Coming soon: ‘Repeal of the Job-Killing Health Care Act’ – Part II?


Professor Victor Rodwin writes:

The House vote to repeal what critics call “Obamacare” (the Patient Protection and Affordable Care Act – ACA — signed by President Obama on March 23, 2010) was a key part of the GOP campaign to win back the House of Representatives in the November elections. It worked as an effective mobilizing call to arms.

HR2  (Repeal of the Job-Killing Health Care Act) passed the House by a vote of 245 to 189 on January 19, 2011. The Senate, however, killed the bill February 2, and the issue receded to a background murmur. Republicans and Democrats have drawn their swords over the President’s budget, instead.

Still, repealing the health care act is likely to return to the political agenda. House Speaker John Boehner (R-Ohio) states that “The Congress can do better in terms of replacing Obamacare with common sense reforms that will bring down the cost of health insurance and expand access for Americans.”

To assess such a proposition, one would have to know more details about his party’s solutions. But proposals so far are conspicuously absent.

After Congress passed the ACA, Boehner called it a “dangerous experiment.” Texas Gov. Rick Perry called it “socialism on American soil.” Many of their Republican colleagues have reread the script used by the American Medical Association (AMA) in opposing extensions of health insurance coverage propounded by President Franklin Roosevelt, Harry Truman, Lyndon Johnson and Bill Clinton. They suggest that the ACA will result in a “government take-over” of American medicine, at worst, and “government-run” health care, at best.
But such attacks are dangerously misleading because they distort present realities and generate ill-founded fears.

We already have a massive government role in American health care; and for good reasons. We have socialized expenditures for our highest-risk populations – the elderly and severely handicapped (Medicare) and for the very poor (Medicaid) —  and we have a system of socialized medicine for our military veterans, which delivers health care of higher quality than what is received by the average American.

At the same time, most health care in the U.S. is provided by private non-profit hospitals and private doctors reimbursed on a fee-for-service basis. Clinical decisions remain largely in the hands of our physicians and to the extent that there has been increasing intervention and regulation of these decisions, it has come most forcefully from private insurance companies. Meanwhile, we have more government expenditure of biomedical research (NIH) and public health (CDC) than any nation in the world. And the system produces staggering rates of innovation in pharmaceutical research, medical devices and medicine.

The ACA is largely a bipartisan, half-way reform strategy inspired more by former Republican Governor Mitt Romney of Massachusetts than by left-leaning advocates of single-payer health insurance reform. It does not nationalize the health insurance industry. It does not increase the share of public hospitals. It does not set uniform prices for hospital and physician payment across all payers. And it does not assure universal coverage.

At best, the ACA, if implemented in 2014, will begin to increase coverage to 32 million of the more than 50 million Americans who are currently uninsured. It will achieve this objective through Medicaid expansion and the creation of health insurance exchanges that will strengthen federal regulation of the private health insurance industry through the prohibition of risk selection by insurance companies (the ban on refusals to cover pre-existing conditions and to set annual and life-time limits on coverage).

Finally, the ACA, passed before the extension of the Bush tax cuts for the wealthiest Americans, begins to reverse the post-Reagan policies of increasing income inequalities. It does so by increasing the existing Medicare payroll tax on all those earning over $200,000 ($250,000 for couples).

These are significant, but modest, steps toward what political scientist Jo White calls the “international standard” among health systems in wealthy capitalist democracies – Japan, Germany, France, United Kingdom, Canada, Switzerland, Australia, Netherlands, and many more.

This standard, met by all governments in such nations, either imposes taxes on its citizens or enforces a health insurance mandate to provide access to a minimum level of health care services. Without taxes or a mandate, there can be no universal health insurance coverage. Without universal health insurance coverage, we cannot meet the international standard.
 

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Thoughts for the New NYC Schools Chancellor, Cathie Black


Amy Ellen Schwartz writes:

Cathie Black’s appointment as New York City Schools Chancellor came at a difficult period. While her predecessor, Joel Klein, enjoyed swelling public coffers and large increases in per pupil spending, Chancellor Black takes office at a time when the budget is shrinking, certainly significantly and maybe substantially.

At the same time, while Chancellor Klein claimed standardized test results “proved” his reforms were working, the recent adjustments in those metrics have fueled doubt about whether – and to what extent – his hallmark strategies such as replacing large comprehensive high schools with new, small schools and increasing school autonomy “worked”. Even more, the turmoil created by opening and closing schools – and the attendant expense — raises questions about the sustainability of these reforms.

Bottom line: Cathie Black faces considerable challenges in the months ahead and it behooves us to help her succeed. In that spirit, I offer the following suggestions.

