Tag

obama

Mar 28
0
ruler

Why We Measure

By | Art & Social Change, Art That Counts | No Comments

Moving briefly away from the nitty-gritty of metrics, I want to spend some time on the bigger-picture: namely, why we measure and what is measurable.

Why do we measure results of an art project or nonprofit? Artists and nonprofits seek out metrics for several reasons — to provide required metrics for a grant application or report; to prove that donations were used well; to evaluate programming for renewal or expansion; to establish their successes and shortcomings in achieving their mission.

Basically, these motivations can be divided into two types:

  • because someone else wants the data (e.g., donors, grantmakers, government agencies).
  • because the artist/organization has an interest in self-assessment.

In the case of the former, groups have little to no investment in the data itself, only in the outcome. In the latter, however, the motivation to establish the value of the organization or project indicates an investment in what is measured and the story that can be told using that data. (Also, as I wrote previously, frustration with the metrics required by funders can result in organizations getting invested in adopting metrics relevant to their specific mission and programs.)

As Andrew Taylor wrote recently,

If you care internally about good decisions, and metrics will help you (and they will, if they’re specific), then measure. If you are specifically aware of external value that will flow your way if you can express your impact in specific ways, then measure. If neither of these is true, then really, don’t bother. Measuring won’t make a measurable difference.

Measuring for the sake of measurement sends you down a rabbit hole of wasted time and energy. In order to achieve metrics that are worthwhile and reliable, requires establishing goals, monitoring/soliciting data, sorting and analyzing the data and sharing it with stakeholders/leaders. These are not simple tasks, as highlighted by Bill Gates in his 2013 Annual Letter for the Bill and Melinda Gates Foundation:

You can achieve amazing progress if you set a clear goal and find a measure that will drive progress toward that goal-in a feedback loop […]. This may seem pretty basic, but it is amazing to me how often it is not done and how hard it is to get right. […]  I think a lot of efforts fail because they don’t focus on the right measure or they don’t invest enough in doing it accurately.

But what’s the right measure? And what is actually measurable? It’s fairly common for nonprofits and community art projects to be able to establish some basic facts and figures relating to attendance, demographics, and dollars raised. Sometimes these are enough to demonstrate impact or value in a short-term way, but, in general, the results side of nonprofits remains complex and difficult to measure. Just as website analytics have evolved beyond mere clicks and page views to developing a relationship ladder (e.g., converting visitors into subscribers), nonprofits should be willing to investigate and pillage the metrics used by other industries:

All efforts can benefit from these approaches — in both looking beyond our immediate sphere for inspiration, and in stepping back and asking exactly why we want to measure in the first place.

IMAGE CREDIT. CC photo via Flickr user cAtdraco.
Mar 19
0

A Brief History of Belt-Tightening

By | Health | No Comments

When Barack Obama announced health reform as a part of his first presidential campaign, the cost of healthcare was never a major priority. Expanding coverage was always the main intent despite the fact that the United States spends more on health care than any other country in the world, reaching almost three trillion dollars or about 17 percent of the nation’s GDP. So if you’re going to attempt comprehensive health reform, why wouldn’t you have cost control included? If you take a look at other attempts of cost control in the past, you can see how the piece-meal attempts have not gotten close to fixing the problem.

The last time a president directly controlled health care costs was in 1971 under President Nixon with his executive order to freeze wages and prices. His Cost of Living Council allowed physician’s fees to increase by only 2.5 percent a year but its authority expired in 1974. The council however, did spark in interest into looking at how hospitals were paid, which were at that time on a per diem basis. The department of Health, Education and Welfare then came up with a payment system based upon diagnosis, now called the Diagnosis Related Grouping (DRG) system and widely used throughout the world. In 1984 Medicare adopted DRG, which is based upon the average cost of treating a patient per a particular diagnosis. During Nixon’s time in office Medicare also changed to have a regulated room and board cost to all hospitals and limited the per diem cost, which was not regulated. Yet, eight states at that time decided to control the rates that Medicare paid to hospitals, and today Maryland is the only state left standing.

After Nixon sparked the idea of health reform and cost containment, President Ford attempted a unique approach. Under the National Health Planning and Resource Development Act, local planning agencies were created to approve new facilities or buy expensive equipment. The agencies were presented with Certificates of Need (CON) to determine if spending was appropriate. The program was inefficient as CONs sometimes were too hard to get, and was eventually eliminated under President Reagan.

Then we have President Carter who was ambitious with his attempt at cost control. Twice during his presidency his proposals for limiting hospital’s total revenues were defeated. At this time, congress must have been feeling pretty optimistic as they agreed to have hospitals voluntarily contain costs. And that policy is still in use today.

The next attempt at cost control was under the Balanced Budget Act of 1997 that proclaimed physicians’ fees would decrease in the future if they exceeded a targeted amount set the previous year. It was enacted for the first two years, but since 2002 congress has postponed the decrease each year and has even allowed small increases. So much for that!

From past attempts at controlling costs, it was obvious a total re-haul of health care spending would be difficult. Obama knew he had to start (somewhat) small to pass something. Though it was an absolute battle to pass, it was a walk in the park compared to what could have been, or what could have never happened at all.

Nonetheless, Obamacare has a few provisions that will feebly attempt to control costs, mostly through regulation of insurance company administration costs by adopting a set of standards (all effective by January 2016) and through Medicare. Medicare Advantage plans have been greatly subsidized in the past, but will be greatly reduced by 2019. Also, the Independent Payment Advisory Board (IPAB) will establish growth spending rates by 2018 and will decrease funding if Medicare exceeds this target.  The other provisions allow for tests or trials to control, such as centering care around primary care physicians, which is why many preventative services are free of cost.

