body> <p> In 1971, the cancer researcher Sidney Farber testified before Congress regarding what would become the war on cancer. At the time there was a...</p> <div style="float: right"> <img src="http://tcf.org/blogs/blog-of-the-century/6a00e54ffb969888330162fc00f8b1970d/image" /> <span></span> </div> <div><p>In 1971, the cancer researcher Sidney Farber testified before Congress regarding what would become the war on cancer. At the time there was a bitter dispute between those who argued for rapid clinical trials of potential therapies, and those who wanted greater emphasis on basic research into fundamental causal mechanisms rooted in cell biology. Farber was emphatically in the first camp.</p> <p>As he<a href="http://books.google.com/books?id=5rF_31RVTnMC&pg=PA105&lpg=PA105&dq=325,000+patients+with+cancer+who+are+going+to+die+this+year+cannot+wait;+nor+it+is+necessary,+to+make+great+progress&source=bl&ots=ulTMxZDBea&sig=j3ppNF-oeyy1mnj3MBbmESN3otQ&hl=en&ei=LjKsTt_XL6GqsQKc5-ydDw&sa=X&oi=book_result&ct=result&resnum=2&ved=0CCUQ6AEwAQ#v=onepage&q=325%2C000%20patients%20with%20cancer%20who%20are%20going%20to%20die%20this%20year%20cannot%20wait%3B%20nor%20it%20is%20necessary%2C%20to%20make%20great%20progress&f=false" target="_self"> put things</a>:</p> <blockquote> <p>We cannot wait for full understanding; the 325,000 patients with cancer who are going to die this year cannot wait; nor it is necessary, to make great progress in the cure of cancer, for us to have the full solution of all the problems of basic research… The history of medicine is replete with examples of cures obtained years, decades, and even centuries before the mechanism of action was understood for these cures – from vaccination, to digitalis, to aspirin.</p> </blockquote> <p>What a fascinating comment. What Farber said--and what he didn’t say--still marks a fault line in both social science and policy analysis. There are important insights on both sides, which I will discuss on another occasion.</p> <p>When it comes to social policy, I’m maybe seventy-five percent in Farber’s camp, too. To be polite, social science theoretical models and available data don't quite match the frontiers of cancer research.</p> <p>Our underlying behavioral models are really pretty poor. Even if these models were better, they wouldn't automatically translate into effective clinical or policy interventions. Elaborate non-experimental statistical methods are even weaker guides. So a good experimental study of a feasible intervention is incredibly valuable.</p> <p>That’s one reason I try to closely follow the Movement to Opportunity (MTO) experiment, which sought to facilitate the movement of low-income African-American and Latino families from high-poverty to low-poverty areas.</p> <p>MTO’s mixed findings have disappointed many advocates and policymakers. The benefits of residential mobility appeared more modest and varied within MTO’s rigorous experimental design than previous non-experimental studies had led many people—me, for instance--to expect. Families offered the opportunity to move into low-poverty communities appeared no more likely to exit welfare or to achieve economic self-sufficiency. Girls displayed improved educational, psychological, and behavioral outcomes in low-poverty communities. Yet for some reason boys seemed to do worse. The impact of MTO on children and youth’s academic outcomes was much smaller than we would hope to see.</p> <p>The MTO experience is also chastening because it highlighted the many and diverse barriers that hinder families’ residential mobility. Only about half of the families offered vouchers to move into low-poverty areas chose to do so.</p> <p>Given the mixed findings, it’s easy to overlook the very real benefits many families experienced. They lived in safer, more cohesive neighborhoods and were less likely to have been recent victims of crime. Women experienced reduced mental health difficulties.</p> <p>And, in the latest study published last week in the <i><a href="http://www.nejm.org/doi/full/10.1056/NEJMsa1103216">New England Journal of Medicine</a></i> by my colleague Jens Ludwig and others, these women were markedly less likely to satisfy screening criteria for diabetes.</p> <p>What accounts for these benefits? We don’t exactly know. Yet this finding and others indicate that we really can help low-income families by assisting their efforts to move into more prosperous and safer communities. More <a href="http://theincidentaleconomist.com/wordpress/weekend-edition-neighborhoods-obesity-and-diabetes/">here</a>.</p></div> </body> </html>