Beyond “What Works”: While education officials and policy makers tout the importance of finding out “what works”, we need more than that. We need to figure out “what’s worth the money” or what gives the biggest bang for the public buck. Is the high cost of new small schools worth the money, or would we do better to invest in\mid-size schools or schools-within-schools? Unfortunately, relatively little attention has been paid to the costs of interventions and reforms and so the evidence base is thinner than it should be – this is a gap that needs to be filled.

Special Education is Critical:
Between 2002 and 2008, full-time special education students increased by 20 percent, from just over 82,000 to over 98,000. (That’s an increase from 7.5 to 9.5 percent of total enrollment.) At the same time, direct per pupil expenditures for special education increased 31 percent. Together, this means that Special Education eats up a larger and larger share of the budget, threatening to crowd out spending and services for general education students. (My forthcoming paper with Leanna Stiefel provides more detail.) While federal and state rules and regulations place significant restrictions on classification, services, and so on, the school district can and must find ways to deliver required services in the most cost effective way possible.

Don’t overestimate the value of value-added: Although evaluating the efficacy of teachers and schools using test score based value-added measures has undeniable intuitive appeal, the usefulness of these measures in improving schools now is much more limited than the publicity might suggest. For one thing, value-added measures can only be calculated for a fraction of teachers in NYC public schools. (Currently, only about one in five.). More importantly, however, it seems unlikely that value-added scores will identify significant numbers of previously unidentified “bad teachers” that can then be dismissed to make way for (or save the jobs of) otherwise-hidden ‘great teachers”. I am certain that value-added analyses have an important role to play in education policy and practice in the long run – and equally confident that the short-run returns will be fairly small.

Moving Matters:
Chancellor Klein was fond of saying that much of his reform efforts were guided by a desire to create a system of good schools and not a good school system. In practice this meant that accountability fell to individual schools for the students currently enrolled. Who, then, is responsible for making sure that students enroll in schools that can provide the services they need? That they choose “well”? In a different vein, a growing body of research shows that student mobility between schools- prompted, say, by family dissolution, foreclosure, or behavioral or academic problems – harms their performance and, potentially, affects their peers. Helping students navigate between schools, adjust to new environments, and succeed will mean attention and accountability for the school system and not just a collection of good schools.

One of my colleagues once claimed that every home in New York City was within walking distance of one of the best public schools in the country…. and one of the worst. As a parent and alum of the New York City public schools, I wish Cathie Black the best of luck in her effort to make all of our schools better.

References

Stiefel, L., Schwartz, A. E. (2011). “Financing K-12 Education in the Bloomberg Years, 2002-2008″ in Jennifer A. O’Day, Catherine S. Bitter and Louis M. Gomez (Eds.), Education Reform in New York City: Ambitious Change in the Nation’s Most Complex School System (pp. 55-84). Cambridge MA: Harvard Education Press.
Stiefel, L., Schwartz, A. E., Conger, D. (2010). “Age of Entry and the High School Performance of Immigrant Youth.” Journal of Urban Economics, 67:303-314


Bill Drayton: The Gentle Visionary


Bill Drayton.jpg

If your idea isn’t fitting (your vision), you can change
it. If the world isn’t fitting you idea, you can sometimes change it as well.” -Bill
Drayton

To many in the field of social entrepreneurship, Dr. Bill
Drayton is not only a founder of the field but also a visionary. He has
consistently iterated his approach to social change and in the process assisted
millions of people in countries across the globe. 

NYU Wagner and the Catherine
B Reynolds Program in Social Entrepreneurship were lucky to host Dr. Bill
Drayton for a series of events last week. Since it began 30 years ago, Ashoka has provided seed capital to more than 7,000 high-impact social entrepreneurs. The average number of people served by
these high-impact social entrepreneurs is 174,000 and more than half of them
change government policy through their innovation. These entrepreneurs don’t just teach a man to
fish; instead they change the entire fishing industry, government fishing
policies and ultimately the world’s perception of fishing.

After spending time interviewing Drayton, who insists on
being called Bill, here are some tips this gentle, humble, kind and powerful
visionary feels like all of us at NYU need to consider:

 1.      
The Biggest Barrier to Creating Change is Not
Giving Yourself Permission

Our biggest barrier to creating change is actually
ourselves. Drayton advises, “All
those people who tell you you can’t do things. Be polite; but ignore them.” So
stop listening to the naysayers. Allow yourself to look at a problem, develop a
large scale solution, implement that solution and then constantly refine it as
you work to change the system. Give yourself permission to be great, and just
go do it.