Most of the cost control attempts in Obamacare are experimental. And USA Today claims that in the past three years Obamacare has slowed health care spending growth. Others would strongly disagree. Considering we spend the most on health care in the world, and have the 38th best health system (it makes me cringe to say this), Obamacare is better than nothing.

IMAGE CREDIT. Emory University.
Feb 19
0

Obamacare Keeps Calm and Carries On

By | Health | No Comments

The final count is in! The federal government will be providing health insurance exchanges for 26 states. On February 15th, states had their last chance to opt for a federal partnership to run an exchange – essentially an online marketplace for health insurance. States will always have the option to take control of the exchanges themselves (which the feds would prefer), but for now only the other 24 states have chosen to set up their own and have them running by October 1st of this year.

Some states were skeptical that they would have the funds and manpower ready to meet that deadline. But many Republican-led states simply refused to run their own exchanges because they didn’t want to be a part of Obamacare, despite the fact that most Americans agree that exchanges will work best under state control. The department of Health and Human Services ideally wanted all of the states to take control of the exchanges and will have to work hard to adjust its original plans, as has so often been the case for Obamacare. The story of the president’s signature reform has been one of change.

Indeed, that we have exchanges at all is the result of a shift in position. The basis for the exchanges is the individual mandate, which requires all U.S. citizens (with certain exceptions) to have health insurance by January 1, 2014. Originally, President Obama was against the individual mandate – a topic hotly debated in his primary battle with Hilary Clinton. Once president, he saw that there was no other choice. Without the mandate, the government couldn’t require insurers to turn away sick people as some people might wait until they were sick to buy insurance.

As of now, uninsured people with pre-existing medical conditions have been able to enroll in the government’s Pre-Existing Condition Insurance Plan, but the Obama administration announced Friday that they had to cap the plan due to financial restrictions. Other changes have been made since Obama originally proposed his vision for health reform. Obama had wanted to include a public option or a publicly-run insurance plan (similar to Medicare, which is government-run) to compete with the private insurers in the exchanges. This would potentially drive down insurance premiums and lower administrative and medical service costs.

But a public option would be tricky to get right since it wouldn’t work if too many people were enrolled, or too few. If enrollments in a public option were too numerous, providers wouldn’t be able to “cost shift” – currently, by charging higher premiums to private, fee-paying patients, doctors and hospitals gain back losses from providing services to Medicare patients, Medicaid patients and the uninsured. Conversely, if there were severe enrollment restrictions and too few people were enrolled in a public option, it would most likely be those with a high risk. This would leave the public option bankrupt and private insurers rolling in the dough from having so many healthy people enrolled.

And of course a public option is considered by conservatives to be a first-step toward a single-payer health system (a health system in which one entity pays for all health services), which liberals would cheer, but which they believe to be dangerous government intrusion on the workings of the market.

As a compromise on the public option, the Senate offered a Medicare expansion to enroll people at the lower age of 55. Neither this nor the public option could get passed so the Consumer Operated and Oriented Plan (CO-OP) was born. A CO-OP is a non-profit insurance plan controlled by the patients it insures and must be included in all state exchanges. The government is offering low-cost loans to both new groups and existing ones. Twenty-four states have received loans and their CO-OPs will be highly monitored to make sure they will repay loans and are meeting goals.

Even after clearing so many obstacles, many are still skeptical the plan for Obamacare can be carried out. Will a federal exchange be ready by October? For one, it’s an enormous feat of information technology and logistics that will need to connect many government departments such as Homeland Security (to verify citizenship) and the IRS (to determine subsidy eligibility). By July, insurance plans for the exchanges are expected to be chosen, but will HHS have and choose the best plans?

Could the federally-run exchange look like a public option?

Will states eventually take over their own exchanges?

Will people even know about the exchanges by next year?

Will the exchanges really provide competitions for insurers?

And will policymakers be forced to make yet more changes to address these questions?

As America’s great experiment with healthcare reform unfolds, only time will tell.

IMAGE CREDIT. endthefedusa.ning.com.

 

Nov 13
0

Obamacare –A Reform that Keeps the Status Quo

By | Health | No Comments

Since the turn of the 20th century there have been people calling for healthcare reform in the United States. Why did it take over a hundred years? In the United States, the major players would rather keep things the same than make a drastic change. Obama knew that many before him had failed miserably. So Obamacare builds on our current, privatized, for-profit health care system (that’s right, Obamacare is actually the opposite of socialized medicine). Our system has a lot of groups with a lot of benefits and most do not want to sacrifice them for universal care. To reform healthcare, you have to make changes, but not too many or else you won’t keep enough people happy.
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Oct 30
0

Obamacare Explained

By | Health | No Comments

Health policy in the United States is unique, to say the least. We are the only developed economy that does not have nationalized health care and despite popular belief, the United States does not have the best healthcare in the world even though we spend the most on it. According to the World Health Organization, the United States ranks 37th in health care – just behind Costa Rica and above Slovenia and Cuba. So how did we get into this economic and unhealthy mess? It’s a long story full of scandals, politics, history, economics, and American culture. In this space, I’ll seek to tell that story and explain healthcare policy, and the debates that swirl around it, in accessible terms.

In just a week, Americans will go to the polls to decide whether President Obama will get a second term. Healthcare reform – the president’s signature legislative achievement – hangs in the balance.  Read More