2.        Collaborative Entrepreneurship is Key

If you’ve been at NYU Wagner for any period of time you’ll
have already been in a number of group projects. Although we might all struggle
with Wagner’s obsession with teams Dr. Drayton agrees that collaboration is
key; “We’ve learned (at Ashoka) how to create the most powerful force in the
world- collaborative entrepreneurship.”

Five years after receiving an Ashoka Fellowship an average
of 97% of Ashoka Fellows are still working on their project, 88% of their
projects/organizations have been copied and 55% have changed government policy.
These are extremely powerful people, correcting ineffective systems or simply
creating new ones. Drayton explained
that when these visionaries work in teams they have an even greater exponential
effect on changing a particular system. Therefore, Drayton encourages
social entrepreneurs to consider ‘collaborative entrepreneurship’ and openly
admired Wagner and The Reynolds Program’s commitment to team spirited
innovation. 

3.      
Learn it Young

Drayton also emphasized how incredibly important it is
for children and young adults to learn that they can create change. Most, if
not all, of Ashoka’s fellows started their changemaking path very early in life
and can trace when their hunger for change first began. He noted how those
experiences, at a young age, serve to enforce a person’s empathy, their
confidence and helped to develop their change-making skill set. This idea forms the basis of Ashoka’s Youth
Venture Program, which is designed to give young people an opportunity to
implement their vision of change and learn the associated skills before the age
of 20.

So the next time you are working with a youngster, whether
they’re your student or your younger brother, try to create conditions whereby
they can realize their power to change the world.

4.       Times are Changing and Everyone is a Changemaker

Drayton firmly believes that society’s traditional
hierarchal structure, in which most of the world’s resources are concentrated
in the hands of a few, is quickly disintegrating. As information technologies shrink the
boundaries between cultures and countries, Drayton firmly believes that the
world will soon be a much ‘flatter’ place (I mean he’s right- just look at Egypt). And
those who cling to the old, hierarchal way of doing things will be lost along
the way. He emphasizes the need for the world to change into a place where
‘everyone is allowed to be a changemaker.’ 
From businesses that allow each employee, from the janitor to the CEO,
to voice their vision for the company’s future to a country’s democratic,
government structure, Drayton
believe it is time we embrace every person’s voice.

 5.      
NYU Wagner and Reynolds are ‘Islands of Change’

Throughout our interview and throughout his speech Drayton continued to praise the entrepreneurial and collaborative efforts of
NYU Wagner and the Reynolds Program. He even suggested that, “The Reynolds
program is an island of what the world will be like.” He believes that only a
university committed to social innovation, entrepreneurship and empathy will
succeed in the coming years. And he believes that NYU is perfectly situated on
the cusp of that paradigm shift. 

It is no wonder NYU Wagner and NYU Reynolds are already such close
friends of Ashoka.

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Egypt’s Uprising in Focus, in Two Parts


Thumbnail image for Tahrir Square.jpg

As Egypt‘s younger generation mount million-strong demonstrations
for “Bread, Freedom and Social Justice” — as one protester’s sign
read — the shock waves from the uprising have reverberated through the
government of Hosni Mubarak, the White House, and the digital
tentacles of students and other pro-democracy sympathizers in every corner of
the globe.

On
February 7
 & 8, 2011, NYU Wagner and its Research Center for
Leadership in Action (RCLA)
 launched public discussions illuminating
some of the less-visible aspects of the revolt, its better-known causes, and
where this history-changing moment may lead.

In the first of these two events, which drew nearly 150
students altogether, Natasha Iskander, assistant professor
of public policy, and Waad El-Hadidy,
senior associate for RCLA, began by showing photos and YouTube videos capturing
the good cheer and thoroughly Egyptian-style humor on display
on the streets of downtown Cairo — such as many makeshift hats worn by demonstrators,
fashioned from chunks of asphalt or plastic water bottles, and fastened with
scarves.

Another video showed a young Egyptian woman’s impassioned
plea for reform of the country’s political process.

Remarkable, said Iskander, was the nonviolent nature of the
demonstrations, a feature she called “historic in its own right,”
especially given the distributive, leaderless character of the protests.

“The protesters are everybody,” she said.

And the issues animating them transcend lines of religion,
class, and generation, Prof. Iskander and El-Hadidy said. Even in the wake of
the Mubarak government’s unleashing of thugs on camels and horses to storm the
crowds, the police kidnap and detention of journalists and activists, and the
sewing of civilian chaos to erode the movement’s public support, the protesters
as a whole appeared free of bitterness toward the Egyptian authorities. It’s a
reflection of the socially intimate nature of life in Egypt, a place,
said Iskander, where police and army personnel live as neighbors with the
people now taking to the streets, and their families.

“This is a real turning point in the history of Egypt,”
said Iskander, speaking of the spontaneous mass movement, although she
cautioned that knotty issues will require negotiators to emerge, and
negotiation, such as election reform. These matters go beyond the immediate
question of Mubarak’s hold on power, and are more complex.

Still, the uprising beginning Jan. 25 ” took the world
by surprise, it took the people of Egypt by surprise, it also took the
demonstrators by surprise,” said El-Hadidy.

Thumbnail image for Egyptian Revolution.jpgOn Feb. 8, the second discussion, moderated by El-Hadidy,
featured: Mona Eltahawy, a frequent CNN guest analyst on Arab
and Muslim issues; Karim Tartoussieh, who is writing his dissertation at NYU on
digital disobedience, culture and citizenship in Egypt; Omar Youssef Cheta, a
PhD candidate in the joint program in Middle Eastern and Islamic Studies, and
History at NYU; and Rania Salem, a doctoral candidate at Princeton. Joining
Wagner and RCLA in sponsoring the panel discussion was the John W. Draper Interdisciplinary Program
at the College of
Arts and Science at NYU.

The day’s speakers described the sparks precipitating the
protests, ranging from the government’s growing use of summary arrests and
police brutality, to the lack of good prospects for younger people, who
represent a third of the population, to the Tunisian revolt that toppled that
country’s longtime ruler. Facebook and YouTube, too, brought people out to the
streets, and  Eltahawy noted that Egypt’s release  of Google
executive Wael Ghonim, a key figure behind the Facebook and YouTube push,
was galvanizing the movement as she was speaking.

He’s a 30 year old who scared the crap out of a 30 year old
regime,” Eltahawy said, predicting Ghonim could become one of the
pro-democracy movement’s most important representatives in the tense and
uncertain days to come.

View
pictures from Egypt
.

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Department of Buildings Commissioner Urges New Yorkers to Realize Maximum “MPG” From Our Buildings


New York University's Puck Building at 295 Laf...

Image via Wikipedia

As chilly winter weather has NYU Wagner students turning up the
heat in their apartments, the recent event “Greening Gotham: The Rise of
Energy-Efficient Buildings and the Road Ahead” was an inspiring reminder to consider
energy use in our homes, offices and the city at large. Introducing New York
City Department of Buildings
Commissioner Robert LiMandri, Wagner Associate
Dean Tyra Liebmann noted the irony of the last-minute change in venue: The burst
pipes that flooded the Puck Building, forcing the event to move to the Kimmel
Center remind us “of the important role that buildings play in our lives, both in
keeping us safe and healthy and in fostering community.”

The importance of the city’s buildings, as well as the work
of the DOB, was a sentiment echoed by first-year urban planning student Scott
Hobbs, who met LiMandri when he was an Urban Fellow working at the department. Hobbs pointed out recent
successes of the DOB as well as new programs it has recently launched, such as
public art installations at construction sites.

Once on stage, LiMandri called on a volunteer to
describe what she considered when deciding to move into her Queens
condo, and while transit access and pet policies were on her list, the types
and costs of the building’s energy systems were not. According to the
commissioner, New Yorkers rarely consider the energy efficiency of our homes
prior to purchase. And while New York City utilizes voluntary programs (such as
LEED certification), mandates (such as the new, greener energy code) and
incentives (like tax abatements for solar roofs) to green the city’s 1,000,000
plus buildings, it is up to individuals to make choices that will move the New
York region toward a more energy-efficient future.

After describing how New York City agencies are working
towards a greener built environment in the five boroughs, LiMandri emphasized
that while energy-saving strategies such as cool roofs, street trees and solar
energy
save money, more importantly, they enhance livability in our cities. He
made clear that the choices we make today, both about our overarching policies
and our individual actions, will affect the health and well-being of future
generations.

When the commissioner took questions from the audience,
there were multiple concerns about the efficacy of the LEED building rating
system, which awards points based on predicted, rather than actual, energy
savings. In response, LiMandri recommended retro-commissioning every 10 years,
likening it to regular car tune-ups: “It’s not only how you drive, but how well
you maintain your vehicle.”

The commissioner’s remarks demonstrate that the DOB, far
from being an agency stuck in the ways of the past, is forward-thinking and
actively engaged in the most pressing problems facing our built environment.
But he was quick to note that “it’s not about over-regulation, it’s about
enabling.”

We are all able to take a stand and do something about
sustainability in our cities. Volunteer to paint a roof white as part of the
Cool Roofs Program, plant a tree and talk to your landlord about the energy
efficiency of your building–after all, you’re paying for it!

Listen to a podcast of the event and check back for a slideshow presentation.

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